Medicare's coverage for PureWick external catheters: A clarification
Managing Incontinence Made Easier with PureWick
Say goodbye to the hassle of incontinence with innovative solutions like the PureWick system. Designed with women in mind, this system is perfect for those resting or sleeping, easing the burden of urinary issues.
The PureWick setup consists of an external catheter extending from the vulva to the buttocks, connected to a tube leading to a collection container. Place the container comfortably on a nightstand or table for convenience.
In a groundbreaking move, the Centers for Medicare & Medicaid Services (CMS) ruled in 2024 that Medicare can cover the PureWick system under the durable medical equipment (DME) benefit of Part B.
Sex, Gender, and Medical Devices
Remember, sex and gender exist across various spectrums. We'll use "male," "female," or both to refer to sex assigned at birth, shedding light on the terminology[5].
When Does Medicare Cover PureWick External Catheters?
Medicare Part B offers coverage for DME, which includes essential medical items such as oxygen supplies, walkers, and hospital beds. To qualify, you'll need a prescription from a Medicare-enrolled doctor or healthcare professional for home use[6].
DME can now include external catheters as alternatives to indwelling catheters for individuals with permanent urinary incontinence[7]. As of 2024, the PureWick system is included in this coverage, although Medicare won't cover the device if you already have an indwelling catheter. Also, for female catheters, Medicare limits usage to no more than one metal cup or pouch per week[6]. In a hospital setting, catheters are covered by Part A.
How Much Does Medicare Pay for PureWick?
Prices for PureWick catheters can vary. For instance, a box of 30 catheters costs approximately $209 out of pocket without insurance[8]. However, purchasing them in bulk could save you money.
In 2025, Medicare Part B enrollees will need to meet an annual deductible of $257 and pay a monthly premium of $185. Once these conditions are met, Part B will cover 80% of the approved treatments or services[9].
The Fine Print: Medicare Terms and Conditions
- Out-of-pocket Cost: The amount you pay for care when Medicare doesn't cover the entire amount or the service[10]. Costs may include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount you pay for Medicare coverage[10].
- Deductible: The annual amount you must spend out of pocket within a specific period before Medicare starts funding treatments[10].
- Coinsurance: The percentage of treatment costs you must pay out of pocket[10]. For Medicare Part B, the coinsurance is 20%.
- Copayment: A fixed dollar amount you pay for certain treatments when you have insurance[10]. In the case of Medicare, this usually applies to prescription drugs.
[1] https://www.cms.gov/center/factsheets/purewick-system[2] https://www.cms.gov/Medicare/Coverage/Find-a-Code/nationalcoverageanalysesearch/search.aspx?p_nca_search_term=PureWick[3] https://www.aarp.org/health/conditions-treatments/info-2022/purewick-system-urinary-catheter-for-women.html[4] https://www.senioradvisor.com/reviews/articles/medicare-cover-purewick-external-catheters-for-female-urinary-incontinence[5] https://www.HEADSUP.org/sex-and-gender/[6] https://www.cms.gov/Medicare/Coverage/Find-a-Code/nationalcoverageanalysesearch/search.aspx?p_nca_search_term=PureWick[7] https://www.ac%%%%%%%rans.org/managing-incontinence/catheters-drains-and-stents/external-catheters%20for-women[8] https://purewick.com/pricing/[9] https://www.medicaresupplement.com/blog/what-does-medicare-part-b-cost?rq=2025[10] https://www.medicare.gov/your-medicare-costs/glossary-of-medicare-terms/costs-glossary
- The innovative PureWick system, designed for women's health, is now covered under Medicare's Durable Medical Equipment (DME) benefit due to a ruling by the Centers for Medicare & Medicaid Services (CMS) in 2024.
- To qualify for Medicare coverage of PureWick external catheters, a prescription from a Medicare-enrolled doctor or healthcare professional is required for home use, and the individual must have permanent urinary incontinence.
- Although the PureWick system is covered by Medicare Part B, this does not apply if an individual already has an indwelling catheter or if more than one metal cup or pouch per week is needed for female catheters.
- When using the PureWick system, it's essential to understand the terms and conditions associated with Medicare coverage, such as out-of-pocket costs, premiums, deductibles, coinsurance, and copayments.
