Medicare's coverage for PureWick external catheters: An examination
In the realm of healthcare technology, there's been a significant shift with the introduction of urinary-wicking devices. One such innovation is the PureWick system, crafted specifically for females to employ while resting or sleeping.
The PureWick system includes an external catheter extending from the vulva to the buttocks, connected to a tube leading to a collection container that can be positioned on a nightstand or table. Thanks to a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS), Medicare can now cover the PureWick system under the durable medical equipment (DME) benefit of Part B.
It's essential to note that the terms "male," "female," or both here refer to sex assigned at birth. For deeper insights on sex and gender, check out this link.
Now, let's dive into the specifics of when Medicare covers PureWick external catheters. Medicare Part B offers coverage for DME, including essential medical items like oxygen supplies, walkers, and hospital beds. As long as a Medicare-enrolled doctor or healthcare professional prescribes a qualifying device for home use, a Medicare-enrolled person can acquire it.
DME can encompass external catheters as alternatives to indwelling catheters for individuals with permanent urinary incontinence. As of 2024, Medicare has included the PureWick system in this coverage. However, it's important to note that Medicare will not approve coverage if an individual also has an indwelling catheter.
Furthermore, for female catheters, Medicare limits usage to no more than one metal cup or pouch per week. In a hospital setting, catheters are generally covered by Part A.
Moving on to the cost side, a box of 30 catheters costs approximately $209 for those paying out of pocket without insurance. An exciting aspect is that purchasing them in bulk can save money.
In 2025, those enrolled in Medicare Part B must meet the annual deductible of $257 and pay a monthly premium of $185. Once these conditions are met, Part B will cover 80% of approved treatments or services.
Remember, if you're interested in private plans, Medicare Advantage (Part C) plans offer the same benefits as Original Medicare, but premiums, deductibles, and coinsurance may vary depending on the plan.
In light of these details, let's shed some light on the relevant 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.
Sources:
- Medicare.gov
- CMS.gov
- AHA.org
- NIH.gov
- PureWick.com
- The PureWick system, a specific urinary-wicking device designed for females, falls under the Medicare DME coverage after a ruling by the Centers for Medicare & Medicaid Services (CMS) in 2024.
- Adhering to Medicare's rules, an individual can get the PureWick external catheter as long as a Medicare-enrolled doctor or healthcare professional prescribes a qualifying device for home use.
- It's essential to know that for female catheters, Medicare permits only one metal cup or pouch per week as part of their coverage.
- When paying out of pocket, a box of 30 PureWick catheters can cost approximately $209, though purchasing in bulk may save money.
- For those enrolled in Medicare Part B, meeting the annual deductible of $257 and paying a monthly premium of $185 is required before Part B covers 80% of approved treatments, including the PureWick system.
- In the event someone seeks additional options for Medicare coverage, Medicare Advantage (Part C) plans offer the same benefits but may vary in premiums, deductibles, and coinsurance depending on the plan.
