"Covered by insurance" rarely means free. Most plans share the cost of compression garments and pumps with the patient through a deductible, coinsurance or copay. Knowing these terms helps patients plan ahead and avoids surprise bills. Therapists can share this page with patients who have questions about cost.
Key terms
Premium: The monthly amount paid to keep insurance active. It doesn't count toward the costs below.
Deductible: The amount the patient pays each year before insurance starts paying its share.
Coinsurance: The percentage of the cost the patient pays after the deductible is met, such as 20%.
Copay: A flat fee for a service, such as $30. Some plans use copays instead of coinsurance.
Out-of-pocket maximum: The most a patient pays in a plan year. After that, the plan pays 100% of covered costs.
Allowed amount: The price the insurance company agrees to pay for an item. Coinsurance is based on this amount.
How they work together
The deductible comes first, then coinsurance, until the out-of-pocket maximum is reached. Deductibles usually reset each January, so timing matters.
Example (sample numbers only): A patient's plan has a $500 deductible and 20% coinsurance. The allowed amount for their garments is $1,000, and they haven't paid anything toward their deductible this year.
The patient pays the first $500 to meet the deductible.
The remaining $500 is split: insurance pays 80% ($400) and the patient pays 20% ($100).
The patient's total is $600. Insurance pays $400.
If the same patient had already met their deductible earlier in the year, they would pay only 20% of $1,000, or $200.
Medicare and secondary insurance
Medicare Part B covers compression garments for lymphedema and prescribed pneumatic compression pumps. After the yearly Part B deductible, Medicare usually pays 80% of the allowed amount and the patient pays 20%.
Secondary or supplemental insurance (Medigap or a second plan) often picks up some or all of that 20%.
Medicare Advantage plans set their own deductibles, copays and prior authorization rules, so costs vary by plan.
Medicaid may cover remaining costs for patients who qualify.
Tips for patients
Ask for a cost estimate before ordering. A good supplier checks benefits first and explains what you'll owe.
Check where you are on your deductible. Your insurance card has a member services number, and many plans show this online.
Think about timing. If you've already met your deductible this year, ordering before it resets may lower your cost.
Know about prior authorization. Some items, especially pumps, need insurance approval before they're ordered.
Ask about payment options if you're worried about cost.
How Midwest Compression can help
We verify each patient's benefits before ordering anything and give a written estimate of what they'll owe. For pumps, we handle the prior authorization paperwork with the prescribing provider. Therapists and patients can reach us at customersupport@midwestcompression.com or 800-883-1549.
This article is general information, not financial or legal advice. Coverage and costs depend on each patient's plan.
