Does Medicare provide coverage for PureWick external catheters?
Managing Incontinence Made Easier: The PureWick System
Say goodbye to inconvenience when dealing with incontinence, thanks to the recent innovation - the PureWick system. Designed exclusively for women, this system offers a comfortable solution for those resting or sleeping.
The PureWick system consists of an external catheter that starts from the vulva and ends at the buttocks, connected to a tube leading to a collection container. This container, easily placed on a nightstand or table, takes care of everything.
In a groundbreaking move, the Centers for Medicare & Medicaid Services (CMS) introduced a ruling in 2024, making the PureWick system eligible for coverage under the durable medical equipment (DME) benefit of Part B.
Sex and Gender Note:Sex and gender exist on a spectrum. This article uses "male," "female," or both to refer to the sex assigned at birth. For further insights, check out this link.
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, a device must be prescribed by a Medicare-enrolled doctor or healthcare professional for home use.
DME can include external catheters as alternatives to indwelling catheters for individuals with permanent urinary incontinence. As of 2024, the PureWick system is now included in this coverage. However, Medicare will not approve coverage if an individual already has an indwelling catheter. For female catheters, Medicare limits usage to one metal cup or pouch per week. In a hospital setting, catheters are covered by Part A.
PureWick System Costs and Coverage
A box of 30 catheters costs approximately $209 for those paying out of pocket without insurance. Cost savings can be achieved by purchasing in bulk.
Enrollees in Medicare Part B must meet an annual deductible of $257 and pay a monthly premium of $185. Once these conditions are met, Part B will cover 80% of approved treatments or services.
In the case of Part A, most people are exempt from paying a premium, but they must meet a deductible of $1,676. Afterward, Part A will cover their hospital stay and any necessary medical devices during that period fully for the first 60 days.
With Medicare Advantage (Part C) plans, the premiums, deductibles, and coinsurance vary depending on the plan.
Key Medicare Terms
- Out-of-pocket cost: Refers to the amounts a person must pay for treatments when Medicare does not cover the full costs. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: Monthly payments for Medicare coverage.
- Deductible: Annual amount a person must spend out of pocket before Medicare starts covering the costs.
- Coinsurance: The percentage of treatment costs that a person must pay themselves. For Medicare Part B, coinsurance is usually 20%.
- Copayment: A fixed amount a person with insurance pays for certain treatments. In the case of Medicare, this usually applies to prescription drugs.
- Beginning in 2024, the Centers for Medicare & Medicaid Services (CMS) included the PureWick system in the list of covered medical devices under the durable medical equipment (DME) benefit of Medicare Part B.
- For those on Medicare Part B, the PureWick system, when prescribed by a Medicare-enrolled doctor or healthcare professional for home use, will cover 80% of the costs, subject to an annual deductible of $257 and a monthly premium of $185.
- In some cases, costs can be further reduced by purchasing the PureWick system in bulk, with a box of 30 catheters typically priced at approximately $209 out of pocket.
- It's important to note that Medicare will not approve coverage if an individual already has an indwelling catheter and has a limitation on female catheters to one metal cup or pouch per week.
- The PureWick system, being a durable medical equipment, falls under the umbrella of healthcare items covered by Medicare, along with essential items such as oxygen supplies, walkers, and hospital beds.
- By managing incontinence through the PureWick system, people can experience better health-and-wellness outcomes, including improved women's health and general medical-conditions, as part of a larger focus on health and wellness.
