Check if Medicare is liable for funding external catheters from PureWick.
Managing Incontinence: What You Need to Know About Medicare Coverage for PureWick External Catheters
Embrace the PureWick system, a trailblazing innovation designed for women to tackle incontinence issues while resting or sleeping. This system features an external catheter that connects from the vulva to the buttocks, and a tube that leads to a collection container.
In a groundbreaking move by the Centers for Medicare & Medicaid Services (CMS) in 2024, the PureWick system became eligible for coverage under the durable medical equipment (DME) benefit of Part B.
Let's delve into the specifics of Medicare coverage with PureWick:
Medicare Part B and DME: Coverage Explained
Welcome to the realm of Medicare Part B, where essential medical items such as oxygen supplies, walkers, and hospital beds are covered. To obtain a qualifying device, a Medicare-enrolled doctor or healthcare professional must prescribe it for home use.
When it comes to DME, external catheters like PureWick can be an alternative to indwelling catheters for those with permanent urinary incontinence. Speaking of 2024, the PureWick system is now included in this coverage. However, keep in mind that Medicare won't approve coverage if an individual also has an indwelling catheter.
Moreover, for female catheters, Medicare caps usage to one metal cup or pouch per week. In a hospital setting, catheters are typically covered by Part A.
How Much Does Medicare Pay for PureWick?
Wondering about the costs? As per the manufacturer's website, a box of 30 catheters retails at approximately $209 without insurance.
In 2025, out-pocket costs for enrollees in Medicare Part B will involve an annual deductible of $257 and a monthly premium of $185. Once meeting these conditions, Part B will cover 80% of approved treatments or services.
Part A coverage typically involves no premiums, but a deductible of $1,676 must be met. Post-deductible, Part A will cover hospital stays and medical devices in full for the first 60 days.
Navigating Medicare: A Glossary
- Out-of-Pocket Costs: The amount a person must pay for care when Medicare doesn't cover the total amount or services. Costs can encompass deductibles, coinsurance, copayments, and premiums.
- Premium: The amount of money someone pays each month for Medicare coverage.
- Deductible: The amount a person must spend out of pocket within a certain period before Medicare starts funding treatments.
- Coinsurance: The percentage of treatment costs that 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. For Medicare, this usually applies to prescription drugs.
- The PureWick external catheter system, a solution for managing incontinence, was made eligible for Medicare coverage under the durable medical equipment (DME) benefit of Part B by the Centers for Medicare & Medicaid Services (CMS) in 2024.
- Medicare Part B covers essential medical items like the PureWick system, but a Medicare-enrolled doctor or healthcare professional must prescribe it for home use.
- In 2024, the PureWick system was included in the DME coverage, with Medicare not approving coverage if an individual also has an indwelling catheter.
- For female catheters, Medicare caps usage to one metal cup or pouch per week, and in a hospital setting, catheters are typically covered by Part A.
- As per the manufacturer's website, a box of 30 PureWick catheters retails at approximately $209 without insurance, and in 2025, enrollees in Medicare Part B will pay an annual deductible of $257 and a monthly premium of $185.
- Out-of-Pocket costs for enrollees in Medicare Part B involve deductibles, coinsurance, copayments, and premiums, serving as the amount a person must pay for care when Medicare doesn't cover the total amount or services.
