Jack's Blog on Medicare Plan Choices

Medicare Coverage for Compression Stockings: What You Need to Know

Compression stockings are an important medical device for many seniors, helping to improve circulation and reduce swelling in the legs. However, Medicare’s coverage of these stockings is limited. Let’s review when Medicare covers compression stockings and what you need to know.

Medicare Part B covers compression stockings only in very specific circumstances:

1. For patients with open venous stasis ulcers: If you have an open wound on your leg due to venous insufficiency, Medicare will cover gradient compression stockings as part of the treatment.

2. As part of lymphedema treatment: If you’ve been diagnosed with lymphedema and compression stockings are part of your prescribed treatment, Medicare may provide coverage.

It’s important to note that Medicare does not cover compression stockings for general use, such as to prevent blood clots during travel or to manage mild swelling.

Requirements for Coverage

To have Medicare cover your compression stockings, you’ll need:

1. A doctor’s prescription

2. A documented medical necessity

3. To obtain the stockings from a Medicare-approved supplier

Out-of-Pocket Costs

If you qualify for coverage, you’ll typically be responsible for 20% of the Medicare-approved amount after you’ve met your Part B deductible.

Alternatives for Those Who Don’t Qualify

If you don’t meet Medicare’s strict criteria for compression stocking coverage, you have a few options:

1. Check your Medicare Advantage plan: Some plans offer additional coverage for items not included in Original Medicare.

2. Use a Flexible Spending Account (FSA) or Health Savings Account (HSA): If you have one of these accounts, you can use pre-tax dollars to purchase compression stockings.

3. Look for over-the-counter options: While not as strong as prescription-grade stockings, these can be more affordable for daily use.

Conclusion

Medicare’s coverage of compression stockings is limited.  As I say often in the case of limited coverage, I believe this is because of past cases of fraud.   We all pay a price for healthcare fraud.  I did a little research and here is what I found.

Fraud Concerns in Compression Stocking Coverage

Unfortunately, like many areas of healthcare, there have been instances of fraud related to Medicare coverage of compression stockings. Here are some key points to be aware of:

1. Unnecessary Prescriptions: Some unethical providers have prescribed compression stockings to patients who don’t medically need them, solely to bill Medicare.

2. Upcoding: This involves billing for higher-grade, more expensive compression stockings than what was actually provided to the patient.

3. Phantom Billing: In some cases, suppliers have billed Medicare for compression stockings that were never actually delivered to patients.

4. Kickback Schemes: There have been instances where medical suppliers offered kickbacks to healthcare providers for prescribing unnecessary compression stockings.

5. Misrepresentation of Medical Conditions: Some providers have falsely diagnosed patients with conditions that would qualify for Medicare coverage of compression stockings.

Red Flags for Watch For:

– If you’re offered free compression stockings without a proper medical evaluation

– If you’re pressured to accept compression stockings you don’t need

– If you receive bills for compression stockings you never received

Protecting Yourself:

1. Only accept compression stockings prescribed by your regular doctor based on a genuine medical need.

So, there you have it. Not the best news if you use compression stocking like me, and you don’t meet Medicare’s guideline.