Medicare's coverage for PureWick external catheters: An inquiry
Rewritten Article:
Managing Incontinence Just Got Easier: Enter the PureWick System
Say goodbye to hassle when it comes to incontinence management. The latest breakthrough in this sphere is the PureWick system, tailored especially for women during their sleep or resting moments.
The PureWick system consists of an external catheter that extends from the vulva to the buttocks, connecting to a tube leading to a collection container. This nifty device can be placed on a nightstand or table for convenience.
In a significant move by the Centers for Medicare & Medicaid Services (CMS) in 2024, the PureWick system is now covered under the durable medical equipment (DME) benefit of Part B for Medicare.
A Quick Take on Sex and Gender
Sex and gender exist on a spectrum. For the purpose of this article, we use the terms "male," "female," or both to denote sex assigned at birth. More on that here.
When Does Medicare Cover PureWick External Catheters?
Medicare Part B provides coverage for DME, encompassing crucial medical items such as oxygen supplies, walkers, and hospital beds. A Medicare-enrolled individual can procure a qualifying device provided it's prescribed by a Medicare-enrolled doctor or healthcare professional for home use.
DME may include external catheters as alternatives to indwelling catheters for those with permanent urinary incontinence. As of 2024, Medicare includes the PureWick system in this coverage. However, it's essential to note that Medicare won't approve coverage if an individual is already using an indwelling catheter. Furthermore, female catheters are limited to no more than one metal cup or pouch per week. In a hospital setting, catheters are covered by Part A.
How Much Does Medicare Pay for PureWick?
According to the manufacturer's website, a box of 30 catheters typically costs around $209 for those without insurance. Bulk purchases can lead to savings.
Starting 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.
With Part A, most people are exempt from paying a premium, but they must meet a deductible of $1,676. Afterward, Part A will cover their hospital stay and any necessary medical devices during that period completely for the first 60 days.
Medicare Advantage (Part C) plans are private plans that must deliver the same benefits as Original Medicare. Premiums, deductibles, and coinsurance might vary based on the plan.
Medicare Terminology 101
- Out-of-Pocket Cost: The amount an individual pays for care when Medicare doesn't fully cover or provide coverage for it. Such costs include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly fee someone pays for Medicare coverage.
- Deductible: An annual amount an individual must pay out of pocket for treatments before Medicare starts to pay.
- Coinsurance: The percentage of treatment costs that an individual must cover. For Medicare Part B, it's usually 20% of the total cost after meeting the deductible.
- Copayment: A fixed dollar amount an insurance holder pays for certain treatments. For Medicare, this generally applies to prescription drugs.
- The Centers for Medicare & Medicaid Services (CMS) included the PureWick system in the durable medical equipment (DME) benefit of Part B for Medicare in 2024.
- Incontinence management has been simplified with the introduction of the PureWick system, designed for women during rest or sleep.
- The PureWick system consists of an external catheter and a collection container, making it a convenient alternative to indwelling catheters for those with permanent urinary incontinence.
- Medicare Part B provides coverage for medical items like the PureWick system, but it won't approve coverage if an individual is already using an indwelling catheter.
- The cost of a box of 30 PureWick catheters is approximately $209 without insurance, although bulk purchases can lead to savings.
- In 2025, those enrolled in Medicare Part B will have to pay an annual deductible of $257 and a monthly premium of $185 to cover 80% of the approved treatments or services, including the PureWick system.
