Original Medicare (Part A and B) covers wound care in inpatient and outpatient settings, including medically necessary supplies. Medicare Advantage (Part C) must provide equal coverage, but costs vary by plan.
As you get older, your body becomes more susceptible to wounds. Wounds can result from accidents, falls, surgery, or chronic conditions like diabetes.
Wounds can also take longer to heal when you’re older. If you have a wound, it’s important to properly care for it. As long as a wound remains open, you are at increased risk of infection.
The good news is that Medicare does pay for medically necessary wound care supplies and treatment. It’s important to know in advance what the 2024 Medicare guidelines are so you can keep your costs low while getting the proper care for your wound(s).
Medicare Part A covers medical care you receive in an inpatient facility like a hospital, inpatient rehab facility, or skilled nursing facility.
Medicare Part B covers any outpatient wound care you receive from either your healthcare professional or skilled nursing care facility. Part B covers the cost of your treatment and any medically necessary supplies your healthcare professional uses to care for your wounds.
Medicare Part C, also known as Medicare Advantage, is a health insurance plan that provides the same basic coverage as Medicare Parts A and B but usually with additional benefits. Talk with your Medicare Advantage insurer for details of your plan’s wound care coverage.
Medigap, or supplemental insurance, is a private insurance plan that helps cover your part of Medicare costs. This kind of plan will help you pay for any additional out-of-pocket wound care costs after Medicare pays its portion.
Keep in mind…If your doctor recommends a newer type of wound care therapy, like stem cell treatments for example, verify first that Medicare will pay for the therapy. If it’s not an approved therapy, you will be responsible for the full cost, which can be expensive.
The following types of supplies are generally covered when prescribed or provided by a healthcare professional:
Primary dressings (applied directly to the wound):
- sterile gauze pads
- hydrogel dressings
- hydrocolloid dressings
- alginate dressings
Secondary supplies (used to keep primary dressings secure):
- gauze
- bandages
- adhesive tapes
Disposable supplies
Disposable wound care supplies like adhesive bandages, gauze, and topical antibacterial creams aren’t covered if you buy them yourself. Medicare doesn’t consider these everyday items “durable medical equipment,” so they aren’t included under Part B.
Skilled nursing after 100 days
If you’re receiving wound treatment as part of long-term care at a skilled nursing facility, Medicare will only pay for your wound care supplies until the 100-day limit for each benefit period. After 100 days, you will be charged the full amount for services and supplies.
Custodial care
While keeping wounds clean and covered is part of good wound care, Medicare does not consider bathing and dressing part of wound care. Those are considered “custodial care” services, which aren’t covered by Medicare.
To receive benefits from Medicare, you must be enrolled in Original Medicare (Part A and Part B), or you must be enrolled in a Part C/Medicare Advantage plan. For wound care supplies and care to be covered, you will first need to meet your annual deductible and then pay any applicable copays or premiums due.
Before you begin treatment, it’s a good idea to verify that your doctor is an enrolled Medicare provider. Your doctor will have to provide a signed, dated order for the wound care supplies you need, clearly stating:
- the size of your wound
- the type of dressing needed
- the size of dressing needed
- how often your dressing needs to be changed
- how long you are likely to need the dressing
Medicare Part A
For most Medicare beneficiaries, there is no premium for Medicare Part A. In 2024, you’ll likely pay the annual deductible of $1,632 toward wound care treatments received in a hospital or other inpatient facility.
After you’ve met the deductible, you’ll have a certain period where you’ll pay nothing for these services. Once these time periods have passed (which are different at hospitals vs. skilled nursing facilities), you will begin to pay a daily coinsurance amount.
You won’t be charged for any supplies your healthcare professional uses while you’re being treated.
Medicare Part B
If you receive outpatient wound care, you’ll need to meet a Medicare Part B deductible of $240. You’ll also need to pay the monthly Part B premium, which in 2024 is $174.70.
After you’ve met the deductible and paid the premium, you’ll only be responsible for 20% of the approved cost for wound care. Supplies used by your healthcare professional are fully covered.
Medicare Part C and Medigap
If you have a Medicare Part C (Medicare Advantage) or Medigap plan, your premiums, coinsurance payments, and annual deductible vary according to your plan. Check with your insurer as early as possible in the treatment process so you know what your out-of-pocket expenses will be.
Older adults are more likely to have chronic conditions that can lead to wounds, such as diabetes, venous insufficiency (poor circulation), and
Common wounds requiring professional care include:
- burns
- injuries from falls or other traumas
- surgical wounds
- diabetic foot ulcers
- venous and arterial ulcers
- radiation sores
- wounds that need to be debrided (no matter which debridement method is used)
Does Medicare cover the cost of wound VAC?
Vacuum-assisted closure (VAC) of a wound is also called negative pressure wound therapy. Medicare will cover this treatment when deemed medically necessary by your provider.
What are the 10 medical costs that Medicare will not cover?
The following medical services or supplies are not covered by Original Medicare:
- long-term or custodial care
- most dental care
- eye exams for glasses
- dentures
- plastic surgery
- massage therapy
- routine physical exams
- hearing aids and exams to fit them
- Concierge medicine
- Any items or services normally covered when provided with an out-of-network healthcare professional.
How to get wound dressings covered by insurance?
Generally speaking, wound treatment should be covered by most private insurance companies.
What should I expect from a wound care exam?
During a wound care appointment, a healthcare professional will check for infection and assess the wound’s size and blood supply.
Then, they will create a treatment plan, which may include debridement under anesthesia if necessary. Before leaving, they will clean and dress the wound for protection during healing.
Getting the right wound care is critical as you age due to the higher chance of accidents and longer healing time.
Medicare Part A covers your treatment and supplies when you receive wound care at an inpatient facility. Medicare Part B provides coverage for outpatient wound care.
Private Medicare Part C plans also offer wound care coverage, but the specifics vary according to the plan. If you have a Medigap plan, it will likely pay some of the costs you have after Medicare has paid its portion.
Before you get treatment, make sure your doctor is enrolled in Medicare and the treatment methods and supplies are Medicare-approved.