Medicare's coverage for PureWick external catheters: An examination?
Managing incontinence just got a whole lot easier, thanks to innovations like the PureWick system. Designed specifically for female use during sleep or rest, this clever device is here to revolutionize nighttime comfort.
At its core, the PureWick system consists of an external catheter extending from the vulva to the buttocks, with a tube connecting to a collection container that can be placed on a nightstand or table.
As of a 2024 ruling, Medicare now covers the PureWick system under the durable medical equipment (DME) benefit of Part B. But remember, the devil is in the details.
Sex and gender are fluid, and in this article, we use the terms "male" and "female" to refer to sex assigned at birth. Read more about this if you're curious.
When can Medicare cover PureWick external catheters?
Under Medicare Part B, you can get DME—essential medical items such as oxygen supplies, walkers, and hospital beds—as long as a Medicare-enrolled doctor or healthcare professional prescribes it for home use. DME can include external catheters as alternatives to indwelling catheters for those 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. Moreover, 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.
How much does Medicare pay for PureWick?
Without insurance, a box of 30 catheters can cost about $209. But bulk purchasing can save money. For Medicare enrollees, you 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.
Keep in mind that Medicare Advantage (Part C) plans have premiums, deductibles, and coinsurance that may vary depending on the plan.
A quick guide to Medicare terms:
- Out-of-pocket cost: Amount you pay for care when Medicare doesn't fund the entire cost. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: Amount you pay each month for Medicare coverage.
- Deductible: Annual amount you must spend out of pocket before Medicare starts funding treatments.
- Coinsurance: Percentage of treatment costs you must self-fund. For Medicare Part B, the coinsurance is typically 20%.
- Copayment: Fixed dollar amount you pay when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
It's important to note that coverage may vary based on specific circumstances and updates to policy. To get the most accurate information, contact your healthcare provider or Medicare directly.
Sources:1. Centers for Medicare & Medicaid Services2. PureWick
- The PureWick system, a device designed for managing female incontinence, has been covered under Medicare Part B as of a 2024 ruling, making it accessible as durable medical equipment (DME).
- To be eligible for Medicare coverage of PureWick external catheters, they must be prescribed by a Medicare-enrolled doctor for home use, with the caveat that usage is limited to one metal cup or pouch per week.
- The cost of a box of 30 PureWick catheters can reach $209 without insurance, but Medicare enrollees will have to meet an annual deductible of $257 and pay a monthly premium of $185 before Part B covers 80% of the treatment costs.
- In a hospital setting, catheters are covered by Medicare Part A instead of Part B, and it's crucial to know that Medicare Advantage plans may have different premiums, deductibles, and coinsurance.
- It's essential to understand key Medicare terms like out-of-pocket cost, premium, deductible, coinsurance, and copayment when navigating the healthsystems related to Medicare coverage.
- Women's health, medical-conditions, health-and-wellness, and science all intersect in discussions about the PureWick system, as it addresses a specific medical-condition (incontinence) that affects many individuals and offers improvements in health-and-wellness.
