Inquiries about Medicare coverage for PureWick external catheters?
Managing Female Incontinence Just Got Easier: Introducing PureWick External Catheters
Life doesn't have to be put on hold due to incontinence. Kick back and relax with PureWick, the latest innovation in managing female urinary incontinence while resting or sleeping. The PureWick system comes complete with an external catheter that stretches from the vulva to the buttocks, a tube leading to a collection container, and a convenient design allowing for nightstand or table placement.
Good news! In a groundbreaking move, the Centers for Medicare & Medicaid Services (CMS) announced in their 2024 ruling that the PureWick system would be covered under the durable medical equipment (DME) benefit of Part B.
Hang on, let's get one thing straight – we believe sex and gender exist on a spectrum. This article uses the terms "male," "female," or both to refer to sex assigned at birth. Get the lowdown.
When Can Medicare Cover PureWick External Catheters?
You might be wondering, "When will Medicare cover my PureWick catheters?" Well, imagine a world where you can chat with a Medicare-enrolled doctor or healthcare professional about getting those nifty essential medical items covered, such as oxygen supplies, walkers, and hospital beds. If they prescribe a qualifying device like PureWick for home use, Medicare Part B offers coverage through its DME benefit.
Adding context, with the 2024 update, Medicare now considers external catheters, like the PureWick system, as alternatives to indwelling catheters for individuals with permanent urinary incontinence. Interestingly, Medicare will not cover the system if you already have an indwelling catheter, and there's a weekly limit on usage for female catheters (one metal cup/pouch per week). If you find yourself in a hospital setting, catheters will be covered by Part A.
How Much Does Medicare Cover?
An unboxing, if you will! According to the manufacturer's website, a box of 30 catheters sets you back around $209 without insurance. Those enrolled in Medicare Part B can breathe a sigh of relief knowing that the annual deductible in 2025 is $257, and after it's been met, Medicare will cover 80% of treatments or services. Strap in, the monthly premium is a modest $185.
Fun fact – Part A typically exempts most individuals from paying a premium, but they must meet a deductible of $1,676. Once the deductible is taken care of, Part A will gladly cover their hospital stay and any necessary medical devices during that duration for the first 60 days. Medicare Advantage (Part C) plans, consisting of private plans, offer the same benefits as Original Medicare; premiums, deductibles, and coinsurance are subject to the plan's specifics.
Pun-intended Glossary of Medicare Terms
- Out-of-pocket cost: The amount we've all got to cough up for treatments that Medicare doesn't fully cover. This includes deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly fee a person pays for their Medicare coverage.
- Deductible: An annual amount you must shell out before Medicare foots the bill for your treatments.
- Coinsurance: A percentage a person's gotta pony up for treatments that Medicare covers. For Medicare Part B, that's 20%.
- Copayment: A fixed amount a person with insurance shells out at the time of treatment, usually for prescription drugs.
- The Centers for Medicare & Medicaid Services (CMS) has included PureWick external catheters under the durable medical equipment (DME) benefit of Part B, as stated in their 2024 ruling.
- Medicare Part B covers 80% of treatments or services for enrolled individuals, with an annual deductible of $257 in 2025.
- To get PureWick catheters covered by Medicare, a qualifying device must be prescribed by a Medicare-enrolled doctor or healthcare professional for home use.
- When using PureWick external catheters in a hospital setting, Part A will provide coverage, subject to a deductible of $1,676.
