Does Medicare Cover Compression Stockings?

Medicare Part B may cover compression stockings for individuals with specific medical conditions when deemed medically necessary. Unlike durable medical equipment (DME) such as wheelchairs, coverage for stockings falls under distinct provisions for treating particular health issues. Understanding the specific criteria and payment structure is important for those seeking coverage for these items.

Medical Necessity and Coverage Conditions

Coverage for compression stockings under Medicare requires a physician’s prescription and a diagnosis demonstrating medical necessity. The stockings must be required for the diagnosis or treatment of a disease or condition, not for general support or comfort. Conditions that typically qualify include lymphedema and chronic venous insufficiency, especially when associated with active venous stasis ulcers. For venous stasis ulcers, Medicare often requires compression levels of 30-40 mmHg or higher.

For lymphedema, Medicare Part B covers these compression items to control and reduce swelling. Medicare covers three daytime garments per affected body part every six months and two nighttime garments per affected body part every two years. The prescription must clearly state the medical necessity, specific type of stockings, and required compression level.

Medicare Payment Structure

When covered, compression stockings fall under Medicare Part B, which addresses outpatient medical services and certain medical equipment. Beneficiaries are responsible for an annual Part B deductible, which is $257 in 2025. After this deductible is met, Medicare typically pays 80% of the Medicare-approved amount for covered items. The remaining 20% is the beneficiary’s coinsurance responsibility, paid directly to the supplier.

Medicare Advantage (Part C) plans, which are an alternative to Original Medicare, must cover at least what Original Medicare covers. However, these private plans may have different cost-sharing rules, deductibles, or specific networks for suppliers. Medicare Supplement (Medigap) plans can assist with out-of-pocket costs, such as the 20% coinsurance. For these payment rules to apply, the supplier must be enrolled in Medicare and accept assignment, meaning they accept the Medicare-approved amount as full payment.

Acquiring Covered Compression Stockings

Obtaining Medicare-covered compression stockings begins with a detailed prescription from a qualified healthcare provider. This prescription explicitly documents the medical necessity, including the specific type and required compression level. Without this order, Medicare will not consider coverage.

The next step involves finding a durable medical equipment (DME) supplier enrolled in Medicare and accepting assignment. Utilizing Medicare’s online tools or contacting State Health Insurance Assistance Programs (SHIP) can help locate approved suppliers. Confirming the supplier accepts assignment ensures out-of-pocket costs are limited to the deductible and coinsurance. The supplier typically handles claim submission directly to Medicare after verifying coverage. After the claim is processed, the beneficiary receives an Explanation of Benefits (EOB) from Medicare, detailing what was covered and any remaining patient responsibility.