Insurance 101: Medicare
Our Insurance 101 blog series aims to help you understand the basics of how your insurance policy covers products from Feminine Forms, prepare you to use your insurance policy to cover your needs, and give you the information you need to advocate for yourself with your insurance company. This post will explain general information about how Medicare relates to our process at Feminine Forms.
Medicare is a government-sponsored health insurance program in the United States. It primarily serves individuals who are 65 years old or older, as well as certain younger people with disabilities. Medicare aims to provide essential health coverage for seniors and certain individuals with disabilities, helping them access necessary medical services and prescription medications.
Some Medicare customers may have a Medicare Advantage plan. It's offered by private insurance companies approved by Medicare. Medicare Advantage offers an alternative way for individuals to receive their Medicare benefits, often with added features and potentially lower out-of-pocket costs. We work with many Medicare Advantage plans. We will file with Medicare and with your Advantage plan to maximize your benefits and minimize your out of pocket costs.
Feminine Forms is Medicare accredited in Medicare Region D. Being "Medicare accredited" means that a healthcare provider or facility has met specific quality and safety standards set by the Centers for Medicare & Medicaid Services (CMS). This accreditation is necessary for providers to participate in the Medicare program, ensuring they deliver high-quality care to Medicare beneficiaries. It involves ongoing monitoring and compliance with established standards, allowing providers to receive reimbursement for the services they offer to Medicare-covered individuals.
Medicare has a very standardized process of covering products related to breast cancer, mastectomy, and recovery. Because of the standardization, we can confidently tell our Medicare customers what products will be covered and at what rate.
Deductible and coinsurance: Medicare has two portions of annual deductibles. Durable Medical Equipment (DME) falls into part B. As of January 2023, the annual deductible for part B is $226. In January 2024, it will be $240. Once you have exceeded the deductible, the coinsurance rate is 20%, so you will then pay 20% of the cost of your products. Because we can check your current deductible amount and know the coinsurance rate, we can predict exactly how Medicare will cover your products. Therefore, we usually collect the out-of-pocket payment amount from Medicare customers before they leave the store. We then file the claim directly with Medicare.
Covered products: The following products are considered “medically necessary” and are therefore covered by your Medicare insurance policy.
Post surgical camisoles: Following your mastectomy, Medicare will cover two post surgical camisoles. These are considered necessary because they have pockets to hold drains after surgery. They also have a zip up front for easy use, breast pockets for lightweight puffs, and soft fabric to reduce possible irritation.
Breast prosthesis: Medicare policies will cover one breast prosthesis per mastectomy side within the warranty period of the product. We carry two types of breast prosthesis - silicone prostheses for all day, everyday comfort and active form prostheses specially made for exercise and swimming. Silicone prostheses are covered every two years and active form prostheses are covered every six months. Medicare will cover one of those options. We usually recommend getting a silicone prosthesis covered by insurance and paying for an active form out of pocket.
Pocketed bras: All of our bras have pockets to hold breast prosthesis and come from the highest quality vendors. Because these bras are needed to use breast prostheses, they are deemed “medically necessary.” It is important that your bras are in good condition to hold the prostheses securely to your chest wall, so Medicare covers up to 3 to 4 bras every 4 to 6 months. While this may be more frequent than you are used to buying new bras, we highly recommend replacing your bras frequently so they are as supportive as possible. Medicare will cover our $49 bras in accordance with Medicare’s cost allowance for bras (if you choose one of our more expensive bras, you can pay the cost up front and we file them to Medicare ‘non-assigned’ so your bra benefit amount is sent directly to you.)
Not-covered products: wigs, custom breast prostheses, swimsuits, hats and headcovers
The process at Feminine Forms with a Medicare insurance policy is basically the same as with any insurance policy. Make sure to bring your Medicare card (and/or any Advantage plan cards or secondary policies) so we can confirm all your information and get a copy of your card. Because we can easily confirm your deductible status and Medicare has a standardized co-insurance rate, we will usually have you pay your out of pocket costs before you leave the store.
Many of our customers are Medicare beneficiaries, we work with Medicare regularly and are prepared to help you figure out all of the benefits you can enjoy with your Medicare policy.
