Inquiries about Medicare coverage for PureWick external catheters?
Managing Incontinence Just Got Easier: PureWick for Women
Say goodbye to those embarrassing accidents with PureWick, a revolutionary system designed to help females manage their incontinence. Perfect for sleeping or relaxing, PureWick offers a discreet solution to a common issue.
The PureWick system consists of an external catheter that extends from the vulva to the buttocks, connecting to a tube that leads to a collection container. You can conveniently place this container on a nightstand or table, making it easy to empty as needed.
As of a ruling in 2024 by the Centers for Medicare & Medicaid Services (CMS), Medicare now covers the PureWick system under the durable medical equipment (DME) benefit of Part B.
🔍 Sex and Gender:Sex and gender exist on a spectrum. This article uses terms like "male," "female," or both to refer to sex assigned at birth. Learn more.
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 get a qualifying device, you must have a prescription from 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. Moreover, as of 2024, Medicare now covers the PureWick system under this coverage.
But remember, Medicare won't approve coverage if you already have an indwelling catheter, and for female catheters, Medicare limits usage to no more than one metal cup or pouch per week. In a hospital setting, catheters will be covered by Part A.
How Much Does Medicare Pay for PureWick?
According to the manufacturer's website, a box of 30 catheters costs approximately $209 for those paying without insurance. Purchasing them in bulk can save you money.
As of 2025, those enrolled in Medicare Part B must meet the annual deductible of $257 and pay a monthly premium of $185. After meeting these conditions, Part B will cover 80% of approved treatments or services.
Most people with Medicare Part A 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 in full for the first 60 days.
Medicare Advantage (Part C) plans are private plans that must provide the same benefits as Original Medicare. The premiums, deductibles, and coinsurance vary depending on the plan.
Medicare Terms Glossary:
- Out-of-pocket cost: The amount a person must pay for care when Medicare doesn’t cover the total or offers no coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: The amount someone pays each month for Medicare coverage.
- Deductible: The annual amount a person must spend out-of-pocket within a certain period before Medicare starts funding treatments.
- Coinsurance: The percentage of treatment costs a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: A fixed dollar amount a person with insurance pays when receiving certain treatments. In the case of Medicare, this usually applies to prescription drugs.
Source1234
- Under Medicare Part B, the PureWick system, a revolutionary incontinence solution for women, is now covered under the durable medical equipment (DME) benefit, a category that includes essential medical items like external catheters.
- A prescription from a Medicare-enrolled doctor or healthcare professional is required to qualify for a PureWick external catheter covered by Medicare.
- In comparison to purchasing it without insurance, the cost of a box of 30 PureWick catheters is approximately $209 for those using Medicare Part B, as the plan covers 80% of the cost after the annual deductible of $257 and a monthly premium payment of $185.
- It's important to note that Medicare won't approve coverage if an individual already has an indwelling catheter, and for female external catheters, usage is limited to a maximum of one metal cup or pouch per week.
- Medicare Advantage (Part C) plans, which offer the same benefits as Original Medicare, have varying premiums, deductibles, and coinsurance.
- In a situation where Medicare doesn't cover the total cost or offers no coverage, the out-of-pocket costs can include deductibles, coinsurance, copayments, and premiums.
