Can Medicare Help You Save on Expensive Asthma Inhalers?
Medicare Benefits Solutions
Aug 19, 2022
For people with asthma, an inhaler can be a life-saving device. If you’re prescribed an inhaler by your physician to use regularly or in an emergency situation, you may be concerned about the costs. If you have Medicare health insurance coverage, your part D prescription drug plan may be able to help you pay for your asthma inhaler.
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Does Medicare Part D Cover Asthma Inhalers?
Part D prescription drug coverage is optional, but it can be an important part of your Medicare benefits. There are two ways to get Part D coverage. If you have Original Medicare, you can enroll in a stand-alone Prescription Drug Plan (PDP). As an alternative to Original Medicare, you can enroll in a Medicare Advantage plan that will include your Part A and Part B benefits. Many MA plans include prescription drug coverage.
Because Part D plans are offered by private insurance companies, they can vary. All Part D plans are required to include access to the most common medications required by Medicare recipients, but each plan will have its own formulary or list of covered drugs. However, prescribed asthma and chronic obstructive pulmonary disease (COPD) inhalers are typically covered.
Costs can vary from plan to plan, as well. Each Part D plan will have tiers of pricing based on the type of medication. If you are comparing plans and already rely on specific medications, check to make sure any potential plans will include coverage for the medications you need.
If you qualify for Medicare and Medicaid and/or the Extra Help program, you can get help with the cost of drugs covered under Part D. Qualifications are based on income and other financial resources.
TIP: Find out if your existing Medicare plan covers inhalers.
What is Asthma?
“People who have asthma say it feels like breathing through a straw,” according to the National Heart, Lung, and Blood Institute (NHLBI). Asthma is a long-term, severe lung disease triggering episodes of coughing and wheezing. You may experience shortness of breath and a tightening in your chest. Asthma is a chronic illness with no cure, but there are ways you can manage it.
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Asthma Quick Facts
The NHLBI says that asthma:
- Is a serious and incurable lung disease that can be fatal if not managed
- Lurks in the background even when you show no symptoms, likely to surface at any moment
- Is manageable through continuous monitoring and risk reduction techniques
- Manifests in different ways for different people in terms of type, frequency and severity of symptoms, which can range from mild to life-threatening
When you have asthma, your immune system overreacts to triggers, often hypersensitivity to substances like smoke, pollen, dust and chemicals. By releasing elements that diminish the channels for air to flow through, your immune system may respond by triggering:
- Inflammation or swelling of airway linings
- Tightening of muscles that surround the airways
- Production of thick mucus in the airways
All these actions cause the airways in your lungs to become smaller or narrower, making breathing more difficult. Your doctor will develop a treatment plan that may include medication and devices.
Inhalers vs. Nebulizers
Usually, you will administer your asthma medications by breathing them in with an inhaler or nebulizer. Your doctor may prescribe medication in the form of pills, infusions or injections, but inhalers and nebulizers enable direct passage to your lungs.
There are four types of inhalers. The primary difference is how the medicine is released. Devices either spray out the drug, or you breathe it in. You must use inhalers correctly for them to be effective.
- Metered dose (MDI)
- Dry powder (DPI)
- Breath actuated
- Soft mist
A nebulizer is a machine run on battery or electricity, which converts liquid medicine to a mist you breathe in through a face mask or mouthpiece. The administration is relatively simple because you only need to breathe in and out normally. Therefore, some patients find nebulizers an easier device to use than inhalers.
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Does Medicare Part D Pay for Albuterol?
Albuterol sulfate inhalation aerosol is a quick-relief inhaler that causes the muscles surrounding your airways to relax. The drug is available as a powder, solution and suspension. Browse your plan’s formulary under the tier for generic drugs to see if albuterol is listed.
Does Medicare Part D Cover Ventolin?
Ventolin HFA is the brand name version of of the generic drug albuterol, sold with a built-in dose counter. Look for Ventolin in your plan’s formulary under the tier for preferred brands, which is a group of cost-effective brand-name drugs.
Medicare Coverage for Nebulizers
Part B is the benefit that covers medically necessary durable medical equipment (DME) that your doctor orders for home use. DME includes oxygen equipment, wheelchairs, hospital beds, walkers and nebulizers. DME may be purchased or rented, but you are not always given a choice.
Confirm with your physicians and DME suppliers that they are Medicare-participating providers. If so, they must accept assignment, which means you are only responsible for the Part B deductible and 20% of the Medicare-approved amount. Medicare-participating providers will also bill Medicare directly and accept the Medicare-approved amount. If your providers do not participate in the Medicare program, they can charge you any amount.
If you’re enrolled in a Medicare Advantage plan, you may have to use suppliers within the plan’s network, or risk paying out of pocket for your equipment.
Breathe Better Program
The Allergy and Asthma Network reports that “more than 25 million people in the United States live with asthma. Of those, more than 10 million report having had one or more asthma attacks in the past year.”
The National Institutes of Health provides resources to healthcare professionals to help them educate the public about lung diseases like asthma and COPD through a program called “Learn More Breathe Better.” The Breathe Better network comprises organizations nationwide that serve communities by bringing visibility to how lung and respiratory diseases are prevented, treated and managed.
Contact your state health department to explore local resources in your community. The Learn More Breathe Better Program also offers patients and caregivers online access to factual information for educational purposes and as a basis for discussions with your doctor.
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