Inquiry about whether Medicare provides coverage for PureWick external catheters.
Taking Care of Urinary Incontinence with PureWick
Say goodbye to those sleepless nights due to incontinence! The innovative PureWick system, designed specifically for women, is here to make life a bit easier. This nifty device consists of an external catheter that extends from the vulva to the buttocks, connected to a tube leading to a collection container you can place conveniently on a nightstand or table.
As per the 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.
Do you need some clarification on sex and gender? Well, here's the deal: sex and gender exist on a spectrum. In this article, we'll use terms like "male" and "female" to refer to the sex assigned at birth. Learn more about it here.
When does Medicare cover PureWick external catheters?
Good question! Medicare Part B offers coverage for DME, which includes essential medical items such as oxygen supplies, walkers, and hospital beds. If a Medicare-enrolled doctor or healthcare professional prescribes a qualifying device for home use, a Medicare-enrolled person can get it.
DME includes external catheters for those with permanent urinary incontinence, and as of 2024, the PureWick system is covered in this category. But there's a catch: Medicare will not approve coverage if an individual already has an indwelling catheter. Moreover, for female catheters, Medicare limits usage 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?
The PureWick system isn't exactly cheap, but it's slightly more affordable for those enrolled in Medicare Part B. For instance, a box of 30 catheters may set you back around $209 without insurance. However, purchasing them in bulk can help reduce costs.
As of 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.
It's worth noting that 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 fully for the first 60 days.
Remember, Medicare Advantage (Part C) plans are private plans that must provide the same benefits as Original Medicare. The premiums, deductibles, and coinsurance vary depending on the plan.
Glossary of Medicare Terms
- Out-of-pocket cost: The amount a person must pay for care when Medicare does not cover the full amount or offers only partial coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- 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 covering their treatments.
- Coinsurance: The percentage of treatment costs that a person must self-fund. 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.
- The 2024 ruling by the Centers for Medicare & Medicaid Services (CMS) allows Medicare to cover the PureWick system as durable medical equipment (DME) under Part B.
- Medicare Part B offers coverage for DME, which includes essential medical items such as oxygen supplies, walkers, hospital beds, and as of 2024, the PureWick system for those with permanent urinary incontinence.
- When considering Medicare coverage for external catheters like PureWick, it's important to keep in mind that Medicare will not approve coverage if an individual already has an indwelling catheter and limits usage of female catheters to no more than one metal cup or pouch per week.
