Are Compression Stockings Covered by Medicare?

Compression stockings are specialized garments applying graduated pressure to the legs, improving blood circulation and reducing swelling. Medicare coverage for these items can be complex, depending on specific medical conditions and the type of stocking required. This article clarifies when Medicare covers compression stockings, outlining the necessary criteria and processes.

Medicare Coverage Criteria

Original Medicare Part B covers medically necessary durable medical equipment and supplies. While compression stockings are not broadly classified as Durable Medical Equipment (DME), Medicare covers them under specific circumstances. A medical necessity and doctor’s prescription are always required.

Coverage applies to two distinct medical conditions. As of January 1, 2024, the Lymphedema Treatment Act mandates coverage for compression garments used in lymphedema treatment. This includes stockings, socks, and other related supplies, recognized as Durable Medical Equipment, Prosthetic and Orthotic Supplies (DMEPOS). Additionally, Medicare covers stockings when medically necessary for active venous stasis ulcers, where they are considered wound dressings.

Medicare does not cover compression stockings for general circulatory issues, varicose veins without ulcers, or for preventative or comfort purposes. The prescribing physician must document the diagnosis, condition stage, and a detailed plan of care indicating the need for the garments. This documentation is important for establishing medical necessity and ensuring the claim aligns with Medicare’s guidelines.

Types of Compression Stockings and Coverage

Medicare’s coverage for compression stockings is specific to therapeutic purpose and compression level. Higher therapeutic compression levels, measured in millimeters of mercury (mmHg), are more likely to be covered than lower, over-the-counter options. For instance, stockings with compression ratings such as 20-30 mmHg, 30-40 mmHg, or 40-50 mmHg are covered when medically necessary for qualifying conditions.

Standard, off-the-shelf compression stockings are covered if they meet medical necessity criteria. Custom-fitted compression garments are also covered, particularly for complex lymphedema cases, if a professional fitting is documented as essential for effective treatment.

For lymphedema, Medicare covers a specific quantity of garments: three daytime garments per affected body part every six months and two nighttime garments every two years. Replacements for lost, stolen, irreparable garments, or due to changes in limb size, are also covered. Medicare has a fixed reimbursement rate for these items, which may influence the specific features or types of stockings available.

Process for Obtaining Covered Stockings

A comprehensive prescription from an authorized medical practitioner is required. This prescription must include the specific diagnosis, required compression level, anatomical location needing treatment, and the type and quantity of garments. It should also specify the frequency of product replacement.

The beneficiary must acquire stockings from a Medicare-approved Durable Medical Equipment (DME) supplier. Confirm the supplier is enrolled in Medicare and accepts assignment, agreeing to accept the Medicare-approved amount as full payment. This limits the beneficiary’s out-of-pocket costs to the deductible and coinsurance. Beneficiaries can contact Medicare directly to find approved suppliers.

The DME supplier will submit the claim to Medicare, utilizing the detailed prescription and medical documentation. Under Original Medicare Part B, after the annual deductible is met, Medicare covers 80% of the Medicare-approved amount for covered items. For 2025, the Part B annual deductible is $257. The beneficiary is responsible for the remaining 20% coinsurance.

Medicare Advantage Plans and Supplemental Coverage

Medicare Advantage (Part C) plans offer an alternative way to receive Medicare benefits and may also cover compression stockings. These plans must provide at least the same level of benefits as Original Medicare. Medicare Advantage plans are administered by private insurance companies and can have different cost-sharing structures, network requirements, and unique additional benefits.

Beneficiaries enrolled in a Medicare Advantage plan should review their plan documents or contact their provider directly for details on compression stocking coverage. Some plans may offer supplemental benefits, such as allowances for over-the-counter medical supplies, which may be used for stockings not covered by Original Medicare. Confirm any network restrictions and specific requirements for obtaining covered items.

Medicare Supplement Insurance, also known as Medigap, can help cover some out-of-pocket costs associated with Original Medicare. If Original Medicare covers compression stockings, a Medigap policy may help pay for the Part B deductible and the 20% coinsurance. Medigap policies only cover costs for services and items that Original Medicare covers.