Chronic Obstructive Pulmonary Disease (COPD) affects more than 16 million Americans, and inhalers are among the most essential tools for managing the condition day to day. If you have Medicare, understanding which part of your coverage pays for COPD inhalers — and what you can expect to pay — is key to affording the medications you need to breathe more easily.

The short answer: Medicare Part D (prescription drug coverage) covers most COPD inhalers, while Medicare Part B covers related equipment like nebulizers. In 2025, a new $2,000 annual out-of-pocket cap for prescription drugs represents a significant improvement for people managing chronic conditions like COPD.

What Is COPD?

COPD is a chronic lung disease that makes it progressively harder to breathe. It encompasses conditions including chronic bronchitis and emphysema. Most cases are caused by long-term exposure to irritants, particularly cigarette smoke.

COPD is characterized by narrowing and inflammation of the airways, excess mucus production, and damage to lung tissue. These changes make it difficult for air to move in and out of the lungs, causing symptoms including shortness of breath, chronic cough, wheezing, and frequent respiratory infections. According to the CDC, COPD is a leading cause of hospitalization and a significant driver of Medicare healthcare spending.

Managing COPD effectively often requires coordinating care across multiple providers — a primary care physician, a pulmonologist, and sometimes a respiratory therapist. When that coordination breaks down, medications can be missed, referrals delayed, and costs can climb.

A patient advocate can help keep those threads connected, particularly for patients managing COPD alongside other chronic conditions.

Types of COPD Inhalers

There are several types of inhalers used to manage COPD, each working differently to improve breathing. Understanding these categories can help you have informed conversations with your healthcare provider about your treatment plan.

Short-Acting Bronchodilators (Rescue Inhalers)

Short-acting beta agonists like albuterol and levalbuterol are commonly prescribed as rescue inhalers for sudden breathing difficulties. They work quickly — usually within minutes — by relaxing the muscles around the airways. These are used as needed rather than on a regular schedule.

Long-Acting Bronchodilators (Maintenance Inhalers)

These inhalers are taken on a regular schedule, usually once or twice daily, to keep airways open over time. They include long-acting beta agonists such as salmeterol and formoterol, long-acting muscarinic antagonists such as tiotropium and umeclidinium, and combination inhalers like Anoro Ellipta and Stiolto Respimat.

Inhaled Corticosteroids and Combination Inhalers

Inhaled corticosteroids help reduce airway inflammation in moderate to severe COPD and are often prescribed in combination with long-acting bronchodilators. Common combination inhalers include Advair, Symbicort, and Breo Ellipta. Triple therapy inhalers — Trelegy Ellipta and Breztri Aerosphere — combine an inhaled corticosteroid, a long-acting beta agonist, and a long-acting muscarinic antagonist in a single inhaler. Research suggests triple therapy may reduce exacerbations and hospitalizations in certain patients, though it is typically reserved for moderate to severe disease.

Because inhaled corticosteroids can increase certain risks including pneumonia, Medicare plans may require step therapy or prior authorization before covering these combinations. This is one of the situations where having a patient advocate in your corner can make a meaningful difference in getting coverage approved efficiently.

Which Part of Medicare Covers COPD Inhalers?

This is one of the most common points of confusion for Medicare beneficiaries with COPD.

Part D covers inhalers you pick up at the pharmacy. Standard COPD inhalers — rescue and maintenance — are covered under Medicare Part D when prescribed for home use. Part B covers inhalers administered in medical settings, such as a doctor's office or hospital outpatient setting. Part B also covers nebulizer machines used at home as durable medical equipment, though the medications used in nebulizers are covered under Part D. Part A covers inhalers administered during inpatient hospitalizations.

If you have Original Medicare — Parts A and B only — and no Part D plan, you will not have coverage for prescription inhalers picked up at the pharmacy. Enrolling in a Part D plan or choosing a Medicare Advantage plan with prescription drug coverage is essential for inhaler coverage. Understanding what Medicare covers for home health care more broadly can help you identify other benefits you may not be fully using alongside your inhaler coverage.

How Much Do COPD Inhalers Cost Under Medicare?

Costs vary significantly based on your specific plan, the tier your inhaler is on, and how much of your annual deductible and out-of-pocket maximum you have met.

The maximum Part D deductible in 2025 is $590, though some plans have lower or no deductible. After meeting your deductible, you pay 25% of drug costs until you reach your out-of-pocket maximum.

Starting in 2025, once you have spent $2,000 out of pocket on covered drugs, Medicare pays the full cost for the rest of the year — a significant change that benefits people with high-cost maintenance inhalers. Medicare's new Prescription Payment Plan also allows you to spread out-of-pocket prescription costs into monthly payments, which can ease the burden of high costs early in the year.

Generic inhalers may cost as little as $10 to $30 per month, while brand-name maintenance inhalers can cost significantly more before the out-of-pocket cap is reached. Strategies for saving money on prescription medications — including manufacturer assistance programs, Extra Help eligibility, and plan comparisons — can make a real difference for people managing ongoing inhaler costs.

Formulary Tiers and Prior Authorization

Each Medicare Part D plan has its own formulary — a list of covered drugs organized into cost tiers. Lower tiers mean lower copays; higher tiers mean higher out-of-pocket costs. Most plans use a four-tier structure, ranging from Tier 1 generic drugs with the lowest copayments to Tier 4 specialty medications with the highest.

Some plans also require step therapy, meaning you must first try a less expensive inhaler before the plan will cover a higher-tier one.

Prior authorization may also be required for certain combination inhalers, meaning your doctor must submit documentation justifying the medication before coverage is approved. If you are unsure how to navigate these processes, how to get a second opinion or seek additional clinical support can also be relevant when your current treatment plan is not being covered as expected.

What to Do If Your Inhaler Is Not Covered or Is Too Expensive

If your COPD inhaler is placed on a high-cost tier, requires prior authorization that is denied, or is not covered by your plan, you have several options.

You can request a formulary exception, where your doctor submits documentation explaining why you medically need the specific inhaler. Decisions are typically made within 72 hours. You can request a tiering exception, asking your plan to cover your inhaler at a lower tier cost.

If either request is denied, you have the right to appeal — urgent appeals must be decided within 24 hours. Manufacturer assistance programs offer support for people who cannot afford their medications. And if you have limited income and resources, you may qualify for Medicare's Extra Help program, which significantly reduces Part D costs, including inhalers.

Navigating formulary exceptions and appeals can be complex, particularly when you are already managing a demanding health condition. Aviator Health offers dedicated Medicare patient advocates — covered by Medicare — who can help you understand your coverage, file appeals, and lower your out-of-pocket inhaler costs. You can get started at aviatorhealth.co/signup.

What Else Does Medicare Cover for COPD?

Beyond inhalers, Medicare covers a range of services and equipment for COPD management.

Part B covers outpatient pulmonary rehabilitation programs for people with moderate to severe COPD, combining exercise, education, and support to improve lung function and quality of life. Part B also covers nebulizer machines as durable medical equipment when prescribed for home use, supplemental oxygen if your blood oxygen level falls below a documented threshold, and diagnostic testing including spirometry. Parts A and B cover specialist visits, emergency care, and hospital stays related to COPD management and flare-ups.

It is worth noting that Medicare coverage for COPD-related needs is more extensive than many patients realize. The same is true in other areas — many patients are surprised to learn what Medicare covers for eye exams, chiropractic care, and cataract surgery. Taking time to understand your full coverage can prevent unnecessary out-of-pocket spending across multiple areas of care.

For patients managing COPD alongside other conditions that require regular specialist coordination, requesting medical records from your providers and keeping a centralized record of your care history can make transitions between providers and care settings much smoother.

Frequently Asked Questions

Do all Medicare Part D plans cover COPD inhalers?

Most Part D plans cover at least some COPD inhalers, but the specific drugs covered and their tier placement vary by plan. It is important to review your plan's formulary each year during the Annual Enrollment Period, which runs from October 15 to December 7, to ensure your inhaler is covered and to compare costs.

What if I need a nebulizer instead of an inhaler?

Nebulizer machines are covered under Medicare Part B as durable medical equipment when prescribed and medically necessary. The medications used in the nebulizer are covered under Part D. You pay 20% coinsurance for the machine after meeting your Part B deductible.

Can I change my Part D plan if my inhaler becomes too expensive?

Yes. During the Annual Enrollment Period each fall, you can switch to a different Part D plan that covers your inhaler at a lower cost tier. Medicare's Plan Finder tool allows you to compare plans based on your specific medications.

Is albuterol covered by Medicare?

Albuterol is covered by most Medicare Part D plans, though coverage and cost-sharing vary by plan. Checking your plan's formulary directly will confirm coverage and help you understand what you can expect to pay.

How can a patient advocate help with COPD coverage?

A patient advocate can help you navigate prior authorization requests, file appeals for denied coverage, identify cost-saving programs like Extra Help or manufacturer assistance, and coordinate across the multiple providers typically involved in COPD care. For Medicare-eligible patients, Aviator Health provides this support at no out-of-pocket cost. Learn more at aviatorhealth.co.

Medical Disclaimer

This article is for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Medicare coverage rules and costs may change; always verify current coverage details with Medicare or your plan directly. If you are experiencing a medical emergency, call 911 or your local emergency services immediately.

Sources

Centers for Disease Control and Prevention. (n.d.). COPD facts. https://www.cdc.gov/copd/data/index.html

Medicare.gov. (n.d.). Prescription drug coverage (Part D). https://www.medicare.gov/drug-coverage-part-d

Centers for Medicare and Medicaid Services. (n.d.). Nebulizers policy article. https://www.cms.gov

National Institutes of Health / National Heart, Lung, and Blood Institute. (n.d.). COPD treatment guidelines. https://www.nhlbi.nih.gov/health/copd/treatment

Medicare.gov. (n.d.). Pulmonary rehabilitation programs. https://www.medicare.gov/coverage/pulmonary-rehabilitation

Medicare.gov. (n.d.). How to appeal Medicare drug plan decisions. https://www.medicare.gov/appeals

Alliance of Professional Health Advocates. (n.d.). Profession overview. https://aphadvocates.org/profession-overview/