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 are also known as DMEPOS. Ostomy supplies are prosthetic devices under Medicare.
Medicare Guidelines for Ostomy Supplies
Part B pays for 80% of allowable charges for ostomy supplies. Beneficiaries must first pay the Part B deductible unless they have supplemental coverage. 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 a Medicare assignment to receive coverage.
The National Institutes of Health reports that 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.
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. The U.S. National Library of Medicine states that 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 a 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. Robert 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. Under Part A, you’re left with deductibles and other cost-sharing. Under Part B, you’re responsible for the remaining 20% of all your medical costs as well as deductibles. There are a few ways you can get supplemental coverage.
One option is through a Medicare Advantage plan. 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 Advantage may cover less than that.
They also come with copays for each visit, Original Medicare does not. If your goal with supplemental insurance is to have less out-of-pocket costs, then a Medicare Supplement 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 Part D for prescription coverage, we can help. Our team of agents is experts in Medicare. They know the lingo and all the ins and outs. We make sure to say up to date and informed on all your Medicare benefits. We have a great Facebook community to help keep you informed as well as a YouTube channel we upload new videos to regularly.
If you would like to see how much these options cost in your area, give us a call. We can pull 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 comparison form to see your options now.