Does Medicare Cover Bed Sores?
This article was updated on: 10/20/2018
Bed sores, also called pressure sores, can develop when you spend most of your time in bed or in a wheelchair, according to the National Institutes of Health’s National Library of Medicine. If you have a medical condition that prevents you from changing positions frequently, you may be at risk for developing bed sores. Fortunately, most care to help you prevent bed sores, and treatment to help resolve them, is eligible for Medicare coverage.
What are bed sores?
Bed sores are painful injuries to the skin that can develop as a result of prolonged pressure (for example, if you sit or lie down for long periods of time and don’t move around much). The National Library of Medicine reports that bed sores most often appear over bony areas of the body that rest on the bed or wheelchair, such as hips, heels, ankles, and the lower back and tailbone area. In some cases, damage from bed sores can go deeper than the skin.
Bed sores may get worse over time. Doctors classify bed sores into different levels, or stages, to indicate how severe they are and how much tissue damage is present, according to the Mayo Clinic.
Stage I: Discolored areas, possibly painful, but no broken skin
Stage II: Shallow, reddish, blister-like wounds with damage to the skin and dermis underneath
Stage III: Deep, crater-like wounds with exposed fat and yellowish dead tissue
Stage IV: Wound may expose underlying muscle, tendon, or bone with deep damage to underlying tissues.
If the bed sores are covered with dead, crusted tissue, and your doctor cannot tell how deep the damage extends, the bed sore is considered “unstageable,” the Mayo Clinic states.
Who is at risk for bed sores?
The most common risk factors for developing bed sores relate to a lack of mobility:
- Partial or complete paralysis
- General weakness, or post -surgery recovery
- Illness or injury that requires prolonged bed rest or wheelchair use
- Sedation or coma
- Weight loss and lack of fat and muscle to cushion the skin and bones
- Neurological deficits that prevent you from feeling pain and pressure points on your body
- Bowel incontinence that leads to bacteria and moisture in vulnerable areas
- Diabetes and vascular disease that restricts blood flow to the extremities
Besides the risk factors above, reports the Mayo Clinic, sliding or dragging across a bed (such as a hospital bed) can cause bed sores in some cases. You should notify your health-care provider if you have any symptoms of a bed sore that aren’t helped by changing position.
How can you prevent bed sores?
The National Institutes of Health recommends that you change the patient’s position every two hours, keep the skin clean and dry, and place cushions or pillows such that they’ll relieve pressure. Some pharmacies sell wheelchair cushions that are especially designed for helping prevent pressure sores.
How does Medicare cover bed sores?
Original Medicare (Part A: hospital insurance, and Part B: medical insurance) may cover prevention of, and treatment for, bed sores. If you’re an inpatient in a Medicare-approved facility such as a hospital or skilled nursing facility, Part A generally covers your care, which may include prevention or treatment of bed sores. Medicare Part B usually covers care of a surgically treated wound; typically you pay 20% of the Medicare approved amount. Both Part A and Part B have deductible amounts you may have to pay before Medicare coverage begins.
In some cases, you may be eligible for Medicare coverage for limited home health care, under Part A and/or Part B, which may include prevention and treatment of bed sores. The following conditions apply:
- You must be under a doctor’s care.
- You must only need intermittent skilled nursing care.
- Your doctor must certify you are homebound.
- The agency providing the care must be Medicare-certified.
If you qualify for home health care, you pay nothing for Medicare-approved services, and 20% of any allowable charges for approved medical equipment and supplies under Part B (your Part B deductible also applies).
Some people opt to get their Medicare benefits through Medicare Advantage plans (also called Medicare Part C), which is an alternative way to get Original Medicare benefits (except for hospice care, which Medicare Part A still covers). Medicare Advantage plans cover all the same treatments and services as Original Medicare, but may include other benefits, such as prescription drug coverage and even routine vision, dental, and hearing care.
If you’d like to know more about Medicare coverage for bed sores and other home health care options, I’m happy to assist you. You can request an email with information for your unique needs, or even schedule a phone call, by clicking the appropriate button below. To find out about plan options in your area that you may qualify for, click the “Compare plans” button below.