Does Medicare Cover Compression Socks?

Compression socks are specialized garments that apply pressure to the legs, assisting with blood circulation. The question of whether Medicare covers these items can be intricate for beneficiaries. This article clarifies when and how Medicare may provide coverage for compression socks, offering guidance for those seeking financial assistance for these medical devices.

Understanding Medicare’s Stance on Compression Socks

Medicare’s approach to covering compression socks is specific, with coverage extended only under particular medical circumstances. Original Medicare, specifically Part B for medical insurance, generally considers compression socks as durable medical equipment (DME) if they meet certain criteria. DME is equipment that can withstand repeated use, serves a medical purpose, is typically only useful to someone who is sick or injured, is used in the home, and is expected to last at least three years.

Compression socks are not universally covered as DME for all conditions. Medicare Part B can cover them when they are deemed medically necessary for specific diagnoses. General preventative use or comfort-related needs do not qualify for coverage. Instead, coverage focuses on severe medical conditions where these garments are an integral part of a treatment plan.

Meeting the Coverage Requirements

Medicare coverage for compression socks hinges on demonstrating medical necessity, involving specific health conditions. Primary conditions for coverage include severe lymphedema and chronic venous insufficiency that has led to venous stasis ulcers. For lymphedema, a condition characterized by swelling due to a compromised lymphatic system, coverage became available starting January 1, 2024, due to recent legislative changes.

A written order or prescription from a treating physician is required for coverage. This order must include specific information to substantiate the medical necessity. It should clearly state the diagnosis, the precise type of compression sock required, the necessary pressure gradient in millimeters of mercury (mmHg), and the duration for which the socks are needed.

Medicare covers higher-pressure, medical-grade compression garments, typically those with pressure gradients of 20-30 mmHg or higher. Over-the-counter (OTC) compression socks or those with lower pressure levels (e.g., 10-15 mmHg) are not covered because they do not meet the medical necessity criteria. Custom-fitted compression garments may also be covered when medically appropriate. For lymphedema, Medicare outlines specific quantity limits, covering three daytime garments per affected body part every six months and two nighttime garments every two years.

To ensure coverage, compression socks must be obtained from a supplier enrolled in the Medicare program. These suppliers must agree to accept Medicare assignment, meaning they accept the Medicare-approved amount as full payment for the item. This requirement helps regulate costs and ensures beneficiaries are not overcharged for covered equipment.

Navigating the Coverage Process

Once medical necessity and prescription requirements are met, a structured process follows to obtain compression socks through Medicare. A detailed prescription from a healthcare provider is the foundational element, outlining the specific medical need and garment specifications.

Finding a Medicare-enrolled Durable Medical Equipment (DME) supplier is the next step. Beneficiaries can use the Medicare.gov website’s supplier directory or call 1-800-MEDICARE to locate approved suppliers. Selecting a supplier that accepts Medicare assignment ensures they will bill Medicare directly and accept the Medicare-approved amount for the items.

The chosen supplier handles direct billing to Medicare on behalf of the beneficiary. The supplier submits a claim with all required documentation, including the physician’s order. After the claim is submitted, Medicare processes it, and the beneficiary receives an Explanation of Benefits (EOB) detailing what was covered and their financial responsibility. If a claim is denied, beneficiaries have the right to appeal the decision.

Costs and Exclusions

Understanding the financial obligations associated with Medicare coverage for compression socks is important for beneficiaries. Under Medicare Part B, after meeting the annual deductible, beneficiaries are responsible for a 20% coinsurance of the Medicare-approved amount for medically necessary durable medical equipment. For 2025, the Medicare Part B annual deductible is $257.

Medicare Advantage (Part C) plans, offered by private insurance companies, must cover everything Original Medicare covers. These plans may have different cost-sharing structures, including varying copayments, deductibles, or coinsurance amounts for DME. Some Medicare Advantage plans might also offer additional benefits, such as an allowance for certain over-the-counter medical supplies, depending on the specific plan’s design.

Several common exclusions exist for Medicare coverage. Medicare does not cover over-the-counter compression socks unless specifically prescribed for a qualifying medical condition. Socks purchased without a valid, medically necessary prescription from an approved provider are also excluded. If compression socks are obtained from a supplier not enrolled in Medicare or one that does not accept assignment, Medicare will not cover the costs. Compression socks used solely for general comfort, mild swelling, or preventative purposes without a qualifying medical diagnosis are also not covered.