Medicare's coverage for PureWick external catheters: Query regarding insurance coverage for PureWick external catheters by Medicare.
Having Trouble With Incontinence? Check Out PureWick!
Struggling to manage incontinence? Look no further than the PureWick system, the latest innovation in urinary wicking devices especially designed for females. Use it while sleeping or resting – say goodbye to leaks!
The PureWick system comes with an external catheter that extends from the vulva to the buttocks, connecting to a tube leading to a collection container. Place the container on a nightstand or table, and you're all set!
Great news for Medicare beneficiaries! According to a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS), the PureWick system is now covered under the durable medical equipment (DME) benefit of Part B.
Sex and Gender Spectrums Explained
Remember that both sex and gender are multifaceted. This article will primarily use terms like "male" and "female" to refer to sex assigned at birth. Get more info here.
When Does Medicare Cover PureWick External Catheters?
Part B of Medicare offers coverage for DME, which includes essential medical items such as oxygen supplies, walkers, and hospital beds. To get a qualifying device, you just need a Medicare-enrolled doctor or healthcare professional to prescribe it for home use.
Under Part B, external catheters like PureWick are covered for individuals with permanent urinary incontinence. Starting in 2024, Medicare includes the PureWick system in this coverage.
However, Medicare will not approve coverage if an individual also has an indwelling catheter. Moreover, for female catheters, Medicare limits usage to no more than one metal cup or pouch per week. In a hospital setting, catheters are covered by Part A.
How Much Does Medicare Pay for PureWick?
As stated on the manufacturer's website, a box of 30 catheters costs approximately $209 without insurance. Purchasing in bulk can help save some dough.
In 2025, Medicare Part B enrollees must first meet the annual deductible of $257. Once this is accomplished, Part B will cover 80% of approved treatments or services. This means you're still responsible for 20% coinsurance. Don't forget to factor in the monthly premium of $185.
If you're on Part A, you may not have to pay a premium, but you will need to meet a deductible of $1,676. Afterward, Part A will cover your hospital stay and any necessary medical devices in full for the first 60 days.
Medicare Advantage (Part C) plans are private plans that offer the same benefits as Original Medicare. Premiums, deductibles, and coinsurance may vary depending on the plan.
Medicare Terms Glossary
- Out-of-pocket cost: The amount a person must pay for care when Medicare does not cover it entirely. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount paid for Medicare coverage.
- Deductible: An annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: The percentage of treatment costs that a person must pay themselves. For Medicare Part B, coinsurance is 20%.
- Copayment: A fixed dollar amount a person must pay for certain treatments while having insurance. For Medicare, this usually applies to prescription drugs.
- The PureWick urinary wicking device, particularly designed for women, is being covered under the durable medical equipment (DME) benefit of Medicare Part B, starting in 2024, as declared by the Centers for Medicare & Medicaid Services (CMS).
- Medicare beneficiaries who have permanent urinary incontinence may be able to obtain the PureWick system, as external catheters like it are included in the DME coverage for these individuals.
- However, it's important to note that Medicare will not approve the coverage of the PureWick system if the individual already has an indwelling catheter, and female users are limited to no more than one metal cup or pouch per week.
- The manufacturer's website states that a box of 30 PureWick catheters typically costs around $209 without insurance, though purchasing in bulk can help save money.
- When it comes to Medicaid, the annual deductible for Medicare Part B enrollees is $257, and once this amount is met, Medicare will cover 80% of approved treatments or services, leaving the individual responsible for the remaining 20% as coinsurance.
- In the year 2025, healthcare costs related to managing incontinence, such as PureWick, will still require some out-of-pocket costs, as the monthly premium for Medicare Part B is $185, and Medicare Advantage (Part C) plans may vary in premiums, deductibles, and coinsurance.
