People with COPD deal with a restricted oxygen supply due to inflammation in the tubes leading to their lungs. They often have shortness of breath, wheezing, and chest tightness. They also risk having more serious problems like pneumonia, heart attacks, and lung cancer.
Living with COPD can mean you live with steep expenses. In the big picture, costs linked to COPD in the U.S. shot up to $49.0 billion in 2020, from $32.1 billion in 2010 -- a 52.6% jump, according to the CDC. On an individual level, a 2018 study estimated an average person with COPD racked up $6,246 more per year in direct medical costs than other people.
Even if your insurance coverage is solid, your health and drug deductibles and copays, or coinsurance premiums can pile up over time. If you eventually need lung surgery (which is not uncommon with COPD), that can be very expensive. It is wise to research and prepare for the costs of COPD.
Top Priority: Quit Smoking
Smoking is the No. 1 cause of COPD. (Other causes include asthma and exposure to secondhand smoke and to some fumes and chemicals.) If you smoke, quitting is a must. If you’ve tried before, don’t give up. This is the biggest investment you can make in your health.
Quitting smoking can be tough, but help is available. Start with your doctor to see what would help. And check out the COPD support groups listed on the American Lung Association’s website.
Next, you’ll want to be proactive in anticipating and managing the costs associated with COPD. Doing that may help you take care of yourself with greater peace of mind.
People with COPD may need to see a specialist called a pulmonologist twice a year if the disease is stable or monthly if symptoms flare up routinely. One insurance company reports pulmonologist office visits typically are priced between $260 and $372. You will be responsible for that charge if insurance does not cover it. You may still have a per-visit copay even with insurance.
Your pulmonologist may prescribe medications to treat COPD symptoms or complications either regularly or on an as-needed basis. Most COPD medications come in pill form or are taken into your lungs from an inhaler or a similar device called a nebulizer. Medications commonly taken by COPD patients include:
Bronchodilators, which help relax the muscles around your airways to make breathing easier. They can be short-acting (lasting for a few hours and taken before activities) or long-acting (taken every day). Examples of short-acting bronchodilators are ipratropium (Atrovent HFA) and levalbuterol (Xopenex). Some long-acting bronchodilators are aclidinium (Tudorza Pressair) and arformoterol (Brovana).
Combinations of medications to make the most of their individual benefits. For example, fluticasone and vilanterol (Breo Ellipta) are a combination of a bronchodilator and a corticosteroid. Fluticasone, umeclidinium, and vilanterol (Trelegy Ellipta) and aclidinium and formoterol (Duaklir Pressair) bring together different kinds of bronchodilators.
Short-acting bronchodilators and corticosteroids are not terribly expensive. For example, ipratropium is priced online for as little as $16 for a month’s worth of solution, and the fluticasone steroid spray for about $16. But your costs go up for long-term bronchodilators and combination medications. Online prices for aclidinium range from $193 to $606 (making a 30% copay range from $57.90 to $181.80); Breo Ellipta lists at $155 ($46.50 copay). And not all bronchodilators are covered by Medicaid.
Tips: Check medication assistance programs offered by many drugmakers, and price-shop medications among pharmacies and online. Also, the American Lung Association website offers patient support groups and examples of management plans for COPD medications.
If your COPD is moderate to severe, your pulmonologist may recommend:
- Oxygen therapy to increase the oxygen level in your blood
- A pulmonary rehabilitation program combining exercise, diet changes, and counseling
- An in-home breathing mask
One study pegged the equipment cost for portable oxygen therapy at $1,582. Current costs of pulmonary rehabilitation are hard to pin down online, but the American Thoracic Society publishes a directory of pulmonary rehabilitation providers near you at livebetter.org. An in-home bilevel positive airway pressure (BiPAP) device can be found online for about $675.
If your COPD symptoms are not successfully treated, lung surgery is sometimes unavoidable. If they’re healthy enough, people with COPD may get:
- A bullectomy, in which a surgeon removes large air sacs that interfere with your breathing. One study found the total cost of a bullectomy can reach $27,000.
- Lung volume reduction surgery, in which diseased tissue is removed from your lungs’ upper lobes so you can breathe more freely. Removing part of a lung from a person with COPD resulted in $22,000 to $26,000 in inpatient costs, according to one study.
- A lung transplant, if COPD’s damage to your lungs cannot be repaired. Hospitalization costs for a lung transplant for people ages 40-59 reached $197,980 in a study.
How much of those costs you’d pay for depends on your insurance.
Under the Affordable Care Act, private insurers cannot limit coverage of your COPD by calling it a preexisting condition. Insurance companies, Medicare, and Medicaid combine to pick up more than 90% of the COPD costs noted by the CDC. That means you can expect most, but not all, of your costs for COPD doctor visits and medications to be covered if you are insured.
Insurance also should pick up special therapies your pulmonologist says are medically necessary -- for example, Medicare does cover pulmonary rehabilitation for COPD. But you should confirm your out-of-pocket share in advance.
To manage your part of the costs for COPD surgeries, you should consult your insurer’s network before any procedure -- and not just for a qualified lung surgeon and hospital, but also for other needed providers like an anesthesiologist.