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Medicare Part B (Medical Insurance) covers medically necessary ostomy supplies if you’ve had a colostomy, ileostomy, or urinary ostomy. Medicare covers the amount of supplies your doctor says you need, based on your condition.
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 covered by Medicare Part B as durable medical equipment. Specifically, these items are considered prosthetics because they replace a body organ or organ function. You will owe 20% of the Medicare-approved amount for these supplies. Medicare pays the other 80%.
People who choose to receive Medicare Part B pay a monthly amount, or monthly premium, to get this insurance coverage. Part B helps cover eligible doctors’ visits, lab tests and outpatient care. It also helps pay for supplies, including ostomy supplies, when they are medically necessary.
For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements.
Ostomy supplies are covered for use on a beneficiary with a surgically created opening (stoma) to divert urine, or fecal contents outside the body. Ostomy supplies are appropriately used for colostomies, ileostomies or urinary ostomies (see covered diagnosis codes below.)
If you need an ostomy pouch, belt, and adhesive each month and your doctor agrees, Medicare will cover the supplies. There are various supplies and devices that Medicare covers—including durable medical equipment, diabetes supplies, and prosthetic devices.
Medicare covers ostomy supplies if you have a valid prescription signed and dated by your doctor. Before you can avail of coverage, check for ostomy suppliers that accept Medicare. Remember, Medicare will not pay for your ostomy supplies if your supplier is not Medicare-enrolled.
Does Medicare Cover Ostomy Supplies? Medicare insurance usually provides coverage for ostomy surgery and supplies required for maintenance through Part B. Medicare Part B, or Medical Insurance, helps cover outpatient treatment on a temporary or continual basis.
Millions of people across America rely on Medicare for their essential medical supplies, including ostomy products. Medicare typically covers a portion of the overall cost of each order (typically 80%), so there is usually an out-of-pocket cost to the insured customer.