This is just a reminder that the Lymphedema Treatment Act requires traditional Medicare to begin covering compression garments and supplies starting January 1, 2024. While most other plans follow the lead of traditional Medicare, they are not required to do so, and it could take some time for them to align.
If you have a Medicare Advantage plan, or any other type of insurance, it’s imperative that you reach out to urge them to also include comprehensive coverage for lymphedema compression supplies beginning January 1st. If you have not yet done so, all of the instructions are below.
If you are trying to select between traditional Medicare and a Medicare Advantage plan during this open enrollment period, please be advised that, while Medicare Advantage does have to cover anything that traditional Medicare does, they do not have to do so on the same terms, and each Medicare Advantage plan may differ. Meaning, the allowable quantities, replacement frequencies, and other details of the coverage could be different.
For example, traditional Medicare will be covering at least two sets of daytime compression garments every six months, for a total of four sets per year. The word sets is key, because that means a garment for each affected body part constitutes one set. This was something our group advocated very strongly for, to ensure that the coverage was equitable and that patients with more affected body parts would have access to the quantities they needed.
If another plan were to decide the annual limit was eight total compression garments per year, and base the coverage on number of individual garments, not sets of garments, that would be quite different. For a patient who only needs one arm sleeve, for example, that would be very generous. But for a patient who needs to wear two arm sleeves, two gloves and a chest piece each day, this would fall far short of meeting their needs.
This is why we are urging each of you to please contact your own insurance companies, to urge them to not only include coverage for compression garments, but to also ensure that they, like traditional Medicare, provide comprehensivecoverage starting in 2024!
If you have any type of insurance other than traditional Medicare, it is very important that you complete the action item below if you have not yet done so.
This includes private insurance plans (whether employer-based or purchased separately), supplemental and secondary plans, Medicare Advantage, Medicaid, TriCare, and VA health care.
Use the following links to access the instructions and template language seen in the image below for contacting your insurance provider:
Please respond to this message if you have trouble accessing the information through the above links. Thank you for your advocacy!
Heather Ferguson
Founder & Executive Director
Lymphedema Advocacy Group
LymphedemaTreatmentAct.org
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