Medity Health

December 26, 2023

The Lymphedema Treatment Act (LTA), signed into law in 2023, marked a significant turning point for millions of Americans living with lymphedema. This groundbreaking legislation introduced Medicare coverage for compression garments for people who are treating lymphedema.

Let's delve into the specifics of what garments are covered, how many garments are covered and more to help you prepare for 2024.

All Medicare recipients with a diagnosis of lymphedema are covered under the Lymphedema Treatment Act (LTA), which was signed into law in 2023 as part of the Consolidated Appropriations Act of 2023. This is regardless of:

• Age: All Medicare beneficiaries, regardless of age, are eligible for coverage if they meet the other requirements.

• Medicare Part: Coverage applies to both Medicare Part A (hospital insurance) and Medicare Part B (outpatient medical insurance).

• Type of lymphedema: The LTA covers all types of lymphedema, including primary lymphedema, secondary lymphedema, and lipedema.

The LTA offers comprehensive coverage for a wide range of compression garments, catering to individual needs and treatment plans. Here's a breakdown:

• Ready-to-wear garments: These come in various sizes and are readily available for purchase, catering to individuals with typical body shapes.

• Custom garments: For those with unique body shapes or specific needs, custom-made garments offer a perfect fit, maximizing treatment effectiveness.

• Nighttime garments: Designed for overnight wear, these garments help maintain reduced swelling achieved during the day and prevent fluid buildup while sleeping.

• Compression wraps: Offering temporary compression, these wraps can be used for targeted relief or during situations where wearing full garments might be impractical.

• Accessories: The LTA also covers essential accessories like donning and doffing aids, liners, zippers, padding, and fillers, making it easier to wear and manage the garments.

The LTA will also cover garments from the top manufacturers in the industry, including: Juzo, Sigvaris, Jobst, L&R, and Medi. So, you will still receive the same high-quality garments that you expect to help with your lymphedema.

While the Lymphedema Treatment Act (LTA) doesn't specify a precise number of garments covered, it defines some general guidelines:

Daytime Garments:

• 3 garments per affected body part every 6 months.
• This means if you have lymphedema in both arms, you'd receive 3 garments for each arm (total of 6 garments) every 6 months.
• Garments can be standard-fit or custom-fit, or a combination of both.

Nighttime Garments:

• 2 sets (one garment for each affected body part) per 2 years.
• Similar to daytime garments, the number doubles if you have lymphedema in both arms.
• Nighttime garments can also be standard-fit, custom-fit, or a combination.

Additional Points:

• The LTA allows for replacements if garments are damaged or lost within the covered timeframe.
• It's always best to consult your doctor or healthcare provider for an accurate assessment of your needs and how the LTA applies to your individual case.

To have your compression garments covered under the Lymphedema Treatment Act, you'll need to have a prescription from a doctor for your compression garments. On the prescription, make sure you have the following details to ensure that your garments will be covered:

1. Lymphedema Diagnosis:

• Clearly state the diagnosis of lymphedema, mentioning the type (primary, secondary, lipedema etc.) and affected body part(s).

2. Garment Details:

• Specify the type of garment needed (stockings, sleeves, wraps, pumps etc.) and the number of sets required (daytime and/or nighttime, as per your doctor's recommendation).
• Mention the compression level prescribed (mild, moderate, high etc.) based on your individual needs.
• Indicate any specific features needed, like open toes, zipper closures, or padding, for optimal comfort and functionality.

3. Medical Justification:

• Briefly explain why compression garments are medically necessary for managing your lymphedema. You can mention the expected treatment benefits, like reducing swelling, improving mobility, or preventing further complications.

4. Doctor Information:

• Include your doctor's full name, signature, and contact details, including their National Provider Identifier (NPI) number.

5. Date:

• Ensure the prescription has the current date to validate its recent issuance.

For anyone who is covered under traditional Medicare (not a Medicare Advantage plan) — these supplies will be covered under Part B, so the annual Part B deductible and 20% coinsurance will apply to your compression supplies.

As for the deductible, in 2024, the Medicare deductible will be $240 (an increase from $226 in 2023). Once you’ve met the $240 deductible for Medicare, you’ll only be responsible for 20% of the cost of your compression garments (e.g. if you buy $100 of garments and you’ve hit your deductible, you’ll pay $20 and Medicare will cover the rest).

For Medicare Advantage and all other types of insurance — out-of-pocket costs will vary depending on the specific terms of your plan. It is likely that your compression supplies will be subject to the same copay and deductibles as supplies covered under the DMEPOS (Durable Medical Equipment, Prosthetic and Orthotic Supplies) section of your policy.

We continue to get more information about the Lymphedema Treatment Act, so we will continue to update this article throughout the next few months as we learn more. If you have any questions, don't hesitate to reach out to us, and we'd be more than happy to help answer questions in any

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