Medicare Coverage for Compression Stockings: Suppliers, Expenses Explained
Medicare Advantage plans now cover compression stockings for individuals who meet specific medical conditions, primarily related to lymphedema and other medically necessary indications. This coverage follows provisions from the Lymphedema Treatment Act, incorporated into Medicare Part B benefits.
For Medicare Advantage members, medical policies now include coverage for lower extremity pressure gradient compression stockings when medically indicated. A prescription or order from a healthcare provider is required, and these garments must be properly fitted by an expert to ensure efficacy.
Compression stockings provide graduated pressure, usually between 20 and 50+ mmHg, and are designed to promote the mobilization of edema fluid and prevent reaccumulation, particularly in the maintenance phases of treatment.
The key conditions under which coverage applies generally include diagnosed lymphedema requiring maintenance compression therapy, other medical indications warranting compression therapy, such as venous insufficiency or to prevent deep vein thrombosis (DVT), though specifics depend on the plan’s medical policies.
Under Medicare, a person who qualifies for compression stockings coverage will need to meet their annual deductible, which is $257 in 2025, to receive coverage. Afterward, Medicare will cover 80% of the cost. In addition, a person will need to pay the Part B premium, which starts at $185, depending on their income level.
It's essential to note that Medicare Advantage (Part C) plans may vary in their coverage of over-the-counter medical expenses, including compression socks and stockings. Therefore, it's crucial to contact the Medicare Advantage plan provider to check coverage and understand requirements for reimbursement, such as any price limits, necessary paperwork, and limits on the number of compression stockings and socks that can be purchased.
For those eligible for Medicaid, help with costs for compression stockings may be available, but coverage depends on the state.
In summary, Medicare Advantage plans cover compression stockings mainly if a medical necessity is established—such as lymphedema—and if prescribed and fitted properly. Coverage terms such as quantity limits and frequency (e.g., 3 daytime sets every 6 months) follow Medicare Part B guidelines embedded in the Advantage plans. Always check the specific plan’s medical policy as details can vary by insurer and region.
[1] Centers for Medicare & Medicaid Services. (2019). Medicare Coverage of Compression Garments for Lymphedema. Retrieved from https://www.cms.gov/medicare-coverage-database/details/nca-details.aspx?NCAId=319 [2] Medicare Advantage Medical Policies. (2022). Compression Stockings. Retrieved from https://www.medicareadvantagemedicalpolicies.com/compression-stockings/ [3] American Academy of Orthopaedic Surgeons. (2021). Lymphedema and Compression Garments. Retrieved from https://www.aaos.org/news/aaosnow/articles/2021-01-25-lymph.aspx [4] National Institute on Aging. (2022). Medicare Costs and What They Cover. Retrieved from https://www.nia.nih.gov/health/medicare-costs-and-what-they-cover [5] Centers for Medicare & Medicaid Services. (2021). Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Benefit. Retrieved from https://www.cms.gov/medicare/what-medicare-covers/durable-medical-equipment
- Medicare Advantage plans now cover compression stockings for individuals diagnosed with lymphedema, as well as for those with other medical conditions that necessitate compression therapy, such as venous insufficiency or the prevention of deep vein thrombosis (DVT).
- Medicare Advantage members can receive coverage for lower extremity pressure gradient compression stockings when medically indicated, but a prescription or order from a healthcare provider is required, and these garments must be properly fitted by an expert.
- Compression stockings, which provide graduated pressure and aid in the mobilization of edema fluid, are primarily covered under Medicare Advantage plans if they are medically necessary for health conditions like chronic diseases or medical-conditions.
- Although Medicare Part C (Medicare Advantage) generally covers compression stockings, specifics such as quantity limits and frequency, price limits, and necessary paperwork may vary by insurer and region, so it's important to contact the Medicare Advantage plan provider for more details.
