April 29th 2024
By Ari Parker
Learn about how Medicare covers ostomy supplies if you’ve just had an ostomy procedure
By Ari Parker
Some surgical procedures can hinder the way waste exits the body. If you’ve had ostomy surgery, you’ll need ostomy supplies to heal properly and provide a safe way to collect and remove waste.
Medicare covers any medically necessary ostomy supplies if you’ve had certain kinds of ostomy surgery. We’ll discuss what your out-of-pocket costs could look like and how frequently Medicare covers ostomy supplies.
Ostomy supplies help you collect and remove bodily waste after an ostomy surgery.
Medicare pays for ostomy supplies if they’re medically necessary after a colostomy, ileostomy, or urinary ostomy.
Medicare covers the amount of ostomy supplies your doctor recommends based on your condition and needs.
There are two medical terms to understand before we get into coverage: ostomy surgery and ostomy supplies.
Ostomy surgery involves creating an opening in the abdomen (called a stoma) to change the flow of waste or urine when the normal functions are impaired or removed. Doctors may recommend ostomy surgery if your digestive or urinary system is damaged, diseased, or removed.
There are various types of ostomy surgery. Below are the most common types of procedures:
Ileostomy: Doctors order ileostomies when a person needs the colon and rectum removed or bypassed. This may occur in serious cases of inflammatory bowel disease, with colorectal cancer, or after trauma. An ileostomy involves creating a stoma in the small intestine. Ileostomies may be temporary or permanent.
Colostomy: This procedure is performed to treat conditions like colorectal cancer, diverticulitis, or trauma to the colon. A colostomy involves creating a stoma within the large intestine.
Urinary ostomy: In this procedure, surgeons remove the bladder to treat bladder cancer, neurogenic bladder dysfunction, or other abnormalities. A urostomy involves creating a stoma in the small intestine to divert urine to a pouch outside the body.
Continent ostomies: These ostomies are surgically reconstructed areas where waste or urine can be stored internally and periodically emptied.
You need ostomy supplies to collect and remove waste from the body after you’ve had an ostomy surgery. Ostomy supplies are typically worn outside the body to store waste from the opening in the abdomen.
Common ostomy supplies include:
Ostomy pouches
Ostomy belts
Skin barriers to seal and protect skin from irritation
Adhesive removers and skin preparation for ostomy supplies
Accessories such as odor-neutralizing products and stoma caps
Wound care items
Supportive clothing
Your doctor is the best resource for determining which ostomy supplies you’ll need. Before and after the procedure, you’ll receive materials that discuss proper care to ensure that you heal and manage the ostomy.
Yes, Medicare covers any medically necessary ostomy supplies if you’ve had a colostomy, ileostomy, or urinary ostomy. Medicare considers ostomy supplies prosthetic devices, so your insurance will bill them accordingly. Once you reach your Part B deductible, you’ll pay 20% of the cost of each piece of equipment you need for the ostomy.
Medicare covers as many ostomy supplies as you need—so long as your doctor recommends them for your condition. If you need an ostomy pouch, belt, and adhesive each month and your doctor agrees, Medicare will cover the supplies.
There are various supplies and devices that Medicare covers—including durable medical equipment, diabetes supplies, and prosthetic devices. Learn about Medicare coverage for your needs by calling a Chapter Medicare Advisor at 855-900-2427 or booking a time to chat.
