Medicare Coverage for Ostomy Supplies - What to Expect?

I am looking at transitioning to Medicare next year and wondering how much of the cost of supplies will be covered. Currently, under my company insurance, my supplies are covered 100% after I meet the deductible (which I always do because of other health issues).

It will depend on what you have as a supplement. Whatever company you decide to go with will be able to let you know.

Edit: By company, I mean whoever you pick for your supplement.

Edgepark is clueless when it comes to billing!!! All they say is if there's a payment, then you'll be sent a bill. Always check with your insurance first, and if they say it's covered and Edgepark sends a bill, call your insurance and fight it... I did not pay $245 like they said I had to!!! Also, whoever your supply company is (Convatec, etc.), you can call them and they can tell you who you can get your supplies from with your insurance. Medicare can be a headache to figure out!!! I had to figure it out 20 years before I thought I would have to, becoming disabled and my insurance changed 6 months after getting approved for disability. Make sure you have a supplement. A and B sound like you have everything covered, but your deductible and copays, but they don't. You need a Part D plan, or you're paying out of your butt, which you thought you couldn't use anymore!!!

Those of you that are low income, $2000 for retired or $8,500 for disabled (at least in Wisconsin)... Social Security can help with extra programs to help with lowering copays and deductibles (I've gotten lucky with my case worker from SS; they explained things that Medicare didn't, as well as the supplement insurance rep... made it a lot easier. Hope this helps more) 😊

Unless you have EdgePark. They tell me something different just about every other time I order. I've ordered from them when I had private health health insurance and now on Medicare with supplement coverage. No problems with them when I had private insurance; it was when I switched over to Medicare, now everything gets on back order or they change the quality of supplies. I'm switching from them after 10 years, poor customer service!

I've had my colostomy for two years and have used Byrum as my supplier. It appears they work with Medicare. Perhaps that's what I should do: ask them which supplemental plan works well with them. I have also had a kidney transplant 10 months ago and need the anti-rejection medications covered. One of them is expensive! Thanks for your response.

Used Edgepark for about 17 months with no problem using private medical insurance.

I just transitioned to Medicare and have Original Medicare Part A & B, and a Supplement Plan G.

Getting ready to order my first supplies from Edgepark using Medicare. They screw me and it's bye-bye. All they have to do is be honest. If the government is late on approvals or products are not in stock, say so. We're ostomates; we can handle the truth.

My Ostomy Journey: LeeAnne | Hollister

I've heard a lot of bad-mouthing of Edgepark here. I don't find them as bad as all that. Not perfect, but not perfectly terrible. This year is my first year on Medicare, after being on my wife's health insurance plan. I have received two 3-month orders so far without too much of a hitch. I have Plan B and a Plan G supplement. So far, no problems after my deductible was met. I had some issues with Medicare itself and that caused some issues with Edgepark and the first order of the year. But, the second went by smoothly.

Medicare doesn't cover as much as the private insurance did. There are no problems with the necessities like pouches, skin barriers, wipes, and barrier rings. They allow much less deodorizing lubricant, for instance. Only one bottle a month. For an ileostomate, that one bottle is lucky to last a week. Fortunately, also for an ileostomate, odor isn't that much of a problem and there are other ways to get lubricated. :-)

Daniel

You echo my experience with Edgepark since my first order on March 24. I even had a very helpful Medicare agent on the line with them and me to try to resolve a problem with Edgepark withholding a reordered product because "Medicare won't pay," which was clearly not true. Their internal finger-pointing is not helpful either, and expecting the customer to navigate their internal billing systems is the exact opposite of customer service. I'm looking into new suppliers and hoping for a smoother process. My secondary insurance is with FedBC/BS, and I pay zero out of pocket for my supplies.

I have additional supplemental coverage and 99% of everything is 100% covered. Medicare pays 80% and the supplement pays 20% after an annual deductible of around $200. I live in Florida and have Blue Cross Plan G. If it's covered under Medicare, the supplement covers the balance. For some reason, Edgepark says they do not always receive reimbursement from Medicare for Adhesive Cleaner, so they make me pay for it, and they submit the claim, and then I am reimbursed by Medicare and Blue Cross. There are a couple of items that are not covered now, such as internal deodorant capsules. But almost everything else is covered as long as you order within the quantity limits that Medicare covers.

Very helpful. I have Blue Shield G supplement too. From what I've read, G plan pays automatically. I don't submit claim forms or anything.