Medicare's coverage for PureWick external catheters: Is it inclusive?
Updated Article
Let's dive into the lowdown on urinary-wicking devices, particularly the PureWick system, designed for the ladies to use during their beauty rest. This badass system consists of an external kitten catheter that snakes its way from the hoo-ha to the booty, connected to a tube that funnels pee into a collection container easily placed on a nightstand or table.
As of the 2024 CMS ruling, Medicare now covers the PureWick system under their Durable Medical Equipment (DME) benefits within Part B. That's right, folks - Medicare is stepping up to the plate to help cover this life-improving gadget (just don't tell 'em I said that).
A quick heads-up about sex and gender: they're like a rainbow, with different shades. This article will use the terms "male," "female," or both to refer to sex assigned at birth. Learn more about it here[1].
When does Medicare approve coverage for PureWick external catheters?
Medicare Part B is the party responsible for covering DME, which includes the cool stuff like oxygen tanks, walkers, and hospital beds. To qualify, you just need a prescript from a Medicare-approved healthcare professional and a doctor's note saying you gotta use it at home.
DME can cover external catheters as an alternative to indwelling catheters for individuals suffering from permanent incontinence. From 2024 onward, Medicare includes the PureWick system under this umbrella of coverage.
However, be aware that Medicare won't cover the PureWick if you already have an indwelling catheter. Additionally, for the gals, the Medicare limit for weekly catheter use is one metal cup or pouch per week in the comfort of your own home. In a hospital, catheters will be covered by Part A.
How much does Medicare chunk out for PureWick?
As mentioned on the manufacturer's site, a box of 30 catheters will cost you approximately $209 without insurance. Buying in bulk can help you save some dough, but let's be real, who's got money to burn on pee tubes?
For individuals enrolled in Medicare Part B in 2025, there's an annual deductible of $257 and a monthly premium of $185. Once you've met these requirements, Part B will fund 80% of the approved treatments and services.
With Part A, the premium is generally waved, but you gotta spend that deductible of $1,676 before they'll foot the bill for your hospital stay and any associated medical devices. After that, Part A will cover all costs for the first 60 days.
Medicare Advantage (Part C) plans are private programs that promise the same benefits as Original Medicare. Premiums, deductibles, and coinsurance for these plans can vary, so make sure you do your research.
Medicare Jargon Breakdown
- Out-of-pocket cost: Money you gotta pay out of your wallet when Medicare doesn't cover everything. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly fee you pay for Medicare coverage.
- Deductible: An annual fee you need to meet before Medicare starts chipping in for your treatments.
- Coinsurance: The percentage of your treatment costs that you're responsible for covering. For Part B, that's 20%.
- Copayment: A fixed amount you pay for certain treatments. In the Medicare world, this usually applies to prescription drugs.
[1] Source: https://www.healthline.com/health/gender-identity-guide[2] Source: https://www.medicareadvocacy.org/medicare-info/medicare-coverage-documents/medicare-coverage-policies/durable-medical-equipment-dme/medicare-coverage-of-durable-medical-equipment-dme-how-it-works/[3] Source: https://www.federalregister.gov/documents/2020/12/03/2020-25703/medicare-coverage-of-not-for-reusable-dermagel-sheets-a-limited-class-iii-pneumatic-institutional[4] Source: https://www.medicareinteractive.org/get-answers/medicare-costs/medicare-deductibles-premiums-and-copays/will-i-get-an-elected-notice-of-my-deductible-and-premium-amounts[5] Source: https://www.medicareinteractive.org/get-answers/medicare-claims-and-attendant-care-services/how-do-i-appeal-a-claims-decision/
- Medicare Part B, under Durable Medical Equipment (DME) benefits, now covers the PureWick system from 2024 onward, including external catheters as an alternative for individuals suffering from permanent incontinence.
- To qualify for Medicare coverage for the PureWick system, you will need a prescription from a Medicare-approved healthcare professional and a doctor's note stating that the device is required for home use.
- Jim, a Medicare beneficiary, might need to consider Medicare Advantage (Part C) plans for comprehensive coverage, as these plans could provide extra benefits not included in Original Medicare, such as vision, dental, or health-and-wellness programs.
- On the other hand, Women's Health services, including screenings for breast cancer, cervical cancer, and other medical-conditions, are covered under Medicare Part B with no additional charge once you meet the Part B deductible.
