Medicare's coverage for PureWick external catheters: A question in focus.
Chillaxing with Some PureWick: Navigating Medicare's Coverage for Female External Catheters
Dive into the world of urinary incontinence solutions and one of the latest innovations, the PureWick system tailored for females. This nifty device makes bedtime breezy, providing targeted relief while you catch some Zs.
The PureWick system comprises an external catheter that elegantly traverses from your vulva to your buttocks, connecting to a tube that leads to a collection container you can gracefully place on a nightstand or table for easy access.
Good news, folks! As of a 2024 ruling 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 are fluid and diverse, and this article will primarily refer to biological sex to maintain clarity. If you're curious about the spectrums of sex and gender, learn more here.
So, when does Medicare cover PureWick external catheters?
Medicare Part B includes coverage for DME, including crucial medical items like oxygen tanks, walkers, and hospital beds. To secure a qualifying device, simply ensure a Medicare-enrolled doctor or healthcare professional provides a prescription for home use.
DME may encompass external catheters like the PureWick system for individuals with long-term urinary incontinence, and as of 2024, the PureWick system is included in this coverage. However, keep in mind that Medicare won't approve coverage if you're already using an indwelling catheter. Moreover, for female catheters, Medicare only permits one metal cup or pouch per week. In a hospital setting, catheters will be covered by Part A.
Now that we've got your attention, let's discuss how much Medicare pays for the PureWick system in 2025.
- A box of 30 PureWick catheters may cost approximately $209 when purchased without insurance.
- Those enrolled in Medicare Part B must meet the yearly deductible of $257 and pay a monthly premium of $185. Once these conditions are met, Part B will cover 80% of approved treatments or services.
- In hospital settings, Part A typically exempts people from paying premiums but requires a deductible of $1,676 before providing full coverage for a 60-day period.
- Medicare Advantage (Part C) plans offer varying premiums, deductibles, and coinsurance based on individual plans.
Let's brush up on some essential terminology:
- Out-of-pocket cost: The amount a person needs to pay for care that Medicare doesn't cover entirely or doesn't offer coverage for, such as deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly fee someone pays for Medicare coverage.
- Deductible: The annual amount a person must spend out-of-pocket within a certain period before Medicare starts funding their treatments.
- Coinsurance: The percentage of treatment costs a person must pay out-of-pocket. In the case of Medicare Part B, this amounts to 20%.
- Copayment: A fixed amount a person with insurance pays when receiving certain treatments. This usually applies to prescription medication costs with Medicare.
- The PureWick system, an external catheter designed for women, falls under the category of durable medical equipment (DME) covered by Medicare Part B.
- Medicare will only cover one metal cup or pouch per week for female catheters and will not provide coverage if an indwelling catheter is already in use.
- The out-of-pocket cost for a box of 30 PureWick catheters in 2025 can be approximately $209 without insurance, while Medicare Part B will cover 80% of the cost after meeting the yearly deductible and monthly premium.
- Medicare Advantage (Part C) plans may offer varying premiums, deductibles, and coinsurance for the PureWick system, based on individual plans.
