Medicare's coverage for PureWick external catheters: A question worth exploring?
Let's Chat About PureWick:
If you're dealing with persistent female urinary incontinence while getting some rest, it's high time you checked out the PureWick system! This innovative product is designed specifically for you, and it's been making waves as one of the latest advancements in managing incontinence during sleep or rest.
So, what's the big deal about PureWick? Well, it includes an external catheter that extends from your vulva to your buttocks, connects to a tube, and leads to a collection container. You can easily place this container on a nightstand or table. Sounds convenient, right?
Brace yourself, because here's some fantastic news for you. Thanks to a 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. That means, if your doctor prescribes it for home use, you might be able to get it under your Medicare coverage.
Now, as you might already know, sex and gender are not just black and white. They exist on spectrums. In this article, we'll use the terms "male" or "female" to refer to sex assigned at birth[2].
When can Medicare cover PureWick?
Good question! Medicare Part B offers coverage for DME, which includes essential medical items like oxygen supplies, walkers, and hospital beds. If you're enrolled in Medicare and a Medicare-enrolled doctor or healthcare professional prescribes it for home use, you could potentially get a qualifying device like the PureWick.
However, it's important to note that Medicare will not cover the PureWick system if you already have an indwelling catheter. Also, for female catheters, Medicare limits usage to one metal cup or pouch per week. In a hospital setting, catheters will be covered by Part A[3].
So how much will it cost me?
As mentioned on the manufacturer's website, a box of 30 catheters typically costs around $209 if you pay out of pocket without insurance. But, if you buy in bulk, you could save some cash.
Now, for those enrolled in Medicare Part B, you'll need to meet the annual deductible of $257 and pay a monthly premium of $185. Once you meet these conditions, Part B will cover 80% of the costs of approved treatments or services[3].
If you're using Medicare Part A, most people are exempt from paying a premium, but you'll need to meet a deductible of $1,676. Afterward, Part A will cover your hospital stay and any necessary medical devices during that period fully for the first 60 days[3].
If you're enrolled in a Medicare Advantage (Part C) plan, the premiums, deductibles, and coinsurance may vary depending on your plan[3].
A Few Key Terms:
- Out-of-pocket cost: The amount you'll need to pay for care when Medicare doesn't cover the full cost or the treatment. This can include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount you pay for Medicare coverage.
- Deductible: The annual amount you must pay out of pocket within a certain period before Medicare starts covering the costs.
- Coinsurance: The percentage of treatment costs you must pay after Medicare's part is taken care of. For Medicare Part B, this is typically 20%.
- Copayment: A fixed dollar amount you pay for certain treatments, usually for prescription drugs.
[1] https://www.purewick.com/[2] https://www.plannedparenthood.org/learn/sexual-orientation-gender/transgender[3] https://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/downloads/SE1015_DIVERSIFWick.pdf
- The PureWick system, designed to manage female urinary incontinence during sleep, has gained recognition as one of the newest advancements in health systems.
- As of a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS), the PureWick system is now covered under Medicare as durable medical equipment (DME) under Part B.
- Among the medical-conditions that Medicare Part B covers, the PureWick device is among the essential medical items, providing a potentially affordable solution for those enrolled in Medicare.
- However, it's crucial to note that the PureWick system is not covered by Medicare if an indwelling catheter is already in use. Furthermore, for female catheters, Medicare limits usage to one metal cup or pouch per week.
- In terms of cost, a box of 30 catheters typically costs around $209, but with Medicare Part B coverage, enrollees may only need to pay the annual deductible and a monthly premium after meeting these conditions, with Medicare covering 80% of the costs.
- In discussions about health-and-wellness, women's health, and the latest developments in medical science, the PureWick system offers a promising solution for those dealing with persistent female urinary incontinence.
