Some non-Medicare insurance plans do provide coverage for compression supplies.
State Mandated Coverage: If you have a private insurance plan based in CA, LA, MD, NC, or VA, state law requires, either directly or indirectly, that these plans provide coverage for compression supplies! It is not uncommon, however, for individuals protected by these state mandates to still receive denials. If you have a plan based in one of these states and are still not getting coverage, see the below paragraph on dealing with denials.
Private Insurance Coverage: Unless your plan is based in one of the above states you will have to consult your individual policy documents. It is not unusual for a plan that covers compression garments for lymphedema to still issue an initial denial. And unfortunately, private insurers are increasingly following Medicare coverage guidelines, so many do not provide coverage for compression supplies. The exception is for breast cancer-related lymphedema in women, who are usually afforded coverage thanks to the Women’s Health and Cancer Rights Act of 1998.
State Medicaid Coverage: 47 states plus the District of Columbia cover, or at least partially cover, compression supplies under their state Medicaid plan. To see which states and find links to their coverage policies click here.
Federal (Non-Medicare) Coverage: Tricare, Veterans Affairs, and Federal BCBS plans also cover, or at least partially cover, compression supplies. For links to more information click here.
Dealing With Non-Medicare Denials: Don’t take “no” for an answer! We encourage you to fight every denial. It’s very helpful to enlist the help of your State Department of Insurance. I have personally done this numerous times and have always found my insurance company to be far more responsive as a result. An example from my state’s site is here. If you have a plan based in one of the above states with mandated coverage make sure to include that information, as your insurance company and the Department of Insurance may not be aware of that law. Additional advice on how to approach your appeal is here.
Dealing With Medicare Denials: Again, we strongly encourage you to appeal! Even though it will not be precedent setting, it is possible to win appeals on a case-by-case basis. A great resource for helping you to navigate this process is here.
The above information is accurate to the best of our knowledge. Policies change yearly, however, and if you have information that is contrary to or in addition to what we have shared here please do let us know. We are an all-volunteer group and cannot assist with individual appeals, but if you have a general question we will do our best to provide a timely answer whenever possible.
Heather Ferguson
Founder & Executive Director
Lymphedema Advocacy Group
LymphedemaTreatmentAct.org
