Medicare now partially covers Lymphedema Garment costs! Here is the scoop.

Lymphedema Garment Cost Is Now Covered by Medicare

As of 1/1/2024, Medicare will provide coverage for certain types of lymphedema garments, including compression sleeves, compression stockings, and other compression-based garments. These garments are typically covered under Medicare Part B as durable medical equipment (DME) when prescribed by a doctor to treat lymphedema. It's important to note that Medicare will only cover the cost of these garments if they are purchased from suppliers that are enrolled in the Medicare program.

Patients with Medicare will be responsible for a co-pay, which can range from a few dollars to 20% of the total cost, depending on their specific insurance plan.

Benefits to Patients: The coverage of lymphedema garments by Medicare brings significant benefits to patients dealing with lymphedema, including:

1. Improved Access: Coverage by Medicare enhances access to essential lymphedema garments for patients who may not have been able to afford them otherwise and helps alleviate the financial burden on patients
2. Enhanced Treatment Compliance: With the financial assistance provided by Medicare, patients are more likely to adhere to their prescribed treatment plans, leading to better management of lymphedema symptoms.
3. Quality of Life: By having access to proper lymphedema garments, patients can experience reduced swelling, improved mobility, and overall enhanced quality of life.

Specific Types of Lymphedema Garments Covered by Medicare

1. Compression Sleeves: These garments are designed to apply pressure to the affected arm or leg, aiding in the reduction of swelling and promoting lymphatic drainage. They are typically prescribed for patients with upper extremity lymphedema.
2. Compression Stockings: These garments are primarily used to manage lower extremity lymphedema by applying controlled pressure to the affected limb, helping to minimize swelling and discomfort.
3. Compression Bandages: Medicare also covers multi-layer compression bandaging systems, which are commonly used in the initial intensive phase of lymphedema treatment to reduce swelling and soften fibrotic tissues.
4. Custom-Made Garments: In some cases, patients may require custom-made compression garments tailored to their unique measurements and needs. Medicare may provide coverage for these specialized garments when prescribed by a healthcare professional.

It's important to note that Medicare coverage for lymphedema garments is contingent upon the prescription of a healthcare provider and the purchase from Medicare-enrolled suppliers

Cost Savings for Lymphedema Garments Covered by Medicare

The coverage of lymphedema garments by Medicare offers significant cost savings for patients dealing with lymphedema. Here are the key ways in which Medicare coverage contributes to cost savings:

1. Reduced Out-of-Pocket Expenses: Medicare coverage for lymphedema garments alleviates the financial burden on patients by reducing their out-of-pocket expenses. Without this coverage, patients would have to bear the full cost of these often expensive garments, impacting their financial well-being.
2. Extended Coverage Period: By having Medicare cover the cost of lymphedema garments, patients can access these essential items for an extended period, ensuring continuous and effective management of their condition. This helps avoid frequent out-of-pocket expenses for replacements and upgrades
3. Prevention of Complications: Properly fitting and high-quality lymphedema garments, made accessible through Medicare coverage, can prevent complications such as skin infections and worsening of lymphedema symptoms. This, in turn, reduces the need for costly medical interventions and hospitalizations.
4. Improved Treatment Adherence: Cost savings from Medicare coverage can lead to improved patient adherence to prescribed treatment plans. When patients can afford the necessary garments, they are more likely to comply with their treatment regimen, potentially reducing the risk of costly complications associated with unmanaged lymphedema.

Examples of Lymphedema Garment Costs

Here are some examples of the costs patients may encounter when acquiring lymphedema garments:

1. Compression Sleeves: A standard off-the-shelf compression sleeve for lymphedema can range from $50 to $200, depending on the brand, material, and compression level. Custom-made compression sleeves, designed to fit the patient's specific measurements, can cost significantly more, ranging from $200 to $500 or more.
2. Compression Stockings: The cost of compression stockings for lower extremity lymphedema varies based on factors such as length, compression level, and whether they are off-the-shelf or custom-made. Off-the-shelf options can range from $30 to $100, while custom-made stockings may cost upwards of $300.
3. Compression Bandages: Multi-layer compression bandaging systems, often used in the initial phase of lymphedema treatment, can cost between $50 and $200 for a full kit. These kits typically include multiple bandages and padding materials for effective compression.
4. Insurance Coverage and Co-Pays: While these are the typical retail costs of lymphedema garments, patients with Medicare or private insurance coverage may only be responsible for a co-pay, which can range from a few dollars to 20% of the total cost, depending on their specific insurance plan.

How Often?

Medicare will pay for compression garments as follows:

• Daytime: 3 garments per affected body part every 6 months
• Nighttime: 2 garments per affected body part every 2 years

Medicare will also pay for items, as needed:

• To replace lost, stolen, or irreparably damaged items
• If a patient’s condition changes, like a change in limb size

More information can be found here CMS.GOV