Will Medicare pay for an ostomy nurse?

2 answers | Last updated: Oct 18, 2016
Rose45 asked...

My mother lives alone in senior housing and has big problems with her urine bag that leaks all the time. She changes types all the time due to leakage. She has medicare, does not qualify for low-income assistance, but has huge hernias where the flange should go. Will Medicare pay for a ostomy nurse to come three days a week to help her????


Expert Answers

Medicare Part B home care coverage is extremely limited and probably will not cover regular visits from a nurse for any length of time. But it may cover a few short-term visits from a nurse from a home care agency who can show your mother how to properly and comfortably use her ostomy equipment and supplies. Even if your mother does not qualify for Medicare coverage of full home care from an agency, Medicare could cover one or two visits from a nurse, to show her how to use the equipment, if prescribed by her treating physician.

Medicare Part B home care coverage is available to people who need skilled nursing care when they are confined to home while recovering from an illness, injury or treatment. If your mother is confined to home and is still recovering from the surgery or condition which left her using ostomy, then Medicare Part B could cover ongoing care for a few weeks from a home care agency, if prescribed by her doctor. Also, if she receives treatment for the hernias and is then confined to home, she could receive regular home care visits from a Medicare-paid home care agency while she is recovering. If, instead, this is an ongoing problem but she is no longer recovering from the surgery and is not confined to home, then her doctor would have to write a prescription for a visiting nurse. Or, the doctor could prescribe a visit to an outpatient clinic or other facility where they would teach her how to use her ostomy equipment.

In any of these situations, Medicare Part B can provide coverage, but it all depends on the cooperation and participation of your mother's doctor. Schedule an appointment for her with her treating physician. At that appointment, the doctor should consider the problem of the hernias and be told about the problems your mother is having with her ostomy equipment, then prescribe the proper level of treatment "“ either care from a nurse or a home care agency, or referral to an outpatient facility. The doctor should be reminded that it must be a level of care that Medicare Part B will cover. Once your mother has a prescription from the doctor for the proper level of treatment, Medicare Part B is likely to cover it.


Community Answers

A fellow caregiver answered...

Note that if a patient is not homebound, Medicare will not pay for care from a visiting nurse, even with a prescription from a doctor. Homebound status indicates that the patient needs the assistance of a person or device to leave the home, typically leaves only for medical appointments, and absences from the home for non-medical purposes are generally: * less than once a week * are of short duration, and * do not indicate an ability to receive the needed service routinely as an outpatient.