General Medicare Guidelines for Ostomy Care
In this article:
Number of supplies covered for ileostomy, colostomy, urostomy
Medicare is a federal insurance program. It covers people over the age of 65 and younger people (under age 65) who have certain disabilities.
Hospital and doctors’ fees
Everyone over the age of 65 is entitled to Medicare Part A coverage. Part A is hospital insurance coverage. It covers hospital inpatient care and care in skilled nursing homes (but not long-term care). It also covers some home health care and hospice care. You usually don’t pay a monthly premium for Part A coverage if you or your spouse paid Medicare taxes for at least 10 years while working. Doctors’ fees and outpatient care falls under Medicare Part B, which is optional coverage. People who choose to receive Medicare Part B pay a monthly premium. Part B helps cover eligible doctors’ visits, lab tests and outpatient care. It also covers durable medical equipment (DME), including ostomy supplies, when medically necessary. After you pay the Part B deductible for the year, Medicare covers 80% of the Medicare-approved amount and you pay the 20% (co-pay). If you have additional insurance coverage (supplemental insurance), it may help to cover the 20%.
Ostomy supply coverage
If you have Medicare Part B coverage, then your ostomy supplies are covered. (As noted above, Medicare covers 80% and you pay 20%). You must have a prescription on file with your supplier, signed and dated by your doctor. It is important to make sure the supplier is a participating Medicare supplier (enrolled in Medicare). Otherwise, your claim will not be paid by Medicare.
To maximize your Medicare benefits, ensure you work with a supplier that accepts assignment. Accepting assignment means the supplier agrees to accept the Medicare-approved reimbursement amount for your ostomy supplies. If your supplier does not accept assignment, you may have to pay the entire bill up front and then seek reimbursement from Medicare on your own.
Ostomy Bill of Rights
As a patient, you have the right to informed consent. The United Ostomy Association of America (UOAA) published an Ostomy Patient Bill of Rights, explaining your rights to be empowered and ask questions and to know what is reasonable.
To learn more, visit the UOAA (United Ostomy Association of America)
†Reimbursement Disclaimer: Coloplast Corp. provides this information for your general reference and related to the reimbursement of Coloplast products only. Reimbursement, coverage and payment policies can vary from one insurer and region to another and may change over time. Coloplast does not guarantee coverage or payment of products
