Chronic obstructive pulmonary disease, or COPD, isn't just physically draining — it can be quite financially draining as well.
Michael Ofchus, a COPD Foundation advocate from Texas, knows firsthand the financial stress of living with the disease. At the beginning of 2012, he spent seven weeks in intensive care because of COPD and said it's a miracle he's alive. But the costs associated with COPD have had a huge impact on his quality of life.
The disease that took his strength and damaged his health took his livelihood as well. “I lost half my wages. We don’t have the funds to do the things we used to do,” he said, speaking for himself and his significant other. “We don’t go out a lot. Our primary objective is to get healthier. We have professional guidance telling us if we follow these certain rules, we will be healing, and we will be healthier.”
The financial burden of COPD has also taken an emotional toll. “There is a lot of heartbreak,” admitted Ofchus. “My father, a World War II vet, was buried at Arlington National Cemetery, and I couldn’t make it.”
Not only does advanced COPD limit travel because it's physically incapacitating, but the financial drain also places restrictions on people with the disease. “I have no discretionary income ... no investments,” Ofchus said. Even though insurance pays most of the medical expenses related to his COPD, he says that most of his income goes to paying other expenses related to managing the condition.
The Price of COPD: Daily Medications and Oxygen
Ofchus knows he's lucky to have insurance that covers most of the costs associated with treating his COPD. “I am in hospice, so I don’t have co-pays,” he said. “Before I was in hospice, I was really in trouble financially.”
He takes three daily COPD medications: Advair, which costs on average $286 a month; Combivent, an emergency inhaler that costs $243; and Spiriva, which costs $286. Without insurance, he would have to pay $815 a month for these life-saving medications.
Ofchus also uses a portable oxygen concentrator, a small machine that makes oxygen. His machine was covered by insurance, but without insurance, the cost would be $2,500 to $4,000 to purchase one or $275 a week to rent it. There are additional fees for tubing, filters, nasal cannulas, and other consumable accessories. The machines can be powered with an AC adapter (adding to your electric bill) or a battery. A replacement battery costs from $290 to $400.
Healthy Living: COPD Costs
Eating a healthy diet and exercising are important aspects of managing COPD. Lack of exercise causes muscles to become weak, which causes them to need more oxygen and leads to shortness of breath. Ofchus exercises to stay healthy by doing yoga. The average price for a yoga class in the United States is $12. But you can save money by shopping around — depending on location, you can find a class for as low as $5 or as high as $16.
Making good choices when shopping for groceries is another way you can promote good health, but this is an area where you may want to spend a little extra. Ofchus, who's highly conscious of his diet, avoids eating cheap carbohydrates and tries to be as strict as possible when selecting foods. “High-end foods are really, really expensive,” he said. For example, instead of buying an inexpensive loaf of white bread for $1.69, he opts for healthier whole-grain options, which can cost twice as much or more.
The Cost of COPD Doctor and Hospital Visits
Ofchus visits his health care providers one to three times each month. Fees for physician visits vary depending on the type and length of appointment. Costs can range from $119 to $337, on average. If a hospital stay is required, the cost is significantly higher. A study published in 2010 by the International Journal of Chronic Obstructive Pulmonary Disease pegged the average COPD-related standard hospital admission at $9,745. If the stay includes admission to the ICU, the cost goes up to $33,440. Also, the overall expense of appointments and admissions increases when you factor in time lost from work and money spent for transportation.
The Affordable Care Act and COPD
Certain provisions of the Affordable Care Act may benefit uninsured and under-insured people with pre-existing health conditions such as COPD. One of the changes to the health insurance landscape is that insurers offering coverage through the insurance Marketplace system can no longer deny coverage because of pre-existing health conditions, and they can’t risk-rate applicants and charge a higher premium to an enrollee with COPD than they would charge an enrollee without the condition, explained David H. Howard, PhD, an associate professor in the department of health policy and management at the Rollins School of Public Health at Emory University in Atlanta. “That does not mean that insurance will be free or inexpensive, but people with COPD should see premiums decline," he said.
“People with COPD with incomes below the poverty level will be eligible for Medicaid if they live in one of the 25 states that are expanding the program, said Howard. However, he added, that "most people with COPD with employer-based coverage won’t see major changes” as a result of the health care law.
Tips to Save Money With COPD
One of the best tools for being dollar-savvy while budgeting for COPD expenses is to arm yourself with as much information as possible. “With regard to the Affordable Care Act, Medicaid, and Medicare, there is a lot of information to navigate, [and] it can be overwhelming and confusing,” noted Ofchus, who said that he plans to become a health care navigator to share the knowledge he has gained on his own journey. “It’s very complicated, and people don’t know what to do. You have to ask questions and look after your own best interest. There are benefits available to people that aren’t being used because people don’t know about them." He pointed to things such as routine annual checkups that can lead to early diagnosis and prevention of serious health complications.
COPD treatments can be quite expensive, acknowledged S. Jay Mathews, MD, MS, a board-certified cardiologist at Bradenton Cardiology Center in Florida. To help reduce the financial burden of COPD, he suggested some money-saving tips:
- Ask your physician about generic medications. “When it comes to saving money on treatments, my philosophy has always been to choose generic medications when possible," said Dr. Mathews. "Generics generally offer the same therapeutic efficacy for a fraction of the cost.”
- Contact drug manufacturers about patient-assistance programs. This especially holds true for new and non-generic medications. Ask your doctor for more information or check the manufacturer’s website.
- Look into government assistance programs. If you are not yet eligible for Medicare Part D or if you are younger that 60 and meet certain income guidelines, you may be able to receive government assistance through programs like Medicaid or state-specific programs such as Florida’s Discount Drug Card. Check your county government’s website for information relevant to your area.
- Avoid triggering an exacerbation. “The first step to saving money is prevention,” said Mathews. If you smoke, quit. COPD exacerbations are often triggered by ongoing tobacco abuse. Exacerbations can also be triggered by exposure to dust, pollen, or mold. Avoid these irritants as much as possible. That's not only good for health, but it'll save on treatment costs, which is good for your pocketbook, too.
- Above all, work with your medical team. The aim is to stay one step ahead of your COPD — the better you work to control it, the less expensive emergency measures will be needed.