Chelsey Tucker graduated with a Bachelor of History degree from Metropolitan State University in 2019. She now writes about insurance with her specialty being life insurance and has been quoted on Help Smart Phone and MEL Magazine.

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Dan Walker graduated with a BS in Administrative Management in 2005 and has been working in his family’s insurance agency, FCI Agency, for 15 years. He is licensed as an agent to write property and casualty insurance, including home, auto, umbrella, and dwelling fire insurance. He’s also been featured on sites like Reviews.com.

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Reviewed by Daniel Walker
Licensed Auto Insurance Agent

UPDATED: Nov 28, 2021

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The Lowdown

  • Medicare will cover your visits to a pulmonologist as long as they are considered medically necessary
  • Depending on whether you have original Medicare or Medicare Advantage, your copays and additional costs for pulmonology care may vary
  • You must meet certain requirements to be eligible for care

If you are 65 or older and have COPD or any other chronic issues involving your lungs, you may want to know more about pulmonologists that accept Medicare.

As is true with most long-term care insurance providers, Medicare will cover pulmonology services and procedures as long as they are considered medically necessary by your doctor.

When you begin looking for a pulmonologist you can trust who takes your insurance, talk to your doctor. Your doctor can recommend a pulmonologist near you and will also be able to help you find a pulmonologist that accepts Medicare.

If you’re curious whether your Medicare coverage includes pulmonologists, you can always speak to an agent. And you should consider looking around for Medicare insurance quotes for pulmonologists online to see if you’re paying too much for your coverage.

Search for affordable Medicare insurance that covers pulmonologists today using our free tool above.

Does Medicare cover pulmonologists?

Whether your Medicare coverage includes a trip to the pulmonologist depends on several factors.

For any medical visit to be covered, it must be considered medically necessary. This typically means you’ll need a doctor to refer you to a pulmonologist and note that it is absolutely necessary.

Once you get a referral, coverage then depends upon the treatment or procedures that will be utilized.

For example, Medicare covers pulmonary rehabilitation work but only two one-hour sessions per day for 36 days.

If you do more than two sessions per day or do sessions for more than 36 days, Medicare will no longer cover your pulmonology care unless it was pre-approved by your plan.

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Which Medicare plans cover pulmonologists?

The type of Medicare plan you have will also matter when it comes to coverage for a pulmonologist.

If you have original Medicare, then Part B will cover something like a pulmonary rehabilitation facility. Part A would cover an office visit to a pulmonologist.

Both of these coverages also demand that you pay a copay with each visit.

You will have coverage for your pulmonology care If you have Medicare Advantage. However, your costs will differ from those with original Medicare.

This is because — as is true with some Medicare insurance rates for pulmonologists — your monthly premiums differ based on the private insurance plan you chose.

Is anyone with Medicare eligible to visit a pulmonologist?

Not everyone on Medicare can visit a pulmonologist and expect their visit to be covered.

Medicare has specific requirements when it comes to pulmonology care. These requirements include:

  • That you have moderate to severe breathing conditions or a condition that has worsened over time
  • That your doctor states it is medically necessary for you to visit a pulmonologist and has made a referral
  • That the pulmonology program complies with Medicare’s documentation requirements

If you meet these requirements, then your pulmonology care will be covered by Medicare.

Pulmonologists near you that accept Medicaid are a different story. If you are looking for Medicaid coverage, speak to your doctor to see which pulmonologists might be able to help.

If you have Medicare Advantage or want to purchase Medicare Advantage from a private insurance company, remember that Medicare insurance companies that cover pulmonologists vary in monthly rates.

Because of this, you need to shop around online to find the best deals on coverage and ensure your health insurance doesn’t cost too much.

You can buy Medicare insurance that covers pulmonologists by using our free quote tool below to find a plan that works best for you.