Living Comfortably with PureWick: Understanding Medicare Coverage for Female External Catheters
Medicare's coverage for PureWick external catheters: An analysis?
Managing urinary incontinence just became a bit easier, thanks to innovations like the PureWick system. This device, specifically designed for women, offers a unique solution for nighttime or resting periods. Here's how Medicare steps in to help you cover the cost.
The PureWick system includes an external catheter that runs from the vulva to the buttocks, connecting to a tube leading to a collection container. You can conveniently place this container on a nightstand or table. As per a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS), the PureWick system is now covered under Medicare's Durable Medical Equipment (DME) benefit of Part B.
Medicare Part B and DME: An Overview
Medicare Part B covers DME, which encompasses vital medical items such as oxygen supplies, walkers, and hospital beds. To qualify, the device must be prescribed by a Medicare-enrolled doctor or healthcare professional for home use.
DME may also include external catheters as alternatives to indwelling catheters for individuals with permanent urinary incontinence. As of 2024, the PureWick system is included in this coverage. However, Medicare will not approve coverage if you also have 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.
What Does Medicare Cover and How Much Will It Cost?
The cost of a box of 30 PureWick catheters amounts to approximately $209 for those paying out of pocket without insurance. Although this may seem steep, purchasing in bulk can save money.
As of 2025, those enrolled in Medicare Part B must meet the annual deductible of $257 and pay a monthly premium of $185. Once you meet these conditions, Part B will cover 80% of approved treatments or services.
In the case of Part A, most people are exempt from paying a premium, but they must meet a deductible of $1,676. Afterward, Part A will cover the hospital stay and any necessary medical devices during that period completely for the first 60 days.
Medicare Advantage (Part C) plans are private plans that must provide the same benefits as Original Medicare. Premiums, deductibles, and coinsurance vary depending on the plan.
Decoding Medicare Terms
- Out-of-pocket Cost: The amount a person must pay for care when Medicare does not cover the entire expense or offers partial coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: The amount of money someone pays each month for Medicare coverage.
- Deductible: An annual amount a person must spend out of pocket before Medicare starts to fund their 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.
[1] https://www.medicare.gov/coverage/durable-medical-equipment/[2] https://www.cms.gov/files/document/purewick-statements.pdf[3] https://www.medicareadvocacy.org/wp-content/uploads/2021/09/CMS-MLN-Matters-Article-Clarification-of-PureWick-10-31-2021.pdf[4] https://www.acep.org/clinical---coding/coding-support/current-procedure-terminology-cpt/medicare-code-changes
- The PureWick system, a female external catheter designed for nighttime and resting use, is now covered under Medicare's Durable Medical Equipment (DME) benefit of Part B as per a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS).
- Medicare Part B, which covers DME, also includes external catheters as alternatives to indwelling catheters for individuals with permanent urinary incontinence, with the PureWick system included as of 2024.
- It's important to note that Medicare will not approve coverage for the PureWick system if the individual also has an indwelling catheter, and the coverage is limited to no more than one metal cup or pouch per week for female catheters.
- As of 2025, Medicare Part B enrollees will need to meet an annual deductible of $257 and pay a monthly premium of $185 before Part B will cover 80% of approved treatments or services, including the PureWick system.
- A box of 30 PureWick catheters can cost around $209 for those without insurance, while in a hospital setting, catheters are covered by Part A.
- Medicare Advantage (Part C) plans offer the same benefits as Original Medicare, but premiums, deductibles, and coinsurance can vary depending on the plan.
