Quick Answer
Finding a pulmonologist while on Medicare is vital for beneficiaries suffering from Chronic Obstructive Pulmonary Disease (COPD). Unfortunately, COPD isn’t curable, but the condition is treatable.
Coverage Comparison by Plan Type
| Plan Type | Coverage | Notes |
|---|---|---|
| Original Medicare | Some Plans | Limited coverage under specific conditions |
| Medicare Advantage | Some Plans | Coverage varies by plan and ZIP code |
| Medigap | Not Covered | Only supplements Original Medicare benefits |
| Medicare Part D | May Cover Related Rx | May cover related prescriptions |
Understanding Your Coverage Options
Original Medicare (Part a & B)
Original Medicare (Part A & B) provides coverage for this service when medically necessary. Standard cost-sharing (deductibles and coinsurance) may apply.
Medicare Advantage (Part C)
For those enrolling in a health maintenance plan (HMO), you’ll need a referral to see a pulmonologist with Medicare Advantage. You won’t need a referral if your Medicare Advantage plan is a preferred provider organization plan (PPO).
Depending on your healthcare needs, Medicare Supplement plans can help you reduce healthcare costs when seeing a specialist and more freedom to do so than enrolling in a Medicare Advantage plan. But it’s still important to speak with your specialist to understand whether or not they accept Medicare Assignment and a licensed Medicare agent to ensure which coverage works best for you.
Medicare Supplement (Medigap)
Medicare Supplement (Medigap) provides coverage for this service when medically necessary. Standard cost-sharing (deductibles and coinsurance) may apply.
✦ Frequently Asked Questions
David Haass
AuthorDavid Haass is a licensed Medicare expert who has been helping beneficiaries navigate their Medicare options for over a decade.
Ashlee Zareczny
ReviewerAshlee Zareczny is a licensed Medicare agent dedicated to helping those eligible for Medicare find the best coverage options.