Inquiries about Medicare coverage for PureWick external catheters.
Streamlined Guide: Managing Incontinence with PureWick and Medicare Coverage
Say goodbye to inconvenience with PureWick, the revolutionary female urinary-wicking device designed for everyday use. This system works by extending an external catheter from the vulva to the buttocks, connecting to a tube leading to a collection container. You can easily place the container on a nightstand or table during sleep or rest.
Great news for Medicare beneficiaries! As of a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS), PureWick falls under the durable medical equipment (DME) benefit of Part B.
But what exactly qualifies as DME? It includes essential medical items such as oxygen supplies, walkers, and hospital beds. To get a qualifying device, a Medicare-enrolled doctor or healthcare professional must prescribe it for home use.
For PureWick external catheters, Medicare coverage applies to individuals with permanent urinary incontinence, but it does not cover cases where an individual also has an indwelling catheter. Additionally, Medicare limits female users to one metal cup or pouch per week. In a hospital setting, catheters are covered by Part A.
Now, let's dive into the costs. A box of 30 PureWick catheters typically goes for around $209 without insurance, but bulk purchases can save you some cash. Out-of-pocket costs for enrollees in Medicare Part B include meeting an annual deductible of $257 and a monthly premium of $185. Once these conditions are met, Part B covers 80% of approved treatments or services.
Out-of-pocket costs for enrollees in Medicare Part A are different. Most people are exempt from paying a premium, but they must meet a deductible of $1,676. Afterward, Part A will fully cover their hospital stay and any necessary medical devices during that period for the first 60 days.
Medicare Advantage (Part C) plans are private plans that offer the same benefits as Original Medicare, with premiums, deductibles, and coinsurance varying depending on the plan.
Here's a glossary of Medicare terms:
- Out-of-pocket cost: The amount a person must pay for care when Medicare does not pay the total amount or offer coverage.
- Premium: The amount of money someone pays each month for Medicare coverage.
- Deductible: An annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: The percentage of treatment costs that a person must self-fund.
- Copayment: A fixed dollar amount a person with insurance pays when receiving certain treatments.
- PureWick, a revolutionary female urinary-wicking device, is covered by Medicare under the durable medical equipment (DME) benefit of Part B, making it a viable option for Medicare beneficiaries.
- To qualify for Medicare coverage for DME, a Medicare-enrolled doctor or healthcare professional must prescribe the device for home use.
- PureWick external catheters are covered by Medicare for individuals with permanent urinary incontinence, but the coverage does not extend to cases where an individual also has an indwelling catheter.
- The out-of-pocket cost for a box of 30 PureWick catheters can reach around $209 without insurance, but bulk purchases can help lower the cost.
- Enrollees in Medicare Part B are required to meet an annual deductible of $257 and a monthly premium of $185 before Part B covers 80% of approved treatments or services.
- In contrast, enrollees in Medicare Part A may not have to pay a premium, but they must meet a deductible of $1,676 for coverage during hospital stays and for any necessary medical devices during that period for the first 60 days.
