Inquiring about Medicare coverage for PureWick external catheters?
In the world of managing incontinence, the latest innovation is the PureWick system, specially designed for females to use during sleep or rest. This system includes an external catheter, extending from the vulva to the buttocks, connected to a tube leading to a collection container.
Luckily, as of a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS), Medicare now covers the PureWick system under its Durable Medical Equipment (DME) benefit of Part B.
But, what exactly does this mean for you? Let's break it down.
What is Medicare Part B and does it cover PureWick external catheters?
Simply put, Medicare Part B offers coverage for DME, which includes medical devices such as oxygen supplies, walkers, and hospital beds. To get a qualifying device like PureWick, a Medicare-enrolled doctor or healthcare provider must prescribe it for home use.
As of 2024, Medicare includes the PureWick system in the DME coverage. However, it's important to note that Medicare will not approve coverage if an individual already has an indwelling catheter. Additionally, 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 around $209 without insurance. But don't worry, purchasing in bulk can save you money.
For those enrolled in Medicare Part B, you'll need to meet the annual deductible of $257 (2025) and pay a monthly premium of $185. Once you meet these conditions, Part B will cover 80% of approved treatments or services.
In a hospital setting, Part A usually covers your hospital stay and any necessary medical devices during that period fully for the first 60 days. However, most people are exempt from paying a premium for Part A.
Key Terms to Know
- Out-of-pocket cost: The amount a person must pay for care when Medicare doesn't cover the total amount or offer coverage.
- Premium: The amount of money someone pays each month for Medicare coverage.
- Deductible: The annual amount a person must spend out of pocket before Medicare starts to fund their treatments.
- Coinsurance: The percentage of treatment costs a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: A fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this applies mostly to prescription drugs.
Don't let incontinence issues disrupt your sleep or daily life. With the covered PureWick system, managing incontinence has never been easier! For more detailed pricing and specific requirements, consult with a Medicare representative or a healthcare provider who can guide you based on your unique situation.
References
[1] Medicare.gov. (2022). What Medicare covers. Retrieved from https://www.medicare.gov/what-medicare-covers/
[2] Gussekloo, M. (2023). PureWick: Coverage Details and Costs Under Medicare. Health Resource One. Retrieved from https://healthresourceone.com/purewick-coverage-details-costs-under-medicare/
- The PureWick system, designed for female incontinence management, is now covered by Medicare under its Durable Medical Equipment (DME) benefit of Part B.
- Medicare Part B offers coverage for devices like the PureWick external catheters, but only if prescribed by a Medicare-enrolled doctor for home use.
- As of 2024, Medicare will not approve coverage for the PureWick system if an individual already has an indwelling catheter, and it limits female catheter usage to one metal cup or pouch per week.
- The PureWick system, which costs around $209 for a box of 30 catheters without insurance, will be partially covered by Medicare Part B once the annual deductible of $257 (2025) and a monthly premium of $185 are met.
- In a hospital setting, Medicare Part A usually covers hospital stays and medical devices during that period fully for the first 60 days, and most people are exempt from paying a premium for Part A.
- Key terms to understand in relation to the described system and Medicare coverage include out-of-pocket cost, premium, deductible, coinsurance, and copayment.
