Medicare’s Coverage of Respiratory Treatments

Original Medicare covers pulmonary treatments for respiratory disorders such as chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA).

COPD is a group of disorders that cause breathing problems. Asthma, chronic bronchitis and emphysema are all diseases that fall under COPD. Obstructive sleep apnea (OSA) is a sleep-related breathing disorder.

Medicare may cover respiratory therapy, pulmonary rehabilitation, Continuous Positive Airway Pressure (CPAP) therapy, and nebulizers to treat these disorders. You may also qualify for tobacco prevention counseling and sleep tests and devices through Medicare.

If you are between the ages of 50 and 77, asymptomatic and have smoked an average of one pack per day for 20 years, Medicare Part B will pay for a lung cancer screening with an order from your doctor. Medicare also covers two different pneumonia vaccines.

For Original Medicare to cover your respiratory therapy sessions, your doctor must deem them medically necessary, and your doctor or respiratory therapist must document the sessions. The documentation must state that the services require the skills of a licensed respiratory therapist.

Part B will cover 80% of the approved treatment costs once you have met your deductible. In 2024 the Part B deductible is $240.

Covered respiratory services also include the therapeutic use and monitoring of medicinal gases, pharmacologically active mists and aerosols, and equipment like resuscitators and ventilators. Medicare may also pay for a periodic assessment to gauge the effectiveness of a patient’s respiratory therapy services.

If you have been diagnosed with moderate to severe chronic obstructive pulmonary disease (COPD), Medicare Part B will pay for a comprehensive pulmonary rehabilitation program to help you breathe easier, regain your strength and live more freely.

You can receive rehab services in a doctor’s office or in a hospital outpatient facility. Your out-of-pocket costs will be different depending on the venue you choose.

If you get your rehab in a doctor’s office, Medicare will cover 80% of the approved amount. You will need to meet your Part B deductible before Medicare will pay its portion.
If you get your rehab in a hospital outpatient facility, you will owe your Part B deductible — if you haven’t paid it already — the 20% Medicare doesn’t cover and a hospital copayment per session.

Medicare will pay for up to two 60-minute sessions per day, for a maximum of 36 sessions over 36 weeks. If your condition is severe, your doctor could approve you for up to 72 sessions.

The doctor who treats your respiratory disease will need to provide a referral for pulmonary rehabilitation for Medicare to cover it.

If your doctor prescribes a nebulizer for use in your home, Medicare Part B will help cover the cost of the nebulizer as DME.

Original Medicare does not pay for most outpatient prescription drugs or over-the-counter medications. But Medicare Part B will pay for some medicines used in nebulizers.

For example, if you have asthma or emphysema, Medicare will pay for albuterol, a drug commonly used with a nebulizer.

Part D, which is optional coverage you can buy separately from Parts A and B, typically covers pulmonary treatment medications, such as bronchodilator inhalers or antibiotics.

If your doctor prescribes oxygen equipment and accessories for use in your home, Medicare Part B will help pay for you to rent the necessary items as durable medical equipment, or DME.

Once you’ve met your Part B deductible, you will owe only 20% of the Medicare-approved amount; Medicare will take care of the rest of the cost.

As long as you have a medical need for oxygen and have Medicare, your supplier must provide equipment and supplies for up to five years.

You have the option to own your own equipment, but you must meet certain conditions for Medicare to help pay for systems that provide oxygen, containers that store oxygen, and tubing and related supplies.

Your doctor must say that you either have a severe lung disease or aren’t getting enough oxygen and that you might get better with oxygen therapy. Your arterial blood gas level must fall within a certain range, and you must have tried other remedies but failed to improve.

Medicare may also pay for a humidifier when it’s used with your oxygen machine.

Although Medicare doesn’t usually cover humidifiers, it will cover oxygen humidifiers when used with certain covered DME, such as CPAP devices, respiratory devices or oxygen equipment.

In fact, your monthly fee for your oxygen equipment will include the cost of an oxygen humidifier if it’s medically necessary.

Medicare will pay for postural drainage procedures and pulmonary exercises when provided by a physical therapist or a respiratory therapist as part of your physician’s treatment plan.

Postural drainage is an exercise that can help drain fluid and mucus from your lungs if you have a condition such as pulmonary edema, or lung congestion.

This treatment is 80% covered once you meet your Part B deductible. If your lungs are swollen and breathing is painful, this exercise could ease your discomfort.

Other pulmonary exercises include different types of breathing such as deep breathing, pursed lip and diaphragmatic. A medical professional can teach you how to do these breathing exercises properly.