Inquiries about Medicare coverage for PureWick external catheters?
Solving the Wicked Problems of Incontinence:
Navigating through the complexities of managing incontinence just got a little easier, thanks to innovative solutions like the PureWick system. Designed specifically for ladies, this system offers a life-enhancing solution during sleep or rest.
The PureWick system consists of an external catheter and a collection container. The catheter extends from the vulva to the buttocks and connects to a tube leading to the container, which can be conveniently placed on a nightstand or table.
In a 2024 game-changer, the Centers for Medicare & Medicaid Services (CMS) ruled that the PureWick system can now be covered under Medicare's durable medical equipment (DME) benefit, Part B.
Sex, Gender, and Beyond:
Sex and gender exist on a spectrum. In this article, the terms "male," "female," or both will be used to refer to sex assigned at birth. More info here.
When does Medicare approve PureWick external catheter coverage?
DME, covered under Medicare Part B, encompasses essential medical items, such as oxygen supplies, walkers, and hospital beds. As long as a Medicare-enrolled doctor or healthcare professional prescribes it for home use, a qualifying device can be acquired.
Under DME, Medicare may cover external catheters, like the PureWick system, as alternatives for individuals suffering from permanent urinary incontinence. Thanks to the 2024 ruling, the PureWick system is now included in this coverage category.
However, Medicare will not cover PureWick for individuals with indwelling catheters, and female catheters are limited to 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 can cost approximately $209 for individuals without insurance. Buying in bulk can save some money.
In 2025, those enrolled in Medicare part B will be subject to an annual deductible of $257 and a monthly premium of $185. Upon meeting these conditions, Part B will fund 80% of approved treatments or services.
Generally, Part A does not require a premium, but a deductible of $1,676 must be paid upfront. After this, Part A will take care of the hospital stay and any necessary medical devices during the initial 60 days.
Medicare Advantage (Part C) plans, which must provide the same benefits as Original Medicare, offer varying premiums, deductibles, and coinsurance.
A Glossary of Medicare Terminology:
- Out-of-pocket cost: This refers to the amount a person must cover out-of-pocket for care when Medicare doesn't cover the full amount or provide coverage. This may include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the monthly fee someone pays for Medicare coverage.
- Deductible: This is the annual sum a person must pay out-of-pocket before Medicare begins funding their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must personally cover after Medicare has paid its portion. For Medicare Part B, the coinsurance is 20%.
- Copayment: This is a fixed dollar amount that a person with insurance pays during treatment coverage. Most often, this applies to prescriptions within Medicare.
- The PureWick external catheter system, a solution designed for women with permanent urinary incontinence, can be covered under Medicare's durable medical equipment (DME) benefit, Part B, as long as it is prescribed by a Medicare-enrolled doctor for home use.
- Medicare's out-of-pocket cost for the PureWick external catheter system includes an annual deductible and copayments, with enrollees paying 20% of the cost after meeting their deductible, making it less expensive for those with Medicare coverage compared to the retail price around $209 per box.
- In 2025, those enrolled in Medicare Part B will have an annual deductible of $257 and a monthly premium of $185, with the program funding 80% of approved treatments or services once these conditions are met.
- While Medicare Part A does not cover external catheters like the PureWick system, it does cover catheters and other medical devices in a hospital setting under Part A. Alternatively, Medicare Advantage (Part C) plans, which must provide the same benefits as Original Medicare, offer varying premiums, deductibles, and coinsurance.
