Millions rely on Medicare to cover ostomy supplies. Without coverage, ostomy supplies may run anywhere from $300-$600 each month. Medicare provides coverage for prosthetic devices, Durable Medical Equipment, orthotics, and supplies, also known as DMEPOS. Ostomy supplies are prosthetic devices under Medicare.
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Medicare Guidelines for Ostomy Supplies
An ostomy is a surgical procedure. This procedure creates an opening which is known as a stoma. The stoma goes from an organ or system within the body – to the outside of the body.
Medicare Part B pays for 80% of allowable charges for ostomy supplies after you meet the Medicare Part B deductible. The need for ostomy supplies must be due to specific procedures, including ileostomy, urinary ostomy surgery, or a colostomy. Beneficiaries must use both providers and suppliers that accept and participate in Medicare assignment to receive coverage.
Stomas may be permanent or, in some cases, temporary depending on a patient’s condition. Ostomy supplies are necessary to collect bodily wastes for all ostomies. Ostomy supplies may include scissors, stoma powder, skin wipes, pouch clips, and paper towels.
Example of Temporary Medicare Coverage for Ostomy Supplies
Linda had an infection requiring her bowels to need temporary rest. Linda’s healthcare provider performed a temporary “loop colostomy.” During this procedure, a hole was cut into the side of the colon. Then a certain hole in the wall of the abdomen creates an opening known as a stoma. Thus, creating a way for her stool to drain from the stoma into a bag or pouch that her healthcare provider attaches to the abdomen.
Once Linda was clear of infection, this procedure was easily undone by detaching the colon from the wall of the abdomen. Then, the stoma was closed, allowing the normal flow of stool through the colon.
Example of Permanent Medicare Coverage for Ostomy Supplies
Robert needs a colostomy requiring permanent ostomy supplies. He suffers from cancer requiring the removal of the rectum. After surgery, Robert needs a permanent ostomy bag to allow his stool to drain. In this case, Robert’s medical condition requires him to always use ostomy supplies. Since it’s medically necessary for treating his condition, Medicare will cover most of the costs.
What is the Medicare Limit on Ostomy Supplies?
Medicare will cover up to a three-month supply of ostomy products at one time. You must have a prescription from your doctor to receive coverage under Medicare. The supplier must also be accredited and contracted with Medicare.
| Ostomy Supplies Covered by Medicare | Amount Allowed Per Month |
| Bedside drainage bag | 2 each / month |
| Solid skin barrier 4×4 | 20 each / month |
| Ostomy belt | 1 each / month |
| Ostomy pouch filter | ** no maximum listed |
| Skin barrier, liquid, per ounce | 2 ounces / month |
| Skin barrier, powder, per ounce | 10 ounces / 6 months |
| Skin barrier with flange, convex | ** no maximum listed |
| Ostomy drainable pouch with extended wear barrier | ** no maximum listed |
| Ostomy drainable pouch with barrier, convex | ** no maximum listed |
| Ostomy pouch liquid deodorant | 8 ounces / month |
| Ostomy ring | 10 each / month |
| Ostomy paste (non-pectin based) | 4 ounces / month |
| Ostomy paste (pectin based) | 4 ounces / month |
| Skin barrier with flange, extended wear, convex (4×4 inches or smaller) | ** no maximum listed |
| Skin barrier with flange, extended wear (4×4 inches or smaller) | ** no maximum listed |
| Skin barrier with flange, standard wear (4×4 inches or smaller) | 20 each / month |
| Ostomy standard wear skin barrier greater than 4×4 | 20 each / month |
| Ostomy closed end pouch with filter | 60 each / month |
| Ostomy closed end pouch with barrier, convex, filter, one-piece | 60 each / month |
| Ostomy closed end pouch with filter on non-locking system | 60 each / month |
| Ostomy closed end pouch for locking system, with filter | 60 each / month |
| Ostomy drainable pouch with barrier, filter, one-piece | 20 each / month |
| Ostomy drainable pouch for non-locking system, with filter | 20 each / month |
| Ostomy drainable pouch for locking system, non-filter | 20 each / month |
| Ostomy drainable pouch for locking system, with filter | 20 each / month |
| Ostomy urinary pouch for locking system | 20 each / month |
| Stoma cap | 31 each / month |
| Ostomy drainable pouch with extended wear barrier, filter, one-piece | 40 each / month |
| Ostomy drainable pouch with extended wear barrier, convex, filter, one-piece | 40 each / month |
| Ostomy drainable pouch with barrier attached; one-piece | 20 each / month |
| Ostomy drainable pouch with flange, non-filter | 20 each / month |
| Urinary pouch with barrier | 20 each / month |
| Urinary pouch for use on barrier with flange, two-piece | 20 each / month |
| Skin barrier wipes or swab, each | 150 each / 6 months |
Does Medicare Cover the Full Cost of Ostomy Supplies?
Medicare does not cover everything. Through Medicare Part A, you are left with deductibles and other cost-sharing. Under Medicare Part B, you are responsible for the remaining 20% of all your medical costs as well as deductibles.
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There are a few ways you can get supplemental coverage. One option is through a Medicare Advantage plan. Medicare Advantage plans must cover the same medical services and treatments as Original Medicare. However, how much they cover is up to them. Meaning, Part B may cover 80% of your Ostomy supplies, but Medicare Advantage may cover less than that.
They also come with copays for each visit, while Original Medicare does not. If your goal with supplemental insurance is to have fewer out-of-pocket costs, then a Medicare Supplement (Medigap) plan is the better option for you.
Medicare Supplements will cover the coinsurance and deductibles left behind by Medicare. Some letter plans will leave you with zero out-of-pocket costs outside the monthly premium. There are no copays with Medicare Supplements.
How to Get Supplemental Medicare Coverage for Ostomy Supplies
Whether you would like to enroll in a Medicare Supplement plan, Medicare Advantage plan, or Medicare Part D for prescription coverage to help with ostomy supplies and treatment, we can help. Our team of licensed Medicare agents are experts on all things Medicare.
If you would like to review the options available to you in your area, give us a call. We can prepare a list of all the plans and carriers in your area side-by-side to find you the most affordable option. If you prefer, you can complete our rate comparison form to see your Medicare options for ostomy supplies today.
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I NEED TO FIND OUT HOW LONG A PRESCRIPTION IS GOOD ON OSTOMY SUPPLIES, I HAVE ALWAY HAD ONE I HAD BIRTH DEFECTS AND I WILL ALWAYS HAVE THEM.
Vicki, the doctor who writes the prescription determines the length of validity. I recommend speaking with your doctor about the expiration date of your script.
My DME company says “they require an office visit to prove I still need ileostomy supplies for a permananent ileostomy” or they will not get paid from Medicare. How often do I have to go to the doctor per year for this? One company said twice per year one said once per year – what does Medicare say for DME supplies??
Thank you for reaching out! Medicare will provide ileostomy supplies for up to 3 months at a time with a valid prescription from your doctor. If your doctor continues to write the prescription, you can receive the supplies. The number of times you need to be rechecked is up to your doctor and supplier.
Why only 20 ostomy pouches per month? What if one breaks?
Patricia, the chart above shows the allowances of each type of pouch. Depending on the pouch style, you can receive up to 60 pouches per month.
I was getting supplies from the nurse that came out to help my husband with Physical Therapy. The Physical Therapy ended so I was ordering supplies from a pharmacy. Now that Physical Therapy started again the pharmacy will not fill the supplies stating I need to go through the Physical Therapy office to get the supplies covered but the Physical Therapy office is not familiar with this process and said they have no idea what the pharmacy is talking about. Where should I be getting my husband medical supplies from for his colostomy care.
Hi Lisa – as Part B covers colostomy supplies, your husband should ask his primary care physician or specialist where he can get his medically necessary equipment.
Does Medicare cover the reversal ( or take down) of an ileostomy?
Hi Patty, if a doctor deems an ileostomy reversal medically necessary, Medicare will cover it.
my ostomy supplies supplier keeps telling me that Medicare only allows me to use one supplier. They do not handle a certain product that I need while a different supplier does. I want to stay with my supplier but will I have to change because they don’t offer this one item??
Bert, to my knowledge, there is no rule by Medicare stating you can only use one Ostomy supplier.
Can you tell me the amount that Medicare covers for: 1) Adapt Adhesive Remover Spray and 2) Adapt Adhesive Remover Wipes?
The facility where I order my products has limited the order to ~ either two bottles of the spray every 3 months; or 3 boxes of the wipes every 3 months. Although the names are similiar for these products, I use them for different reasons and need both of them.
Thank you for more information and help.
NH
Hi Nadine! All Durable Medicare Equipment will be covered 80% under Part B as long as the supplier is approved by Medicare. If you have a Medigap plan, it will cover the remaining 20%. Since each supplier charges differently, you would need to ask them how much they charge Medicare to find out how much your out of pocket costs will be.
Regarding ostomy supplies, I have a permanent ileostomy and need supplies every month. How often does the doctor have to approve the prescription for supplies?
Hi Frank! Normally the doctor approves a 3-month supply at one time. If you contact the distributor, they may be able to work something out with you where you get a 3-month supply sent to you at one time automatically every 3-months.