Paying Options and Financial Assistance for Home Care Supplies

Page Reviewed / Updated - Jan. 2014

Home Care Supplies Definition

When considering paying for home care supplies, it is helpful to have a clear definition of what is and is not considered to be a home care supply. Supplies are generally but not always disposable. If they are designed for repeat use, their usage is limited to a single individual. While they are intended to serve a medical purpose, a prescription is not always required to obtain them. Home care supplies are also referred to as consumable medical supplies and should be distinguished from durable medical equipment which is always intended for repeat usage. Home care supplies include items such as adult diapers and other incontinence and urological supplies, ostomy bags and accessories and diabetic test strips and lancets.

 

Cost of Home Care Supplies

There is a great deal of variation in the monthly spending on home care supplies; this depends on the individual, the type of supplies and of course where they choose to make their purchases. Typical monthly spending on adult diapers and other incontinence supplies is between $100 - $250 / month. Diabetic supply spending varies with the type of diabetes; most seniors spend between $50 - $150 / month. Ostomy supply spending averages between $50 - $100 / month.

 

Prescriptions and Home Care Supplies

 When seeking insurance coverage of home care supplies, it is helpful if not essential to have a prescription.

Almost all home care supplies can be purchased without a prescription. However in the hope of having insurance cover the cost of the supplies, it is useful, if not essential, to have a prescription or a statement of medical necessity from a licensed medical profession. If a specific brand of item is of importance, the statement should include the reason(s) for which a particular brand is medically necessary.

Insurance Benefits for Home Care Supplies

Medicare and Home Care Supplies

 Medicare does not cover adult diapers, but does cover some other incontinence products.

As Medicare is the most common health insurance program for elderly Americans, it is worthwhile to discuss Medicare's benefits and coverage for home care or disposable medical supplies. Medicare's coverage is specific to the individual and the type of home care supply. Adult diapers are not paid for by Medicare but ostomy supplies are covered at 80% after the deductible is met. This is provided the individual has a written prescription or can otherwise justify the need for the supply. Medicare Part B and Part D combined pay for approximately 80% of the cost of most diabetic supplies including test strips, lancets, syringes and needles.

 

Medicare Supplemental Insurance and Advantage Plans

These types of insurance are designed more to help beneficiaries with the deductibles and co-payments associated with Medicare; they do not typically add new areas of coverage. For example, Medicare does not pay for adult diapers, therefore Advantage and Supplemental Plans do not either. However, because Medicare pays for 80% of diabetic and ostomy supplies, these plans will cover the remaining 20% for participants.

Medicaid and HCBS Waivers

Medicaid has much more generous benefits than Medicare with regards to home care supplies. Prior to a discussion it may be helpful to distinguish between the two programs. Medicare is a federal health insurance program open to all Americans over 65. Medicaid is a state-specific program specifically intended for low income individuals who also have limited financial assets. Like Medicare, Medicaid will pay for ostomy and diabetic supplies, but unlike Medicare, Medicaid also pays for adult diapers and other incontinence supplies in most states. It is worth noting that Medicaid puts restrictions on which brands are covered and sometimes limits the maximum number of products / month. Again, this is state dependent.

Veterans Administration Health Care

The VA pays for home care supplies including incontinence supplies provided the items are medically necessary.

Other Financial Assistance for Home Care Supplies

Patient Assistance Programs (PAPs)

PAPs are programs that pharmaceutical companies offer to individuals without insurance or without adequate prescription coverage in their insurance policies. Some home care supplies are covered by PAPs. One is much more likely to find assistance for diabetic supplies than they are for ostomy or incontinence. The website Needymeds.org offers a searchable database of PAPs and also lists programs specifically for diabetic supplies.

 Learn more about paying for adult diapers and other incontinence supplies specifically.

Discount Drug Cards

Discount drug cards were initially intended to help individuals who did not have insurance or were under-insured by reducing the purchase price of their prescription drugs. In recent years, the products on which card holders can receive discounts has greatly expanded and now includes over the counter medications and many types of home care supplies. Purchasers paying out-of-pocket for home care supplies should always present their card and ask for a discount on any types of home care product regardless of if a prescription is required.

 The non-profit organization NeedyMeds.org provides seniors with a free discount drug card.  It is widely accepted and unique in that they do not collect and sell the personal information of individuals using their cards.

Coupons / Samples

For certain types of disposable home care supplies, there are coupons and free samples available. Seniors are especially likely to find discounts on diabetic and incontinence supplies. A list of coupons organized by company name is available here. Some common manufacturers of diabetic and incontinence supplies include: ACCU-CHEK, Astra Tech, ConvaTec, Depend, Dignity, Kendall, Prevail, Tena and Tranquility.

Tax Deductibility

For those individuals whose insurance does not pay the total cost of their home care supplies and for those supplies which are paid for out-of-pocket, there is good news in that the complete cost of home care supplies are tax deductible. There are two relevant tax credits and deductions that apply. Most commonly used is the tax deduction for medical and dental expenses. Less common but equally beneficial is the tax credit for elderly dependent care.

 

Shopping Online

The unfortunate reality is that for most seniors, many home care supplies are paid for out-of-pocket. Fortunately the need for home care supplies is very predictable. Both the type of item and the quantity can be determined well in advance of the need for the item. This makes shopping online a very good option for purchasing in bulk and discounts of 50% - 80% can be found over one's local pharmacy. Should one purchase online, we recommend TotalHomeCareSupplies.com who are noted for their inexpensive pricing, excellent customer service and free shipping offers.