Inquiry about Medicare coverage for PureWick external catheters.
Managing incontinence just got a whole lot easier, thanks to the PureWick system. This innovative device is specifically designed for females, perfect for use during sleep or rest. The system comprises an external catheter that connects from the vulva to the buttocks, leading to a collection container that can be placed on a nightstand or table.
In a groundbreaking move, the Centers for Medicare & Medicaid Services (CMS) included the PureWick system in their coverage under the durable medical equipment (DME) benefit of Part B, as of a 2024 ruling. This means that Medicare can now cover these devices for individuals who require them.
However, there are a few conditions to consider. For instance, Medicare will not approve coverage if an individual is also using an indwelling catheter. Furthermore, 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.
Now, let's talk money. As of 2025, those enrolled 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 the approved treatments or services, including external catheters like PureWick.
It's essential to remember that Medicare Advantage (Part C) plans, which must provide the same benefits as Original Medicare, offer varying premiums, deductibles, and coinsurance depending on the plan.
In simple terms, for a Medicare Part B beneficiary in 2025 to receive covered PureWick external catheters, a physician's order is needed, and beneficiaries must pay the $257 annual deductible and the $185 monthly premium. After that, 20% coinsurance applies to covered costs. Coverage is also subject to medical necessity and Medicare contractor approval.
A Glossary of Medicare Terms:
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
- The Centers for Medicare & Medicaid Services (CMS) includes the PureWick system, an external catheter designed for females, in eligible durable medical equipment (DME) under Medicare Part B, starting from a 2024 ruling.
- To receive covered PureWick external catheters under Medicare Part B in 2025, a physician's order is required, and beneficiaries must meet an annual deductible of $257 and pay a monthly premium of $185.
- After paying the annual deductible and monthly premium, Medicare Part B will cover 80% of the approved treatments or services, including medical devices like PureWick, leaving a 20% coinsurance for the beneficiary to pay.
- It's crucial to note that coverage for Medicare Advantage (Part C) plans may vary in terms of premiums, deductibles, and coinsurance, depending on the particular plan.
