Medicare's coverage for PureWick external catheters: An examination
Ready to dive into the world of PureWick, a game-changer for females managing incontinence during sleep or rest times? This nifty system features an external catheter that stretches from the vulva to the buttocks, tamely connected to a tube that leads to a collection container, which can be placed on a nightstand or table for easy access.
As per a 2024 landmark decision by the Centers for Medicare & Medicaid Services (CMS), Medicare is now within the realms of covering the PureWick system under the durable medical equipment (DME) benefit of Part B.
Sex and gender are wide-ranging concepts, and in this context, the terms "male," "female," or both will refer to the sex assigned at birth. Peep the deets for more on this subject.
So, when does Medicare extend its helping hand for PureWick? Well, Medicare Part B, the part of the program that offers coverage for essential medical items such as oxygen supplies, walkers, and hospital beds, comes to the rescue. If a Medicare-enrolled doctor or health professional writes a prescription for a qualifying device for home use, Medicare-enrolled individuals can secure a qualifying device.
Permanent urinary incontinence sufferers might find external catheters an attractive alternative to indwelling catheters. And in 2024, the PureWick system joined this coverage group. However, it's important to note that Medicare won't back PureWick covers if an individual is already sporting an indwelling catheter, and for female catheters, the usage limit is set to one metal cup or pouch per week. In a hospital setting, catheters are covered by Part A.
Now, let's talk money. The PureWick system can set back out-of-pocket buyers approximately $209 for a box of 30 catheters without insurance, but bulk purchases might mean savings.
In 2025, Medicare Part B enrollees have to cough up an 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. Part A usually waives premiums, but a deductible of $1,676 must be paid before Part A kicks in and covers hospital stays and devices during the initial 60 days fully.
Medicare Advantage (Part C) is a private plan that must provide the same benefits as Original Medicare. Premiums, deductibles, and coinsurance differ depending on the plan.
CONFUSED BY THE JARGON? We got ya covered with our handy-dandy Glossary of Medicare terms:- Out-of-pocket cost: The amount a person pays for treatment when Medicare doesn't chip in or offer coverage. This includes deductibles, coinsurance, copayments, and premiums.- Premium: The monthly amount someone pays for Medicare coverage.- Deductible: An annual amount a person must shell out before Medicare starts to assist with treatment costs.- Coinsurance: The percentage of treatment costs someone must cover themselves. In the case of Medicare Part B, it's 20%.- Copayment: A set fee a person with insurance pays for specific treatments, usually applicable to prescription drugs in Medicare's case.
- The PureWick system, a game-changer for female incontinence management, has been approved by Medicare as of 2024, falling under the durable medical equipment (DME) benefit of Part B.
- In 2025, individuals with Medicare Part B coverage will be expected to pay an annual deductible of $257 and a monthly premium of $185 for approved treatments or services, with Medicare covering 80% of these costs.
- For a comprehensive understanding of Medicare terms such as out-of-pocket cost, premium, deductible, coinsurance, and copayment, consult our Glossary of Medicare terms.
