Does Medicare pay for PureWick external urinary catheters?
Managing female incontinence issues will be a breeze, thanks to innovative devices like the PureWick system. Intended for use during sleep or resting periods, this system features an external catheter that runs from the vulva to the buttocks, linked to a container for collecting urine.
The Centers for Medicare & Medicaid Services (CMS) made a groundbreaking ruling in 2024, classifying PureWick as eligible for coverage under the durable medical equipment (DME) benefit within Medicare Part B. This entitles qualifying individuals to procure the device, provided their healthcare provider is Medicare-enrolled and issues a prescription for home use.
DME includes essential medical equipment such as oxygen supplies, walkers, and hospital beds. External catheters, like PureWick, may be provided as alternatives for people with permanent urinary incontinence. As a result of the 2024 ruling, Medicare includes the PureWick system in this coverage.
However, Medicare will not cover the PureWick system if an individual already has an indwelling catheter. Additionally, for female catheter use, Medicare imposes a limit of no more than one metal cup or pouch per week. In hospital settings, catheters are typically covered under Medicare Part A.
The PureWick system may set you back around $209 for a box of 30 catheters, but you can score some savings by buying in bulk. Those enrolled in Medicare Part B will be responsible for an annual deductible of $257 and a monthly premium of approximately $185. Following the meeting of these requirements, Medicare Part B will cover 80% of associated costs.
If you're on Medicare Advantage Part C, you'll have to choose a plan with premiums, deductibles, and coinsurance amounts that vary depending on the specific plan.
Out-of-pocket costs refer to the portion of treatment expenses the patient must personally pay when Medicare does not cover the entire amount. This may consist of deductibles, coinsurance, copayments, and premiums.
Premiums are the monthly payments someone makes for Medicare coverage.
Deductibles are yearly amounts that patients must pay out-of-pocket for treatments before Medicare starts to cover costs.
Coinsurance refers to the percentage of treatment costs that a patient must cover out-of-pocket. In the case of Medicare Part B, this amount is 20%.
Copayments are fixed sums that a person with insurance must pay when receiving certain medical services. For Medicare, this usually only applies to prescription drugs.
- The Centers for Medicare & Medicaid Services (CMS) classified PureWick as eligible for Medicare Part B coverage under the durable medical equipment (DME) benefit in 2024, making it possible for eligible individuals to obtain the device with a prescription from a Medicare-enrolled healthcare provider.
- Medicare Part B will cover 80% of the associated costs for the PureWick system, but patients will be responsible for an annual deductible of $257 and a monthly premium of approximately $185.
- If you're on Medicare Advantage Part C, you'll need to choose a plan with premiums, deductibles, and coinsurance amounts that may vary depending on the specific plan, potentially affecting your out-of-pocket costs for the PureWick system.
