Medicare, a federal health insurance program, is a coverage option for some people with cystic fibrosis, especially adults who are receiving Social Security Disability Insurance (SSDI) payments. If you are no longer able to work due to treatment burdens or other health-related issues, SSDI might be an option for you.
After two years of receiving SSDI benefits, you will be eligible for Medicare. Medicare Part A is
In addition, Medicare could be an option for:
- People 65 years and older who qualify for benefits from the Social Security Administration (SSA) or the Railroad Retirement Board (RRB)
- People younger than 65 years who are receiving SSDI or people receiving certain disability benefits from the RRB
- People with end-stage renal disease (ESRD), which is permanent kidney failure that requires dialysis or a transplant
Medicare is broken down into four “parts” that help cover specific services:
- Original Medicare Part A (Hospital Insurance)
- Original Medicare Part B (Medical Insurance)
- Medicare Part C (Medicare Advantage Plan)
- Medicare Part D (Medicare Prescription Drug Plan)
To see the full list of services covered under Medicare and their costs, visit Medicare.gov.
Medicare Part A (Hospital Insurance)
The first component of Original Medicare (Medicare Part A) focuses on inpatient care. Services typically covered under Medicare Part A include:
- Inpatient hospital care
- Skilled nursing facility care (not custodial or long-term care)
- Hospice care
- Home health care
Most people do not pay a monthly premium for Part A. Each type of Part A services comes with its own set of
Medicare Part B (Medical Insurance)
Medicare Part B, the next component of Original Medicare, focuses on medical services provided outside of hospitals and medical facilities. This includes doctor visits, outpatient services, some preventive care, and other medically necessary services including most nebulized CF medications. Medicare Part B typically covers:
- Services from doctors and other health care providers
- Outpatient care
- Diagnostic tests (blood work) and imaging (X-rays, CT, PET scans, MRIs)
- Home health care when homebound
- Durable medical equipment
- Some preventive services
- Ambulance services
- Emergency department services
- Some prescription drugs (most nebulized CF medications are covered under Part B)
To receive Medicare Part B, you are required to pay a monthly insurance premium. Most people pay the standard premium amount, which is automatically deducted from your Social Security check each month. If you don’t sign up for Part B when first eligible for Medicare, you may be subject to financial penalties.
Out-of-pocket costs for Medicare Part B services vary. Generally, you will pay a
Medicare Advantage Plan (Part C)
Medicare Part C, also known as Medicare Advantage, is provided by Medicare-approved private insurance companies. The companies offering Advantage plans varies by geographical area (zip code and county). Medicare Advantage plans:
- Include all benefits and services covered under Medicare Parts A and B
- Cap Medicare Part A and B out-of-pocket costs in the calendar year
- Usually include Medicare Part D — or Medicare prescription drug coverage
- May include additional benefits and services, such as dental, vision, food, wellness programs, non-emergency transportation, or home modification
While Medicare Advantage Plans are required to follow Medicare guidelines, the amount paid for deductibles, co-payments, and/or coinsurance varies by plan. These plans usually have network restrictions, limiting which doctors and hospitals you can use. These rules can change each year, and the Medicare Advantage plan must notify the enrollee about any changes before the start of the next enrollment year.
Medicare Part D (Medicare Prescription Drug Plan)
Medicare Part D, or the Medicare Prescription Drug Plan, is an optional benefit administered by Medicare-approved private insurance companies to help cover prescription drug costs for those with original Medicare Parts A and B. Those who wish to add standalone Part D coverage to Medicare Parts A or B are usually required to pay a monthly premium, which varies by the plan, household income, and the geographical area (zip code and state) of residence.
The deductible amount for Medicare Part D plans varies by plan. Some Medicare drug plans do not have a deductible at all. And in some plans that do have a deductible, drugs on certain tiers are covered before the deductible is met.
If you take
View changes in the Medicare Part D plan for 2025.
Medicare Extra Help
Medicare Extra Help is offered through the Social Security Administration to help people with limited income and resources with costs related to a Medicare prescription drug plan. To qualify for Extra Help, your income and resources must be below a certain limit. You also won't have to pay a Part D late enrollment penalty while you get Extra Help and
- Are eligible to receive both Medicare and
Medicaid (referred to as full dual eligibility) - Have a Medicare Savings Program that assists with Medicare premiums and cost-sharing
- Receive need-based Supplemental Security Income (SSI) benefits but not Medicaid.
Medicare Supplemental Plans (Medigap)
Medigap is supplemental insurance to cover Original Medicare deductibles and coinsurance. Medigap plans are offered by Medicare-approved private insurance companies and have several requirements:
- You must have Original Medicare Part A and Part B
- You cannot have a Medicare Advantage and a Medigap plan at the same time
- You must pay a separate premium for a Medigap plan, in addition to your monthly Part B and Part D premium
- Medigap plans cover only one person. Your spouse must have a separate individual policy.
Because there is no annual enrollment period for these plans, you can drop your supplement at any time.
Medigap plans strictly follow Medicare guidelines, which means they will cover your Medicare costs for Medicare Part A- and B-covered services only. These plans pay after Medicare pays.
Some things to remember:
- If you already have a Medicare Advantage Plan (Part C), you will not be able to purchase a Medigap plan unless you switch back to Original Medicare.
- Medigap plans do not include prescription drug coverage, so you’ll want to purchase a stand-alone Part D drug plan to cover your medications.
- Medigap plans are available in all 50 states, but in some states Medigap policies may not be available or may have higher monthly premiums for individuals younger than 65.
Medigap plans are standardized and identified by letters A-N. Each plan follows the same structure for what costs it will cover. To get a quote for a Medigap plan, you must contact an insurance company or an insurance broker offering the plan in your area. You can search for the policies offered in your area on medicare.gov.
Comparing Medicare Options
To explore specific Medicare Advantage plans or Medicare prescription drug plans available in your area, visit the Medicare Plan Finder. For more information about Medicare, download the Medicare & You official handbook.