Does Medicare Cover Wound Care? 

While wounds are a normal part of life caused by accidents, surgical procedures, cuts, or other types of traumas, they can also be caused by medical conditions like diabetes, poor circulation, obesity, and decreased mobility. 

Because aging increases the risk of these common health issues, seniors are especially vulnerable to getting wounds. And as the body ages, wounds can take longer to heal, increasing the risk of serious infections. 

To prevent infection and boost the healing process, proper wound care is vital. If you have a wound that’s more than a scratch or bruise, you should see your health care provider. If it’s necessary, he’ll prescribe a wound care plan that might include an initial wound assessment, suitable dressing, regular cleaning with bandage changes, testing for infection, and physical therapy if warranted.  

You may need professional care if you have any of the following types of wounds: 

  • Diabetic ulcer
  • After a surgical procedure
  • Radiation sores
  • From an injury, accident, or other trauma
  • Venous or arterial ulcer
  • A severe burn
  • Any wound that needs debriding (the removal of infected or dead skin tissue) 

If you have Medicare insurance, your wound care supplies and treatment are most likely covered by your benefits, so here’s a look at how you can get this coverage.

How does Medicare cover wound care? 

If your physician prescribes wound care treatment and supplies because they are medically necessary, Medicare covers its share of these costs. For you to be eligible for these benefits your physician must accept Medicare assignment, and you must get your supplies from a medical supplier that also accepts Medicare assignment. If you are enrolled in Original Medicare Parts A (hospital insurance) and B (medical insurance) your coverage depends on where you get your treatment.

All wound care treatment and supplies you receive as a hospital or skilled nursing home inpatient are covered by Medicare Part A. After meeting your Part A deductible for the current benefit period, expenses for your wound treatment and supplies are covered for the duration of your inpatient stay if the hospital or nursing facility accepts Medicare assignment. 

If you are receiving wound care and supplies as an outpatient, Medicare Part B covers its share of your expenses. Part B pays 80 percent of the final approved cost, and you pay the remaining 20 percent after meeting your annual Part B deductible. 

To qualify for coverage of wound supplies, your health care provider must provide a certified order stating the following information regarding the wound care supplies you need:

  • The size of the wound
  • The type and size of the dressing you require
  • The frequency of dressing changes, and the approximate duration of your treatment

Wound care supplies are categorized as durable medical equipment and are covered by Medicare Part B. You must get your supplies from a Medicare-affiliated supplier to receive this benefit. 

If you are homebound, you may qualify for home health services that are covered by Medicare Parts A and B. If you’re eligible for this benefit, your physician will create a wound care plan so a part-time or intermittent skilled care provider can come to your home and perform your wound treatment. 
Medicare recipients who are enrolled in a Medicare Advantage (MA) plan are entitled to the same benefits that Original Medicare Parts A and B include. Most Medicare Advantage plans also offer additional coverage and extra benefits, too. Depending on the type of MA plan you have, your provider may require that you use specific health care providers, hospitals, and medical suppliers to get your coverage. 

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