Inquire about Medicare coverage for PureWick external urinary catheters.
Managing incontinence just got a whole lot easier, thanks to the PureWick system – the latest innovation for females dealing with this issue while sleeping or resting. This system includes an external catheter that extends from the vulva to the buttocks, connected to a tube leading to a collection container. You can place this container on a nightstand or table, ensuring convenience and comfort.
The Centers for Medicare & Medicaid Services (CMS) has made a significant move, ruling in 2024 that Medicare can now cover the PureWick system under its Durable Medical Equipment (DME) benefit for Part B. This means that essential medical items like oxygen supplies, walkers, and hospital beds now include external catheters as alternatives for individuals with permanent urinary incontinence, with the PureWick system among the covered options.
However, it's worth noting that Medicare will not approve coverage if the individual also has an indwelling catheter. Additionally, 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.
As for the cost, without insurance, a box of 30 catheters might set you back around $209. But buying in bulk could help save some cash. For those enrolled in Medicare Part B, out-of-pocket costs will be lower once the annual deductible of $257 is met. Afterward, Part B will cover 80% of approved treatments or services, meaning you'll still be responsible for the remaining 20%.
It's essential to remember that while Medicare offers coverage for certain conditions and devices, the specifics can vary depending on your plan. In case of any uncertainties, it's best to consult with your healthcare provider or a Medicare representative.
A few terms to remember:
- Out-of-pocket cost: The money a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount of money someone pays for Medicare coverage.
- Deductible: The annual amount a person must spend out of pocket within a certain period before Medicare begins to fund their treatments.
- Coinsurance: The percentage of treatment costs a person must self-pay. 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.
(Data Sources: [1] Medicare Coverage Requirements for PureWick External Catheters, [2] PureWick Pricing Information)
- The Centers for Medicare & Medicaid Services (CMS) has announced that Medicare will cover the PureWick system under its Durable Medical Equipment (DME) benefit for Part B starting from 2024, which positions healthsystems to offer this innovation as an alternative for individuals with permanent urinary incontinence.
- In the realm of health-and-wellness, Medicaid will not provide coverage for the PureWick system, but science and research may uncover alternative solutions in the future for females struggling with incontinence.
- In addition to understanding the specifics of PureWick coverage under Medicare, it's crucial to be aware of potential out-of-pocket costs, specifically the annual deductible of $257 and the 20% coinsurance that may still apply after the deductible is met.
