As we age, our bodies become more susceptible to injury. Accidents of falls, surgeries and chronic diseases such as diabetes can result in wounds.
With age, wounds might also take longer to heal. If you have a wound, it is essential to treat it appropriately. As long as a wound remains open, the chance of infection increases.
The good news is that Medicare covers wound care materials and medically required treatments. It’s crucial to be aware of the 2020 Medicare requirements to receive appropriate wound care at a reasonable cost (s).
When does Medicare cover care for wounds?
Medicare Part A covers inpatient care received in a hospital, inpatient rehabilitation center, or skilled nursing facility.
Part B of Medicare covers any outpatient wound treatment provided by a physician or skilled nursing facility. Part B covers the costour therapy and any medically necessary wound care products used by your healthcare professional.
Medicare Part C, often known as Medicare Advantage, is a health insurance plan that typically provides additional benefits in addition to the same basic coverage as Medicare Parts A and B. Discuss the terms of your plan’s wound coverage with your Medicare Advantage insurer.
Supplemental insurance, or Medigap, is a private insurance plan that helps cover your share of Medicare expenditures. After Medicare pays its half, this coverage will help you pay for any additional out-of-pocket wound care costs after Medicare pays its half.
reimbursable wound care supplies
In general, the following types of supplies are covered when prescribed or given by a healthcare professional:
Primary dressings (directly applied to the wound):
- sterilized gauze pads
- hydrogel dressings
- hydrocolloid dressings
- alginate dressings
Secondary materials (used to secure primary dressings):
- gauze
- bandages
- adhesive tapes
What materials for wound treatment are not covered?
Disposable supplies
Self-purchased disposable wound care items such as adhesive bandages, gauze, and topical antibacterial treatments are not cover. Part B does not cover these common goods because Medicare does not consider them to be “durable medical equipment.
Skilled nursing after 100 days
Medicare will only pay for your wound care supplies for the first 100 days of each benefit period if you receive wound treatment as part of your long-term care at a skilled nursing facility. After 100 days, the full sum will be charged for services and supplies.
Custodial care
Medicare does not consider bathing and dressing part of wound care, even though keeping wounds clean and covered is part of appropriate wound care. These services are consider “custodial care” and not covered by Medicare.
How can I qualify for assistance with wound care?
To obtain Medicare benefits, you must enrolled in either traditional Medicare (Part A and Part B) or a Part C/Medicare Advantage plan. To receive coverage for wound care supplies and care, you must first meet your yearly deductible and then pay any relevant copayments and premiums.
Before beginning therapy, you should confirm that your physician is enrolled with Medicare. Your physician must issue a written, dated order for the wound care products you require, indicating clearly:
- The severity of your injury
- Type of dressing required
- The required size of dressing
- How frequently your dressing must be replaced
- How long do you anticipate requiring the dressing
- What expenses might I anticipate?
Medicare Part A
Part A of Medicare is free for the majority of Medicare recipients. In 2020, you will likely pay the annual deductible of $1,408 for hospital or other inpatient wound care.
After meeting the deductible, you will receive these treatments at no cost for a specified duration. After these periods (which vary across hospitals and skilled care institutions) have elapsed, you will begin paying a daily coinsurance payment.
You will not be charged for any supplies used by your healthcare professional throughout your treatment.
Medicare Part B
Medicare Part B requires you to pay a deductible of $198 if you undergo outpatient wound treatment. In addition, you must pay the monthly Part B premium of $144.60 in 2020.
After meeting the deductible and paying the premium, you will be responsible for only 20% of the authorized wound care cost. Supplies utilized by your healthcare provider are pay in full
Part C of Medicare and Medigap
Your Medicare Part C (Medicare Advantage) or Medigap plan will determine your premiums, coinsurance payments, and annual deductible. Determine your out-of-pocket expenses as early as possible in the treatment process by contacting your insurance
What Constitutes Long-Lasting Medical Equipment?
Durable medical equipment contains reusable medical devices and supplies, such as a hospital bed at home or an artificial limb. Contrary to durable medical equipment, single-use medical equipment such as bandages or incontinence pads.
It is essential to comprehend what qualifies as DME and does not, as this impacts insurance coverage. Most public and commercial health insurance plans pay all or a portion of the cost of durable medical equipment.
To qualify as medical equipment:
- Serve primarily as a medical function
- Be prescribed or ordered by a healthcare professional
- Be capable of being utilized repeatedly.
- Typically have a minimum projected lifespan of three years.
- Use within the house
- Useful only for those with an injury or impairment
These are the most prevalent types of durable medical equipment used outside of hospitals:
- Kidney machines
- Traction equipment
- Orthotics
- Prostheses
- Concentrators of oxygen, monitors, ventilators, and related equipment
- Assistive devices for personal care, such as bath chairs, dressing aids, and commodes
- Aids for mobility such as walkers, crutches, crutch substitutes, wheelchairs, and scooters
- Bed equipment like medical beds, pressure mattresses, bili lights and blankets, and lift beds
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