Does Medicare Cover Cystic Fibrosis?

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Bobby Brock Insurance is here to answer common questions about Medicare. Today’s topic is Medicare coverage for Cystic Fibrosis care. 

What Is Cystic Fibrosis?

Cystic fibrosis (CF) is a genetic disease that causes lung infections and hinders breathing over time. Initially, it causes your mucus to be thick, which clogs the lungs and leads to breathing issues, and allows for bacteria to grow. This disorder can also cause serious damage to the digestive system and other body organs. 

Related Post: How Does Medicare Provide Coverage for Alzheimer’s Patients? 

Is it a Rare Disease?

Yes, CF is rare. However, there are over 30,000 people in the U.S. who live with the disorder. 

According to the Cystic Fibrosis Registry, 1 in 4 Fibrosis patients are enrolled in Medicare. Recipients with CF are usually between the ages of 30 and 65.  

Will Medicare Help Cover Cystic Fibrosis Care?

Yes, Medicare will cover CF care and treatments. You just have to use a doctor who accepts Medicare assignment. 

Medicare Part A Coverage

Any care you get from an inpatient facility or hospital will be covered by your Part A benefits. Part A will also cover hospice and home health care if needed. 

Various patients need surgery and blood transfusions to help treat the disease. Medicare will cover a lung transplant for Cystic Fibrosis patients — when necessary. 

Medicare Part B Coverage

Part B covers your doctor visits, equipment, screenings, and medical procedures. It will also cover pulmonary rehab treatments done in the doctor’s office. 

What Will You Pay Out-Of-Pocket for Care?

You’ll still pay 20% of the costs for doctor visits and therapy sessions. You may also need to pay extra fees or meet deductibles. But without Medicare, your out-of-pocket expenses would be exponentially higher!

Medigap and Cystic Fibrosis

When you enroll in Original Medicare (A and B), you can decide to buy a Medicare Supplement (Medigap) plan. A Medigap policy can cover your share of the medical bills and ease the burden of finding extra money for treatments.

Note: Cystic Fibrosis might disqualify you from getting a Medigap plan. 

But if you think Medigap insurance is right for you, it’s best to enroll while you’re eligible — during the Medicare Supplement Open Enrollment Period.

Medicare Advantage and Cystic Fibrosis

Medicare Advantage (Part C) plans cover at least everything that Original Medicare does. These programs will also cover your Fibrosis treatments, screenings, medications, and surgery. You’ll buy your Advantage plan through a private carrier or through an independent broker like us. 

Note: Medicare Advantage plans often have health networks of providers and facilities you may use. If you go to an out-of-network doctor, you could pay higher fees.  

Medicare Drug Plans for Adults with Cystic Fibrosis

Costs for Cystic Fibrosis medications can be extremely high. Those who are on a fixed monthly income cannot afford to pay thousands in medication expenses. There is where Medicare Part D comes in. 

You can buy a separate Part D (prescription drug) plan or an Advantage plan that includes Part D coverage. Part D will typically cover the CF medications prescribed by your doctor.

Make sure the plan covers your medications, though, before you sign up.  

What Else You Should Know

Any disability can qualify you for Medicare before you turn 65. But you must get at least two years of Social Security Disability benefits before you’re eligible. 

If you have Cystic Fibrosis and End-Stage Renal Disease (ESRD), you might be eligible for Medicare before that — particularly if you need a dialysis or kidney transplant. If you’re not sure about your eligibility, contact your local Social Security office.

Get FREE Medicare Help

Medicare can be confusing for many folks. It’s essential to shop for health insurance that includes hospital, medical, and prescription drug coverage, especially for people with Cystic Fibrosis. Call (662) 844-3300 or contact our team online. We’ll find the most fitting options for your situation!

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Justin Brock

President & CEO of Bobby Brock Insurance