Medicare or Medicare Advantage for Chronic Wound Care?

Chronic wound care is a must for anyone facing an injury that refuses to heal, leaving you in a state of fear and discomfort. The last thing you should be worrying about is if your insurance will cover this expensive treatment. Medicare and Medicare Advantage are two plans many Americans over 65 have, but this does not mean they offer the same coverage. It’s important to learn how each of these widely accepted insurance plans covers or doesn’t cover chronic wound care expenses. This way you can ensure you have a plan that fits your needs.

Understanding Chronic Wound Care Needs

As we age, sometimes our bodies are unable to heal wounds as well as they used to. These are known as chronic wounds and can occur for several reasons like surgery or injury. They can come in several forms like diabetic ulcers or pressure sores. These wounds are also sensitive, so it’s important to get a medical professional involved to clean and redress the wound on a regular basis. This way you ensure your wound is being treated by a trained eye that is continuously monitoring it and will be able to act fast if it gets worse. Keep in mind that your specific chronic wound care needs will affect which health insurance works best for you.

Medicare Coverage for Chronic Wound Care

Medicare is a government-run health insurance plan for people over the age of 65 and offers a wide range of coverage. Each part of this insurance plan offers different benefits, restrictions, and costs. It’s important to understand all your options so you can ensure your necessary wound care is covered.

Coverage

Medicare is made up of two parts which cover different healthcare services. Part A covers inpatient hospital services like surgery, hospice care, and at-home healthcare. Part B covers outpatient medical services like preventative, diagnostic, and treatment operations. Depending on whether you start receiving wound care as an inpatient or an outpatient, either part of Medicare could cover it.

An important part of wound care and wound care coverage is the supplies used to treat the injury. Part B in Medicare covers Durable Medical Equipment (DME) which includes the supplies needed to treat your chronic wounds. These supplies include primary dressings like sterile gauze pads or hydrogel dressings, and secondary supplies like bandages or adhesive tape. However, these treatments need to be prescribed by a healthcare professional to be covered by Medicare. Items that you can buy on your own like antibiotic ointment and everyday bandages would not be covered in this plan.

Costs

According to the Centers of Medicare and Medicaid Services, there is no premium for Medicare Part A, though there is an estimated $1,632 annual deductible toward wound care specifically. After you’ve met the deductible, you will enter a period where you don’t have to pay anything for these wound care services. The amount of time will depend on whether you’re in a hospital, skilled nursing facility, or recovering at home. But after this time is up, you’ll have to pay a daily co-insurance rate.

On the other hand, Medicare Part B requires you to pay a monthly premium of about $174.70 and deductible of $240 for outpatient wound care. After you’ve met the deductible, you will have to pay 20% of the approved cost for your wound care. Now that you understand the benefits and cost of Medicare for chronic wound care you can look at your own needs and finances to determine if this insurance plan is right for you.

Medicare Advantage Coverage for Chronic Wound Care

Unlike traditional Medicare, Medicare Advantage, or Medicare Part C, is offered by private insurance companies instead of the government. As a result, its coverage isn’t standardized so its benefits and cost will depend largely on the private insurance company and the healthcare providers in your area.

Coverage

Medicare Advantage covers inpatient and outpatient services as well as prescription drugs, dental, vision, hearing, and fitness services. It’s important to note though that these offerings are subject to the private insurance provider. Medicare Advantage also isn’t accepted by nearly as many healthcare providers as traditional Medicare, which could cost you more money if you require an out-of-network specialist to look at your chronic wound.

Because Medicare Advantage isn’t as standardized as traditional Medicare, you would need to speak with your insurer to understand how many services are covered and by how much. This plan can offer transportation to doctor’s appointments, meal benefits, and some in-home support and care, but only if the providers are in your network. Furthermore, because Medical Advantage plans are owned by private insurance companies, they are usually only able to offer services in their local area and how big that is varies. However, most Medicare Advantage plans do not cover any chronic wound care.

Costs

Due to Medicare Advantage’s privately owned nature there are no standard premiums, deductibles, or other costs. This also almost never covers wound care, so while you may receive additional services with this plan, you still miss out on a lot of other benefits. To understand the full scope of how much your individual plan costs and how much it offers though, you need to speak with your insurance agent to get an accurate quote.

Start Your Chronic Wound Care with Reneuvia Today

While Medicare and Medicare Advantage help people in similar ways, they still have their unique differences. As a patient it’s important for you to know which health insurance plan will best fit your individual chronic wound care. You must consider factors like accessibility, in-network healthcare providers, financial costs, and coverage options. Every person is different, which is why you must look at each plan carefully to determine which will work best for your needs.

Reneuvia is here to help home health agencies and long-term care facilities provide chronic wound care to patients and encourage their healing. If you’re in the Southern Iowa or Northern Missouri area and are enrolled in the traditional Medicare plan our chronic wound care services are covered. Refer a patient or enroll yourself today and start receiving the quality wound care you deserve!