Adjusting to life with an ostomy can be challenging, both physically and financially. From finding the right pouching system to managing daily care, it often takes time, patience and the right supplies to feel comfortable and confident. The cost of ostomy supplies — pouches, skin barriers, adhesives, deodorants — can add up quickly, especially because they need to be replaced regularly. The good news is that Medicare does help cover many of these essential items.
What Is an Ostomy?
An ostomy is a general term for any surgical opening that diverts bodily waste.
“It is a lifesaving surgery where a new opening on the abdomen wall, called a stoma, is made to allow bodily waste like urine or stool to exit into an external prosthetic pouch. Stomas may be permanent or temporary. You can still live a very healthy and active life with an ostomy,” says Linda Coulter, an ostomy nurse and director-at-large at the United Ostomy Associations of America in Biddeford, Maine.
The most common conditions that can lead to an ostomy are:
— Bladder disease. If the entire bladder is removed from cancer or other injury, surgeons create a urostomy to allow urine to drain into an external pouch.
— Colon or rectal cancer. An ostomy is needed if colorectal cancer requires part of the bowel or rectum be removed or bypassed during surgery.
— Congenital conditions. Some people are born with defects in their digestive or urinary systems that make an ostomy necessary.
— Diverticulitis. Severe or recurrent inflammation or infection in the colon can require removal of the damaged sections.
— Inflammatory bowel disease. Conditions such as Crohn’s disease or ulcerative colitis can severely damage parts of the intestine, making an ostomy a necessity.
— Trauma or injury. Abdominal injuries may make normal bowel or urinary function impossible.
[Read: A Patient’s Guide to Digestive Diseases.]
Types of Ostomies
| Ostomy Type | Purpose/Location | Is It Permanent or Temporary? | What It Diverts |
| Colostomy | Diversion for stool made when part of the colon or rectum is removed, damaged or needs time to heal | Can be temporary or permanent | Stool (feces) |
| Ileostomy | An opening created from the ileum (lowest part of the small intestine) | Can be temporary or permanent | Waste from the small intestine |
| Urostomy | Diverts urine away from a diseased or defective bladder | Always permanent | Urine |
[READ: Everything You Need to Know About Colorectal Surgery.]
What Does Medicare Cover?
Most ostomy supplies are covered under Medicare Part B (medical insurance) as durable medical equipment. That means your doctor must prescribe them as medically necessary, and you’ll need to get them through a Medicare-approved supplier.
“Original Medicare typically covers 80% of the cost of ostomy supplies, while the insured individual pays for 20% of the cost. Medicare will generally cover up to 20 drainable pouches for ileostomy, 20 urinary pouches for urostomy and 60 closed-end pouches for colostomy,” Coulter says.
Medicare.gov also notes that you may need to meet the Part B deductible first before you pay just 20% for the cost of supplies.
[READ: What Medicare Does Not Cover.]
Medicare Coverage for Supplies
| Supply Type | Quantity Covered 80% by Original Medicare Part B |
| Drainable pouches | Up to 20 per month (for ileostomy) |
| Urinary pouches | Up to 20 per month (for urostomy) |
| Closed-end pouches | Up to 60 per month (for colostomy) |
| Other supplies | Covered as medically necessary for wafers/skin barriers, pastes, deodorants and belts |
If you have a Medicare Advantage plan, check your benefits to see what your requirements, restrictions and out-of-pocket costs may be.
What Supplies Do You Need?
Managing an ostomy involves more than just changing a pouch. It’s about maintaining comfort, skin health and confidence each day. Having the right supplies makes a big difference in how daily care is managed.
“Ostomy patients should work with an ostomy nurse to help find the best pouching system for them. There is not a one-size-fits-all solution for ostomy supplies. Sometimes it takes trial and error to find the best supplies for each person’s body,” Coulter says.
Depending on the person and stoma type, common supplies include:
— Barrier rings, pastes and removers. Barrier — also called adhesive — rings and pastes are used to help secure an ostomy pouching system and protect the surrounding skin. Barrier removers help make the removal process of the pouching system painless and residue-free.
— Belts or wraps: These provide support and help keep the pouch in place. Belts are adjustable elastic bands that fasten to the flange to provide additional stability for the pouching system. A wrap is worn around the abdomen to conceal the pouch and provide gentle, secure compression to keep the appliance flat against the body.
— Deodorants, cleansers and skin protectant wipes. These are used to control odor, protect skin health and maintain hygiene.
— Pouches (ostomy bags). Pouches collect the waste from the stoma. They can be disposable or drainable one-piece or two-piece systems. “The pouch must be right for the type of stoma. For example, do not use a urostomy pouch for a colostomy stoma. Stoma characteristics such as size and protrusion will also affect pouch choice,” Coulter says.
— Wafers. Also called skin barriers or flanges, wafers are the adhesive component of an ostomy pouching system that sticks directly to the skin around the stoma. They protect the skin from irritation and attach the pouch securely. A wafer extender is a flexible adhesive accessory used to reinforce the edges of the ostomy wafer.
“It’s critical to have the right supplies so that the pouch fits well and provides a reliable seal to prevent leakage,” Coulter says. “Leakage can cause painful skin breakdown and loss in confidence or fear of embarrassment. People living with stomas should feel confident to work or attend social events and be with loved ones and friends.”
Bottom Line
An ostomy is a surgical opening in the abdomen that diverts bodily waste through a stoma, a small opening on the surface of the skin where a pouch is typically worn to collect waste. Ostomy supplies are essential for maintaining comfort, hygiene and quality of life while helping people manage waste safely and resume daily activities after surgery. Original Medicare pays for many ostomy supplies under Part B. If you have a Medicare Advantage plan, check to see what your benefits and out-of-pocket expenses may include. With the right supplies and coverage in place, living comfortably and confidently with an ostomy is absolutely possible.
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Does Medicare Cover Ostomy and Colostomy Supplies? originally appeared on usnews.com
