Does Medicare Cover Compression Garments for Lymphedema?
Medicare Benefits Solutions
Nov 22, 2022
With many Medicare recipients living on a fixed income, costs can add up, especially if you are dealing with a chronic illness. If you’ve been diagnosed with lymphedema, you may have a variety of treatment options available.
Compression garments may be recommended to improve your condition. Medicare covers many medically necessary services and supplies. When it comes to items you purchase on your own at a pharmacy or medical supply store, your benefits can vary.
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Does Medicare Cover Leg Compression Devices?
Medicare Part B typically doesn’t cover medical supplies you use at home, such as bandages, compression garments and other over-the-counter, AKA OTC, products. This means that Medicare normally wouldn’t cover the cost of compression stockings and other lymphedema leg compression devices.
However, Part B may provide coverage when deemed medically necessary. For instance, you would have to pay out of pocket if you want to use compression socks for varicose veins. But, Medicare may approve their use when prescribed by a doctor to help manage venous stasis ulcers, AKA open wounds appearing in the lower leg or ankle area.
TIP: You may be able to find a Medicare Advantage plan that covers certain OTC medical expenses. Use our plan finder to discover Medicare plans that may offer coverage for compression garments and other over-the-counter supplies.
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What is Lymphedema?
Lymphedema is a chronic, incurable condition resulting from a damaged lymphatic system. The lymphatic system contains a fluid known as lymph, vessels to transport the lymph, connective tissue and blood cells.
According to Kaiser Health News (KHN), lymphedema impacts about 5 million people nationwide, mostly after cancer treatment, particularly when lymph nodes are removed. Lymph nodes reside in large groups near mammary glands and in the armpits and groin and are sometimes removed to stop the spread of cancer.
When functioning normally, the lymphatic system drains excess fluid from spaces in between the cells. It transports dietary fats and fat-soluble vitamins for absorption in the gastrointestinal tract and executes immune responses against abnormal cells. When the system malfunctions, the body builds up fluid and causes swelling. This usually occurs in the arms and legs but can impact other areas too.
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How is Lymphedema Treated?
Surgical treatment of lymphedema is reserved for severe cases. Not everyone is a candidate for surgery, and it is not a cure. Nonsurgical approaches, which are more common, often combine physical therapy with compression garments.
A physical therapist (PT) who specializes in lymphedema may use a technique called manual lymphatic drainage (MLD), which is a type of massage that stimulates circulation. Your PT may encourage and guide you to perform this gentle massage on yourself. Comprehensive decongestive therapy (CDT) integrates MLD with multilayer compression bandages, skin care and physical exercises.
Compression garments are wearable items that apply pressure, moving fluid into circulation to lessen swelling and reduce the risk of complications. These garments come in many forms including compression wraps, socks, stockings and sleeves.
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Different Types of Compression Garments
A compression garment is made of a fabric that is tight and stretchy, delivering compression to the limb impacted by lymphedema. Levels of pressure are measured in millimeters of mercury (mmHg). Depending on your personal needs, a variety of compression garments may be recommended by your providers, including the following:
Compression stockings can vary in size and intensity. They are made to fit snugly and stretch to deliver gentle pressure to your leg. Stockings with graduated pressure are tighter around the ankle with reduced pressure as they go up the leg. You may need to replace your stockings two to four times per year. Some people wear compression stockings to treat varicose veins.
A compression sleeve, the tube part of the stocking less the foot, is used to prevent fluid accumulation in the limb. You may need more than one as your limb undergoes changes during physical therapy. If you use the sleeve every day, plan on replacing it every six months due to wear and tear as well as the need to be refitted.
Compression shirts and bodysuits
Compression shirts and bodysuits are designed to facilitate lymphatic drainage following procedures involving the breast, neck, shoulder and chest. Features range from short-to-long compression arm sleeves, underarm cotton pads and back support panels.
Does Medicare Cover Lymphedema Therapy?
According to the Medicare Coverage Database (MCD) for lymphedema decongestive treatment, updated October 2020, Medicare covers manual lymphatic drainage and comprehensive decongestive therapy for patients who have:
- A lymphedema diagnosis
- Recent changes in the condition
- Previous unsuccessful therapies
- Been treated by a qualified medical clinician
- Received services under accepted medical standards, specific and effective for treating the condition
Medicare Advantage Compression Garment Coverage
Medicare Advantage plans often provide benefits that go beyond what Original Medicare covers. Extra benefits may include gym memberships and an allowance or discounts for over-the-counter (OTC) products.
If you are enrolled in a Medicare Advantage plan that includes OTC benefits, you should have received access to an online catalog of available items. Check with your plan specifically to see if compression garments and post-surgical supplies are included.
Lymphedema Treatment Act
Right now, original Medicare excludes coverage for lymphedema compression garments, though that may change in the future. On July 13, 2022, a congressional committee voted in favor of the Lymphedema Treatment Act.
If this initiative is passed, compression supplies prescribed for lymphedema will become a Medicare benefit. Proponents of the Lymphedema Treatment Act argue that treating the condition properly, including the use of compression garments, should lower the incidents of costly hospitalizations and improve the quality of life for patients.
Lymphedema Resources and Support
If you want to research lymphedema therapies, these sources may be helpful:
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