Does Medicare Pay for Inhalers?

Medicare, the federal health insurance program, provides coverage for millions of Americans. This article explores how Medicare helps with inhaler costs and outlines considerations for managing these expenses.

Medicare Parts and Inhaler Coverage

Most inhalers, which deliver medication for conditions like asthma or chronic obstructive pulmonary disease (COPD), are covered under Medicare Part D. Part D plans are prescription drug plans offered by private insurance companies approved by Medicare. These plans help cover the cost of self-administered prescription drugs.

Each Medicare Part D plan maintains a list of covered drugs called a formulary, which outlines the specific medications and their coverage terms. An inhaler’s placement within different cost tiers directly affects the out-of-pocket amount a beneficiary will pay. Coverage can vary between different Part D plans.

Some inhaler-related treatments, such as nebulizers and the medications administered through them, may be covered differently. Medicare Part B, which covers medical services and durable medical equipment (DME), typically covers nebulizers if they are prescribed for home use. Part B will also cover the medications used with nebulizers, provided they are medically necessary. While nebulizers are considered DME, most common metered-dose or dry powder inhalers fall under Part D prescription drug benefits.

Understanding Your Out-of-Pocket Costs

Medicare Part D plans involve several types of out-of-pocket expenses that can affect the total cost of inhalers. A deductible is the initial amount a beneficiary must pay for covered prescriptions before their plan begins to contribute. For 2025, the maximum annual deductible for Part D plans is capped at $590.

After meeting the deductible, beneficiaries typically pay a portion of the cost through copayments or coinsurance. A copayment is a fixed dollar amount for a prescription, while coinsurance is a percentage of the drug’s cost. These amounts vary based on the drug’s tier on the plan’s formulary, with lower tiers usually having lower costs for generic medications.

For 2025, the elimination of the coverage gap, often called the “donut hole,” has occurred. Instead, in 2025, a new annual out-of-pocket spending cap of $2,000 has been implemented for Part D prescription drugs. Once this $2,000 limit is reached, beneficiaries enter the catastrophic coverage phase and pay nothing for their covered Part D drugs for the remainder of the year.

Strategies for Lowering Inhaler Costs

Several strategies can help Medicare beneficiaries manage their inhaler expenses. The Medicare Extra Help program, also known as the Low-Income Subsidy, provides financial assistance for those with limited income and resources. This program helps cover Part D premiums, deductibles, and copayments. For 2025, an individual’s income must generally be below $23,475 and resources below $17,600 to qualify, with higher limits for married couples.

Beneficiaries can also explore options for generic or lower-cost alternative inhalers if appropriate for their medical needs. Consulting with a healthcare provider or pharmacist can help identify suitable alternatives that may be on a lower cost-sharing tier within their Part D plan’s formulary. Additionally, some pharmaceutical manufacturers offer patient assistance programs for specific brand-name inhalers, which can provide financial relief. These programs have their own eligibility criteria based on income and insurance status.

Another effective strategy involves regularly reviewing and comparing Part D plans, especially during the annual Open Enrollment Period. Plans can change their formularies, premiums, and cost-sharing structures each year. Comparing available plans ensures that beneficiaries select one that offers the most favorable coverage and lowest overall cost for their specific inhalers and other medications.

Enrolling in a Medicare Prescription Drug Plan

Obtaining Medicare prescription drug coverage for inhalers involves enrolling in a Part D plan. Beneficiaries can choose a standalone Part D Prescription Drug Plan to complement their Original Medicare (Parts A and B) coverage. Alternatively, they can select a Medicare Advantage Plan (Part C) that includes prescription drug coverage. Many Medicare Advantage plans integrate drug coverage.

Enrollment in a Part D plan is typically available during specific periods. The Initial Enrollment Period is a seven-month window around an individual’s 65th birthday. The Annual Enrollment Period, also known as Medicare Open Enrollment, occurs each year from October 15 to December 7, allowing individuals to join, switch, or drop Part D plans, with new coverage effective January 1.

Special Enrollment Periods may also be available for individuals who experience certain life events, such as moving, losing other creditable drug coverage, or qualifying for Extra Help. When selecting a plan, use resources like the Medicare.gov Plan Finder tool to compare options. This tool allows beneficiaries to enter their specific inhalers and other medications to see how different plans cover them and estimate their annual out-of-pocket costs. Checking a plan’s formulary ensures that all necessary inhalers are covered.