Insurance coverage

Get your ostomy supplies
covered by insurance

Most insurance plans cover ostomy supplies — but navigating the system is confusing. Here's exactly what you're entitled to and how to get it.

What does insurance cover?

Coverage varies by plan but most major insurance types cover ostomy supplies under durable medical equipment (DME).

🏛️
Medicare Part B
80% covered
Medicare covers ostomy supplies under the DME benefit. You pay 20% after your deductible is met.
  • ✓ Pouches, barriers, skin care products
  • ✓ No prior authorization needed
  • ✓ Must use Medicare-approved supplier
  • ✓ Monthly supply limit applies
🏥
Medicaid
Up to 100%
Medicaid coverage varies by state but most states cover ostomy supplies at low or no cost to you.
  • ✓ Often covers 100% with no copay
  • ✓ Coverage varies by state
  • ✓ Requires a prescription from your doctor
  • ✓ May require prior authorization
💼
Private Insurance
Varies
Most private plans cover ostomy supplies as DME. Coverage amount depends on your specific plan.
  • ✓ Check your plan's DME benefit
  • ✓ Usually requires a prescription
  • ✓ In-network suppliers cost less
  • ✓ Appeal denials — you often win
🎖️
VA Benefits
100% covered
Veterans with service-connected conditions receive full ostomy supply coverage through the VA.
  • ✓ Full coverage for eligible veterans
  • ✓ Supplies mailed directly to your home
  • ✓ Contact your VA prosthetics department
  • ✓ No out-of-pocket cost

How to get your supplies covered

Follow these steps to start getting your supplies covered. Most people can get set up within a week.

1
Get a prescription from your doctor
Ask your doctor or ostomy nurse for a written prescription for ostomy supplies. It should specify the type of supplies, quantity, and that they're medically necessary. This is required by all insurance plans.
💡 Ask for a 12-month prescription to avoid reordering paperwork every month
2
Find an approved supplier
Your insurance plan has a list of approved DME suppliers. Using an in-network supplier is critical — out-of-network suppliers may not be covered at all. Call the number on the back of your insurance card to get a list.
💡 Many suppliers handle the insurance billing for you
3
Submit your claim
Give your prescription and insurance information to the supplier. Most suppliers will bill your insurance directly. For Medicare, your supplier must be Medicare-enrolled and will file the claim on your behalf.
4
If denied — appeal immediately
Insurance denials are common and very often overturned on appeal. Get a denial letter, ask your doctor to write a medical necessity letter, and file an appeal. Most appeals for ostomy supplies succeed.
💡 You have the right to appeal any denial. Don't give up on the first no.

Common questions

Answers to the questions we hear most often.

How much will I actually pay out of pocket? ›
With Medicare Part B, you typically pay 20% after your deductible. With supplemental insurance (Medigap), your out-of-pocket may be zero. Private insurance varies widely — call your insurer and ask specifically about your ostomy supply benefit and what your copay or coinsurance will be.
What if my insurance doesn't cover enough supplies? ›
Insurance plans have monthly allowances that may not match what you actually need. In that case, you can supplement with manufacturer coupons, GoodRx pricing, or buy extras from the Gutsy Care peer marketplace at a fraction of retail cost.
Can I use insurance and buy extras on Gutsy Care? ›
Yes. Your insurance covers your base monthly supply. Gutsy Care is for anything beyond that — extra supplies, trying different brands, or buying from other users who have more than they need. The two work together perfectly.
Do I need a new prescription every year? ›
Most insurance plans require a prescription renewal every 12 months. Ask your doctor to write a 12-month prescription so you're covered for the full year without multiple appointments.
What if I'm uninsured? ›
Check if you qualify for Medicaid — income limits vary by state. Also explore manufacturer patient assistance programs (see our Coupons page), GoodRx pricing, and the Gutsy Care peer marketplace for the lowest possible out-of-pocket costs.
Still paying too much?
The marketplace is coming.
Even with insurance and coupons, some months you need more supplies than your plan allows. Join the waitlist to be first when the Gutsy Care marketplace launches.
Join the waitlist →