Does Medicare Cover Compression Stockings for Lymphedema?
Navigate Medicare's coverage for lymphedema compression garments. Learn about eligibility, obtaining supplies, and understanding your financial responsibility.
Lymphedema is a chronic condition characterized by fluid retention and tissue swelling, often in the arms or legs, caused by a compromised lymphatic system. This can lead to discomfort and potential complications. Compression therapy, primarily through specialized garments, plays a role in managing lymphedema by helping to reduce swelling and prevent its progression.
Medicare’s Approach to Lymphedema Treatment
Medicare Part B now provides coverage for certain lymphedema compression garments and supplies, effective January 1, 2024. This change aims to make lymphedema treatment more accessible for beneficiaries. Covered items include standard and custom-fitted gradient compression garments, such as stockings, wraps, and bandages.
Coverage extends to both daytime and nighttime compression garments, recognizing the continuous need for management. These items must be medically necessary for lymphedema treatment. This provision helps beneficiaries manage their condition more effectively.
Meeting Specific Coverage Conditions for Garments
To qualify for Medicare coverage, lymphedema compression garments must be medically necessary and prescribed by a qualified healthcare provider. A lymphedema diagnosis must be established, and the garments must be an integral part of the treatment plan. The healthcare provider must confirm the items are appropriate for the patient’s condition.
A detailed prescription from the healthcare provider is required, outlining specific information for the garments. This documentation must include the lymphedema diagnosis, garment type, compression level, affected body part, and replacement frequency (e.g., two sets per affected body part every six months). Garments must be obtained from a Medicare-enrolled supplier who can submit claims on the beneficiary’s behalf.
Steps for Obtaining Covered Garments
Obtaining Medicare-covered lymphedema garments begins with a written prescription from a qualified healthcare provider. This prescription serves as the official order, detailing the specifications required for the beneficiary’s condition. Ensure all required information, such as the diagnosis and garment type, is accurately included.
Once the prescription is obtained, locate a Medicare-enrolled supplier. Medicare.gov offers a search tool to find participating suppliers, or a healthcare provider’s office may offer recommendations. The supplier will assist with ordering the garments, which may include a fitting appointment to ensure proper sizing and compression. The Medicare-enrolled supplier submits the claim directly to Medicare. Afterward, the beneficiary will receive an Explanation of Benefits (EOB) from Medicare, detailing how the claim was processed.
Patient Costs and Financial Considerations
Beneficiaries are responsible for certain costs associated with Medicare Part B coverage for lymphedema compression garments. The annual Medicare Part B deductible must be met before Medicare begins to pay. For 2025, this deductible is $240.00.
After the deductible is satisfied, Medicare pays 80% of the Medicare-approved amount for covered garments. The beneficiary is responsible for the remaining 20% co-insurance. Choose a supplier who “accepts assignment,” meaning they agree to accept Medicare’s approved amount as full payment, limiting out-of-pocket costs to the co-insurance. Supplemental insurance plans, such as Medigap policies or employer-sponsored health plans, may help cover this 20% co-insurance.