Does Medicare Cover Compression Stockings for Lymphedema?

Lymphedema can be a real pain in the legs (and arms). This chronic condition, often caused by damage to the lymphatic system, leads to uncomfortable swelling. People with lymphedema are often prescribed compression stockings as part of their treatment. But if you’re covered by Medicare, you might be wondering — does Medicare pay for these socks or are you stuck covering the bill yourself?

The short answer: It depends. Medicare does cover some medical equipment and treatments related to lymphedema but when it comes to compression stockings specifically things get a little tricky.

What is Lymphedema?

Lymphedema occurs when your lymphatic system is damaged or blocked which causes lymph fluid to build up in your tissues. It can cause swelling pain and even infections. It’s most commonly associated with cancer treatments like surgery or radiation that involve the lymph nodes but it can happen due to other reasons too.

• Primary Lymphedema: This is a rare genetic condition that causes the lymphatic system to malfunction from birth or develops later in life.
• Secondary Lymphedema: This occurs because of damage to the lymphatic system usually from surgery radiation or infection. It’s much more common than primary lymphedema.

Regardless of the cause, compression stockings are often recommended to help manage the swelling by promoting proper circulation.

Does Medicare Pay for Compression Stockings?

This is where things get a bit messy like your sock drawer after laundry day. Medicare Part B covers Durable Medical Equipment (DME) but unfortunately compression stockings don’t usually make the cut. Medicare classifies compression stockings as “non-covered items” when it comes to lymphedema even though they play a big role in managing the condition.

Exceptions to the Rule

There are some cases where Medicare might cover compression garments but it’s like finding a matching sock in that drawer—rare and a little frustrating.

1. Custom-fitted compression garments: If your doctor specifically prescribes custom-fitted compression garments Medicare might cover them under certain conditions.
2. Post-surgery: If you’re recovering from surgery like a mastectomy and have lymphedema as a result Medicare may help cover compression garments in some situations.
3. Medicare Advantage Plans: Some Medicare Advantage plans might offer coverage for compression stockings but this depends on the specific plan.

“It’s frustrating how limited Medicare’s coverage is for compression stockings even though they’re so essential for managing lymphedema” says Henry Beltran founder of Medicare Advisors Insurance Group LLC. “Patients shouldn’t have to worry about paying out-of-pocket for something that’s crucial for their health. But alas that’s how the system works right now.”

How Much Do Compression Stockings Cost?

Compression stockings aren’t cheap. Depending on the type and compression level they can range anywhere from $50 to $100 per pair or even more for custom-fitted ones. If you’re going to wear them every day (which you probably should) that can add up fast.

Types of Compression Stockings:

• Over-the-counter compression stockings: These are usually more affordable but may not offer the level of compression needed for lymphedema.
• Prescription compression stockings: These are typically more expensive but are tailored to your specific needs. Prices for these can range from $100 to $200.
• Custom-fitted compression garments: These are the cream of the crop when it comes to compression gear but expect to shell out $200 or more per pair.

Potential Drawbacks of Compression Stockings

Like any medical treatment compression stockings aren’t perfect. Sure they help manage lymphedema but they also come with their fair share of quirks.

• They can be uncomfortable: Wearing tight socks all day is about as fun as it sounds. It takes some getting used to especially in the summer when they can make your legs feel like a sweaty mess.
• Hard to put on: Ever try putting on super tight stockings? It’s like trying to wrestle a snake! Many people struggle to put them on especially those with limited mobility.
• They wear out: Compression stockings lose their effectiveness over time. This means you’ll need to replace them regularly which adds to the overall cost.

“Compression stockings are great but let’s face it no one enjoys putting them on every morning. It’s like trying to squeeze into skinny jeans after a big meal” jokes Henry Beltran. “But at the end of the day they’re necessary for managing lymphedema.”

What Can You Do If Medicare Doesn’t Cover Compression Stockings?

If Medicare doesn’t cover your compression stockings (which is likely) there are still some options to explore.

1. Talk to your Medicare Advantage plan: As mentioned before some Medicare Advantage plans offer coverage for compression stockings. It’s worth checking with your plan provider to see if you’re eligible.
2. Check with local programs: Some non-profit organizations or local programs may offer financial assistance for medical supplies including compression stockings.
3. Use your Health Savings Account (HSA): If you have an HSA or Flexible Spending Account (FSA) you can use those funds to cover the cost of your compression stockings.
4. Shop around: Compression stockings vary widely in price. Look for deals online or ask your healthcare provider if they can recommend more affordable options.

Tips for Choosing the Right Compression Stockings

Not all compression stockings are created equal. Here are some tips to help you choose the right pair:

1. Get fitted by a professional: If possible get fitted by a healthcare provider to ensure you’re getting the right level of compression.
2. Choose the right level of compression: Compression stockings come in different levels of pressure. 20-30 mmHg is usually recommended for mild lymphedema while 30-40 mmHg is better for more severe cases.
3. Consider the material: Compression stockings come in a variety of materials including cotton nylon and spandex. Some materials are more breathable and comfortable than others.

“Choosing the right compression stockings can make a world of difference in comfort and effectiveness. Don’t just grab any pair off the shelf talk to your doctor and get fitted properly” advises Henry Beltran.

Conclusion

Compression stockings are an essential part of managing lymphedema but unfortunately Medicare doesn’t usually cover them unless you fit into a specific category. While there are some exceptions most people will need to cover the cost out-of-pocket or explore other options for assistance.

Medicare Advisors Insurance Group LLC can help guide you through your Medicare plan options to make sure you’re getting the best coverage possible. Henry Beltran and his team are here to help answer your questions about Medicare coverage for lymphedema compression stockings and much more.

“We can’t change Medicare’s policies but we can help you navigate them. Our goal is to make sure you’re getting the care you need without the financial headache” says Beltran.

So while you might have to wrestle with your compression stockings at least you won’t have to wrestle with Medicare alone.