Do You Need a Prescription to Get Ostomy Supplies?

Medicare Benefits Solutions

Feb 2, 2022

The medical field has many interesting medical terminologies and techniques. Original Medicare must be well-familiarized with all medical aspects and procedures to safeguard and apply proper Medicare benefits to those eligible Medicare beneficiaries. 

Medicare beneficiaries who are facing health conditions regarding ostomy procedures can benefit by becoming familiar with some of these very unique medical terms and purposes an ostomy provides, as well as what Medicare benefits can be expected.

What is an Ostomy?

The word “ostomy” comes from the word “stoma.” A stoma or a natural and hollow opening of the body generally refers to the mouth, nose, anus and ears. These openings provide any type of natural and necessary bodily flow from the inside-out, the outside-in, or both. 

When disease or injury occurs to an organ, a stoma may need to be created. For example, if the colon is injured as a result of colorectal cancer or another disease, this may lead to compromised functionality requiring a colostomy. Creating an outlet or stoma from the colon wall to the outside of the body allows proper drainage or removal of wastes produced within the colon walls. These wastes are able to be expelled outside of the body while bypassing the rectum and the anus.  

Other types of ostomies include the following examples:

1. Ileostomy – this process attaches the stoma to the bottom of the small intestine (or ileum), circumventing the colon, rectum and anus.

2. Urostomy – this process attaches the stoma to the tubes that transport urine to the bladder, circumventing the bladder.

What Are Ostomy Supplies?

The list below is not a complete list of needed supplies for one type of ostomy procedure. This list is a comprehensive one that offers respective glances for individual needs. To determine which supplies suit your personal medical needs, please discuss details with your physician.

Ostomy Supplies to Consider:

– Scissors
– Skin wipes
– Clean towels/paper towels
– New 1 or 2-piece wafer pouch system
– Measuring card/pen
– Pouch clip
– Stoma powder
– Stoma paste or ring seal
– Closed bags
– Open and drainable bags
– Stoma caps

Ostomy supplies can help make the medical and physical recovery transitions easier. They are designed to assist as a regular part of after-ostomy care. While ostomy procedures are specific and different, many of the aftercare ostomy supplies are the same or similar because of the nature of an ostomy’s functionality.

What Ostomy Supplies are Covered by Medicare?

Medically necessary ostomy bags are considered for coverage under the Part B portion of Original Medicare benefits plan if you’ve had an ileostomy, urostomy, or colostomy. For sufficient aftercare and appropriate Medicare coverage that serves your medical circumstances best, discuss the types of covered ostomy supplies your physician recommends.

Medicare Part B does require Medicare beneficiaries to pay the deductible, as well as 20% of the total cost of the ostomy supplies. Because an ostomy requires an extension of the body it is considered as a limb or prosthetic device that is considered medically necessary. Medicare will cover prosthetics.

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How Many Ostomy Bags Does Medicare Pay for a Month?

It is important to understand that Medicare will only pay for prescribed ostomy supplies for three months at a time. Because ostomy supplies can cost between $300-$600 a month, it is wise to work closely with your physician to maintain refillable, on-time prescriptions. 

Discuss suppliers with your physician, too, for a broader range of available supplies in case of shortages or other delivery concerns. Each supplier must have a signed and dated prescription by your physician. Otherwise, Medicare will not approve coverage.

Emergency Ostomy Supply Options Near Me

If you run out of ostomy supplies, don’t panic. Dial 211 on your telephone to connect with your state’s community support assistance and explain your ostomy concerns. UOAA, or United Ostomy Association of America has affiliated groups like Kinders Closet who can assist with short-term ostomy provisions.

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