Does Medicare Cover Ostomy Supplies?
This article was updated on: 10/21/2018
An ostomy is a surgical procedure that creates an opening (stoma) to the outside of the body from an organ or system inside the body, according to the National Institutes of Health (NIH). These openings may be temporary or permanent, depending on your condition. Some of the most common ostomies include colostomy, ileostomy, and urostomy.
All ostomies require ostomy supplies to collect bodily wastes. Ostomy supplies include an ostomy pouch that attaches to your stoma. Other ostomy supplies could include a pouch clip, scissors, stoma powder, skin wipes, and paper towels, according to the U.S. National Library of Medicine.
How does Medicare cover apply to ostomy supplies?
Ostomy supplies fall into a category known as prosthetic devices, and Medicare coverage of durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) applies. Generally, Medicare Part B covers 80 percent of allowable charges for ostomy supplies. You have to meet the Part B deductible, and must need the ostomy supplies because of colostomy, ileostomy, or urinary ostomy surgery. Keep in mind, however, that your costs may be higher if you don’t get ostomy supplies that are:
- Prescribed by a provider who accepts Medicare assignment
- Obtained from a supplier who participates in Medicare
Are there other Medicare options for ostomy supplies coverage?
Original Medicare (Part A and Part B) is just one way to receive your Medicare benefits for ostomy supplies. People who enroll in Original Medicare are covered for inpatient care under Part A and for outpatient care and supplies under Part B, subject to certain restrictions.
The Medicare Advantage (Medicare Part C) program gives you an alternative way to receive your Original Medicare benefits such as ostomy supplies. Medicare Advantage plans are offered through private, Medicare-approved insurance companies and include all your Part A and Part B benefits except hospice care, which is still covered under Medicare Part A.
Many Medicare Advantage plans also include an expanded range of benefits, such as routine vision or hearing care, as well as prescription drug coverage in most cases. Some plans require you to use providers within a plan network. You’re still in the Medicare program under Medicare Part C, and need to continue paying your monthly Medicare Part B premium, along with any premium the plan might charge.
Do you have any questions about Medicare coverage of ostomy supplies?
If you want to know more about Medicare coverage for ostomy supplies, or would like to find out how a Medicare Advantage plan might help you get all your Medicare coverage in one convenient plan, I’d be happy to help. You can request a phone call or an email with personalized information just for you by clicking one of the buttons below. To learn more about Medicare plan options in your area, click the “Compare Plans” button.