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. This means it is not appropriate to share the item for hygienic reasons). While home care supplies are intended to serve a medical purpose, a prescription is not usually reget to obtain them. Home care supplies are also referred to as consumable medical supplies. They should be distinguished from durable medical equipment, which is always intended for repeat usage. As examples, home care supplies include items such as:
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 $80 – $300 / month. Diabetic supply spending varies with the type of diabetes; most seniors spend between $280 – $500 / month. Ostomy supply spending averages between $75 – $125 / month.
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 the specific brand is medically necessary. For example, an individual may require a high capacity, adult diaper. And if so, the prescription should specify “adult diapers with a minimum absorbency of 75 ounces such as those provided by brand X.”
Original Medicare does not cover adult diapers, but does cover some other incontinence products.
As Original Medicare, frequently simply called “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.
(MA) Plans, also called Medicare Part C, offer an alternative way to receive Original Medicare. These plans allow persons to receive all of their Original Medicare benefits, plus supplemental benefits, such as hearing and dental services, via private insurance companies. In addition to the coverage of ostomy and diabetic supplies, which are covered by Original Medicare, some MA plans also provide coverage of other home care supplies, such as adult diapers. MA plans, and their coverage of supplemental benefits, vary based on the state in which one resides and the specific plan. So it is vital persons do their research if seeking a plan that covers specific consumable medical supplies.
Medicare Supplemental Insurance, also referred to as Medigap Coverage, is intended to help Original Medicare beneficiaries with deductibles and co-payments. This type of coverage does not typically add new areas of coverage. For example, Medicare does not pay for adult diapers, therefore Supplemental Insurance Plans do not either. However, because Medicare pays for 80% of diabetic and ostomy supplies, Medigap plans will cover the remaining 20% for participants. As a side note, persons enrolled in Medicare Advantage plans are not eligible for Medicare Supplemental Insurance Plans.
Medicaid has much more generous benefits than Medicare with regards to home care supplies. Before this discussion, it is 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 while these home care supplies may be available through a state’s regular Medicaid program, they often are made available through HCBS (Home and Community Based Services) Medicaid Waivers. In addition, Medicaid puts restrictions on which brands are covered and sometimes limits the maximum number of products per month. Again, this is state dependent and Medicaid program dependent.
The VA pays for home care supplies including incontinence supplies provided the items are medically necessary.
VA Pensions, specifically the Aid and Attendance (A&A) and Housebound pensions, do not pay for home care supplies directly. But indirectly, the complete cost can be reimbursed. These pensions provide veterans with financial assistance up to a minimum monthly income level. It is calculated by subtracting their actual income and any unreimbursed medical expenses. Under A&A and Housebound, home care supplies, including incontinence supplies, are considered unreimbursed medical expenses (UME). A veteran receiving either of these pensions simply needs to include the cost of these items on their application and the VA will reimburse them by increasing their pension benefit in an equal amount. Read more about VA Pensions.
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 supplies. The website, Needymeds.org, offers a searchable database of PAPs and also lists programs specifically for diabetic supplies.
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 type of home care product regardless of if a prescription is required.
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.
For those individuals whose insurance does not pay the total cost of their home care supplies, and for those supplies that are paid for out-of-pocket, there is good news. 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.
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 35% – 75% can be found over one’s local pharmacy. Should one purchase online, we recommend DiscountMedicalSupplies.com with whom we have partnered. The organization is noted for their inexpensive pricing and excellent customer service.