Understanding Medicare > Medicare Coverage & Benefits > Chronic and Long-Term Care

How Medicare Covers Asthma Treatment for Older Adults

Written by:

Jason Kolkey

Reviewed by:

Melissa Johnson

5 min read

Key Takeaways

More than 4 million U.S. adults over the age of 65 have asthma, and Medicare coverage can help.

Work with your doctor to develop a treatment plan that fits your symptoms, triggers, and lifestyle.

You may be prescribed a range of drugs for long-term control and quick relief of asthma. You’ll need a Medicare Part or a Medicare Advantage Prescription Drug plan to help with the costs of most medications you take at home.

Some people with severe asthma receive a procedure called a bronchial thermoplasty, which may be covered under certain circumstances.

According to data from the Centers for Disease Control and Prevention (CDC), more than 20 million U.S. adults have asthma, including over 4 million who are 65 and older. If you’re enrolled in Medicare, the public health insurance program for older adults and people with certain disabilities, your coverage may help you breathe easier.

Original Medicare consists of two parts: Part A, which is hospital insurance, and Part B, which is medical insurance. Medicare Part B will cover asthma diagnosis and treatment in an outpatient setting, like your doctor’s office. Medicare Part A would cover a hospital stay because of severe asthma.

A Medicare Advantage plan from a private insurance carrier can substitute for Original Medicare. Details and costs vary by plan, but the coverage for asthma and other treatments must at least match what you would receive through Original Medicare. Plans may also offer additional benefits, but you will need to visit in-network doctors and pharmacies to get the most out of your coverage.

Let’s take a deeper look at what Medicare can do for older adults with asthma.

What Medicare coverage is right for my specific situation?

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Does Medicare Cover Asthma Medications?

Based on factors like the severity of your condition and your triggers, a doctor may prescribe drugs that can either prevent asthma attacks or alleviate the symptoms when one occurs. You’ll likely have medications for both long-term control and for quick relief (also called rescue), such as:

Bronchodilators are a type of drug called a beta-2 agonist that works by relaxing muscles in your airways. A bronchodilator is commonly taken during an asthma attack to quickly relieve symptoms by using a metered dose inhaler, which pushes the medication into your lungs. Otherwise, you may use a nebulizer, a device that turns your medication into a mist to be inhaled through a face mask or mouthpiece.

Corticosteroids are anti-inflammatory drugs that can treat the swelling in your airways. For regular use, this type of medication is often taken with an inhaler. However, quick-relief versions, taken as a pill or intravenously, may be used for the short-term treatment of severe symptoms.

Combination inhalers administer both a long-acting beta-2 agonist and a corticosteroid for routine symptom management.

Anticholinergics work quickly to relax the muscles in your airways, making it easier to breathe. These drugs may be prescribed as an alternative to a beta2-agonist if you experience side effects.

Allergy medications can prevent asthma attacks that are triggered by allergens.

Biologic therapies may be used for moderate or severe asthma that can’t be controlled with other medications. They involve administering a drug via injection or intravenous infusion that targets specific cells or antibodies that cause inflammation.

Original Medicare generally only covers drugs you take in clinical setting like your doctor’s office, but not prescriptions that you take at home. You’ll need either a standalone Medicare Part D prescription drug plan or a Medicare Advantage Prescription Drug plan from a private insurance carrier to help with your medication costs.

Asthma Symptoms and Treatment

Asthma is a chronic condition that inflames and narrows your airways, the tubes that transport air into and out of your lungs. The condition often starts in childhood, but it can also develop later in life. Lifestyle factors like smoking or drinking alcohol could put you at higher risk.

The most common asthma symptoms are:

Coughing

Wheezing

Shortness of breath

Tightness or pain in the chest

During an asthma attack, your symptoms suddenly become worse, making it difficult to breathe. You might tend to experience attacks under specific circumstances, such as during exercise, when you’re exposed to chemical irritants or dust in the workplace, or because of airborne allergens like pollen or mold spores.

Your doctor may order certain tests to diagnose and monitor asthma, which are covered by Medicare Part B when medically necessary. For example, a spirometry test checks your lung function and airflow by measuring the air you breathe out. A peak flow meter measures how hard you can breathe out.

Though there’s no cure for asthma, your healthcare provider could recommend a range of treatments and strategies that can help control your symptoms. Working with your doctor, you’ll develop a plan that includes:

Avoiding allergens or other triggers

Recognizing the signs of an asthma attack

Taking medications to prevent or treat symptoms

Handling emergencies like a potentially life-threatening asthma attack

We’re here to help navigate your choices.

Does Medicare Cover Bronchial Thermoplasty?

Bronchial thermoplasty is a treatment for severe asthma that your doctor might recommend if long-term control medications aren’t helping enough. The procedure involves using a thin tube to administer heat to the muscles around your airways. This process eliminates some smooth muscle tissue, which can prevent the airways from narrowing and make severe attacks less likely.

In some areas of the country, Original Medicare may cover bronchial thermoplasty if it’s medically necessary, but the Centers for Medicare and Medicaid Services haven’t issued a national determination on coverage for this treatment yet. Medicare Advantage coverage can vary by plan. Your doctor can give you more information about accessing bronchial thermoplasty if it could help in your case.

Managing your asthma as an older adult may require a combination of treatments and lifestyle changes. By understanding how your Medicare coverage will help, you can put your asthma treatment into action.