Medicare's coverage for PureWick external catheters: Examination required.
Managing Urinary Incontinence with PureWick
Say goodbye to discomfort and inconvenience with the innovative PureWick system, designed particularly for women to navigate urinary incontinence while resting or sleeping. This state-of-the-art device, launched in the medical field, offers a convenient solution for those grappling with this common issue.
The PureWick system comes with an external catheter that extends from the vulva to the buttocks, connecting to a tube that leads to a collection container. Position this container on a nightstand or table, and you're all set.
In a groundbreaking move, the Centers for Medicare & Medicaid Services (CMS) confirmed coverage for the PureWick system under the durable medical equipment (DME) benefit of Part B, following a ruling in 2024.
Sex, Gender, and Medical Equipment
When discussing sex and gender, it's essential to remember that they exist on spectrums. In this article, we use the terms "male," "female," or both to refer to sex assigned at birth. For a deeper understanding, check here.
When Does Medicare Cover PureWick External Catheters?
Medicare Part B takes care of Durable Medical Equipment (DME), which includes essential medical items such as oxygen supplies, walkers, and hospital beds. A Medicare-enrolled individual can secure a qualifying device when a Medicare-enrolled doctor or healthcare professional prescribes it for home use.
DME extends to external catheters, serving as alternatives to indwelling catheters for individuals with permanent urinary incontinence. As of 2024, under this coverage, Medicare includes the PureWick system. 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 restricts usage to one metal cup or pouch per week only. In a hospital setting, catheters will be covered by Part A.
Pricing and Costs Associated with PureWick
According to the manufacturer's website, a pack of 30 catheters costs approximately $209 for those without insurance. By purchasing in bulk, you can save money.
By 2025, those enrolled in Medicare Part B are expected to pay an annual deductible of $257 and a $185 monthly premium. Once these conditions are met, Part B will cover 80% of approved treatments or services. When it comes to Part A, most people are exempt from paying a premium but must meet a deductible of $1,676. Following this, Part A will cover the hospital stay and any necessary medical devices during this period in full for the first 60 days.
Medicare Advantage (Part C) plans are private plans that offer the same benefits as Original Medicare, but their premiums, deductibles, and coinsurance can 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 total amount or provide coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: The amount of money someone pays each month for Medicare coverage.
- Deductible: The 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. 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.
In Summary:
The PureWick external catheter system is now covered under Part B of Medicare when prescribed for the treatment of medically necessary urinary incontinence, especially during sleep. The device must be prescribed for home use, and standard DME cost-sharing and documentation requirements apply. Limits on usage and indwelling catheter restrictions are enforced by Medicare. (Source)
- The PureWick system, a device designed to manage urinary incontinence, is covered under Part B of Medicare when it is medically necessary.
- For individuals with permanent urinary incontinence, external catheters like PureWick fall under the Durable Medical Equipment (DME) benefit of Medicare Part B.
- Medicare will only approve coverage for the PureWick system if it is prescribed by a Medicare-enrolled healthcare professional for home use.
- Female users of the PureWick system can only use one metal cup or pouch per week, according to Medicare's restrictions.
- As of 2024, Medicare covers the PureWick system but does not provide coverage for indwelling catheters in conjunction with its use.
- When enrolled in Medicare Part B, individuals are expected to pay an annual deductible of $257 and a $185 monthly premium, with Part B covering 80% of costs for the approved treatments or services.
