Medicare will cover wound care for all beneficiaries, regardless if it’s done in an inpatient or outpatient setting. Wound care can end up being extremely expensive. As we age, we’re more susceptible to injuries or wounds. Some people suffer from post-surgical lesions. Others may suffer from chronic fungal or viral wounds. Because of the prevalence of wounds with age, it’s easy to see why Medicare would cover this treatment. Below, we’ll go over what you need to know about Medicare coverage for wound care.
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Medicare Guidelines for Wound Care
Medicare will cover treatment for surgical wounds. Also, Medicare covers chronic wounds; you may end up getting. Medicare covers wound care supplies for many different types of wounds. Some of the lesions may be from surgeries, ulcers, burns, or flesh wounds. Depending on if you receive wound care as an inpatient or outpatient will determine which part of Medicare will cover the cost.
Inpatient Wound Care Coverage Under Medicare
If you receive wound care in inpatient settings like a hospital, rehab facility, or Skilled Nursing Facility, coverage would fall under Medicare Part A. There is a deductible under Part A. Most Medicare Supplement plans will cover this deductible.
Outpatient Wound Care Coverage Under Medicare
If you receive wound care in an outpatient setting, such as at your doctor’s office, coverage would fall under Medicare Part B. Part B also covers Durable Medical Equipment. This includes any supplies that are medically necessary to treat your wound. Just like Medicare Part A, Part B also comes with a deductible. However, if you have a supplemental plan, it could be covered.
Wound Care Supplies Covered by Medicare
Medicare will cover primary and secondary wound dressings for your injuries. Primary dressings apply directly to your injury, and secondary forms of dressings are like aids to the primary dressings. Secondary dressings are bandages, gauze, and adhesive tape.
- Hydrogel Dressings
- Hydrocolloid Dressings
- Foam Dressings
- Alginate Dressings
Medicare Documentation Requirements for Wound Care
Your doctor will need to provide documentation that your wound is still present. Medicare only covers wound treatment if you have the necessary documents.
- Evidence of your wound
- Size of your wound
- The extent of damage your injury is causing
- Any necessary drainage needs
Medicare Advantage Coverage for Wound Care
With a Medicare Advantage plan, cost-sharing is dependent on the carrier. It’s extremely difficult to predict how much you’ll pay out of pocket with a Medicare Advantage plan. You would want to contact the carrier directly to find out how much they will cover and what your cost-sharing will be.
Medicare Supplement Coverage for Wound Care
Cost-sharing is predictable when it comes to Medicare Supplements. As long as Medicare Part A & Part B pays, your Medigap plan will pay all or most of the remaining costs. If you have Medicare Supplement Plan F, you will pay zero out of pocket. If you have Plan G, you’ll only pay the Part B deductible.
How to Get Help with Your Wound Care Costs Under Medicare
Medicare may cover many of the wound care services you need, but certainly not all. Medigap can help cover the deductibles and coinsurances you’d otherwise pay. To find Medicare Supplement plans in your area, call our team of agents at the number above. We can identify the most affordable policy in your area. If you can’t call now, fill out an online rate form and compare plans in your area!
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- Negative Pressure Wound Therapy Pumps, CMS. Accessed October 2023 .