Does Medicare cover ostomy supplies?

The short answer

Yes. Medicare covers ostomy supplies for people with a colostomy, ileostomy or urostomy — not as durable equipment but under the prosthetic benefit, because the supplies replace the function of an organ. Most Medicare Advantage and commercial plans cover them too, and Florida Medicaid has its own rules for its managed-care plans.

Coverage is item by item: barriers, pouches, rings, paste, belts and accessories each stand on their own, each with its own usual monthly quantity.

What has to line up

• The surgery and the ostomy type documented in your medical record.
• An order from your prescriber listing the specific products and the monthly amounts.
• A supplier enrolled with your plan — we are enrolled with Medicare as a DMEPOS supplier.
• For repeat shipments, confirmation that you actually need the next one before it goes out. Plans expect it, and it is why we contact you before we ship rather than shipping blind.

The quantity rules, without the table

Each supply type carries a monthly quantity the plan considers usual. Needing more than that is common — high output, leak problems, a skin condition that shortens wear time — and there is a route for it: your prescriber documents the reason, and the higher quantity can be covered.

We deliberately do not print the quantity tables here. They differ between Medicare, Florida Medicaid and each commercial plan, and they change. We check the current one for your plan and tell you what it says.

Items on the edge of coverage

Some accessories sit differently on different plans — deodorants, some skin-care items, certain convenience products. Rather than guessing, send us your product list and we will tell you which side of the line each item falls on for your plan, before anything is shipped or billed.

What we do about it

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