Does Medicare Cover Ostomy Supplies?
- Ostomy supplies are medically necessary for people living with an ostomy. Find out whether Medicare covers ostomy supplies and how much it might pay for those items.
Medicare does cover ostomy supplies that are considered medically necessary. The benefit is paid out under Medicare Part B or, for those with a Medicare Advantage plan, covered by Part C.
Find out more about whether Medicare covers ostomy supplies to help you understand your out-of-pocket expenses and plan ahead for these needed items.
Have Medicare questions?
Talk to a licensed agent today to find a plan that fits your needs.
When Does Medicare Pay for Ostomy Supplies?
The designation of ostomy supplies as durable medical equipment is important because that means they're paid for under Medicare Part B.
Medicare Part B is the part of Original Medicare that covers outpatient treatment and supplies, including visits to your doctor or specialist and necessary medical equipment. For ostomy supplies to be considered medically necessary, you must have had an ileostomy, urinary or colostomy and have an ostomy as a result.
If you have a Medicare Advantage plan, you have Medicare Part C. It replaces both Medicare Parts A and B and must provide at least the same coverage. That means ostomy supplies would also be covered in the above cases under your Medicare Advantage Plan.
How Much Does Medicare Pay for Ostomy Supplies?
Medicare Part B comes with a 20% copay. That means you will be responsible for covering 20% of the cost of your ostomy supplies after meeting a small annual deductible.
Millions of Original Medicare beneficiaries are also enrolled in a Medicare Supplement insurance (Medigap) plan that can help pay for ostomy supply costs that Medicare doesn't, such as coinsurance, copays and deductibles.
If you have a Medicare Advantage plan, your deductible and copay costs may be different. It's important to look into how much your plan will pay and how much you may be held responsible for, especially when you know you'll have long-term, recurring expenses such as ostomy supplies.
What Supplies Are Needed for Ostomy Care?
An ostomy must be cared for in a specific fashion to maintain functionality and help reduce any chances of infection. Common ostomy supplies include:
- Pouches (you will need to replace them every few days or as directed by your medical provider)
- Pouch clips
- Stoma/skin barrier powder, paste or liquids
- Wipes to clean the skin around the ostomy
- Support or ostomy belt
- Stoma cap
Are Ostomy Supplies Considered Durable Medical Equipment?
Yes, ostomy supplies are considered durable medical equipment, or DME.
Many people think of things such as walkers, wheelchairs and hospital beds as DME, and that's all correct. But DME is a designation that also covers some types of supplies necessary for treating chronic conditions or illnesses. That includes ostomy supplies, diabetic testing supplies and wound care supplies.
