December 26, 2023
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:
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:
2. Garment Details:
3. Medical Justification:
4. Doctor Information:
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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