Does Medicare Cover Wound Care?
- Medicare covers medically necessary wound care services in some circumstances. Learn how Medicare wound care coverage works, who qualifies and what you'll pay.
Medicare beneficiaries with ulcers, burns or other types of surgical and non-surgical wounds may qualify for wound care coverage. This article explains what wound care services Medicare covers, who is eligible and how much you'll contribute.
When Does Medicare Cover Wound Care?
Medicare may cover wound care supplies in certain circumstances. Medicare only covers medically necessary supplies to care for a surgical or surgically treated wound. It may also cover assessment of your wound and any treatment required to help the wound heal.
Generally, you'll only qualify for Medicare wound care coverage if your wound doesn't heal on its own or you have a complicating medical factor that interferes with the healing process. For example, Medicare may cover the treatment of open surgical wounds or wounds that aren't healing because you have an infection or autoimmune disorder.
Furthermore, your doctor must use an established method to treat your wound following accepted treatment standards, and Medicare doesn't cover experimental wound care treatments. You may not qualify for long-term wound care coverage if your wound doesn't show improvement during treatment.
If you qualify, Medicare may cover:
- Wet and dry dressings, including the cost of dressing changes by a healthcare provider
- Secondary dressings and supplies, such as gauze, bandages and surgical tape
- Debridement (removal of necrotic tissue)
- Management of underlying health conditions to promote wound healing
- Negative pressure wound care
- MIST therapy
What Is the Cost of Wound Care Through Medicare?
Medicare Part B covers wound care services received as an outpatient. Part B covers 80% of the approved amount for your treatment, and you pay the remaining 20%. You will also need to pay the Part B deductible, which is $226 per year as of 2023.
Medicare Part A pays for covered wound care related to inpatient hospital stays. Beneficiaries must pay a Part A deductible of $1,600 per benefit period plus coinsurance beyond day 60 of their hospital stay.
Do Medicare Advantage Plans Cover Wound Care?
Some people choose to purchase a Medicare Advantage plan through a Medicare-approved private insurer. These policies must cover any services covered by Original Medicare, including wound care. However, some Medicare Advantage providers may also cover certain treatments and dressings not included in Medicare Parts A and B.
Medicare Wound Care Requirements
Medicare may require evidence from your doctor that your wound care supplies and treatment are medically necessary. This evidence could include details about the wound, such as its size and location, and the reasons for recommending treatment. Medicare may also request a treatment plan explaining the rationale for using certain dressings or treatment techniques.
Your doctor will also need to monitor your wound and keep records of its condition. For example, Medicare may request evidence that your condition is improving to approve coverage for ongoing treatment.