Does Medicare provide coverage for PureWick external urinary catheters?
Laid-Back Guide on Medicare Coverage for PureWick External Catheters
Embrace the convenience of urinary-wicking devices in managing incontinence, with the PureWick system designed explicitly for ladies to use during rest or sleep. This system includes an external catheter that stretches from the vulva to the buttocks, connected to a tube leading to a collection container that can be positioned on a nightstand or table.
Fact: As the universe of sex and gender morphs, this article categorizes "male," "female," or both to represent sex assigned at birth. Dive deeper into this topic here.
A game-changer in the medical industry, the PureWick system is now covered by Medicare Part B under the Durable Medical Equipment (DME) benefit following a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS).
FYI about gender and sex
Sex and gender exist on spectrums. In this article, we're using "male" and "female" terms to denote sex assigned at birth. Learn a thing or two here.
Confused? Let's clear the air.
Medicare Part B offers coverage for DME, which embraces essential medical items like oxygen supplies, walkers, and hospital beds. A Medicare beneficiary can get a qualifying device as long as a Medicare-approved doctor or healthcare professional prescribes it for home use.
DME encompasses external catheters, like the PureWick system, as alternatives to indwelling catheters for individuals dealing with permanent urinary incontinence. As of 2024, Medicare includes the PureWick system in this coverage, but it rejects coverage if an individual is already using an indwelling catheter. Moreover, female catheters are limited to one metal cup or pouch per week. In a hospital setting, catheters will be covered by Part A.
Money Talks
Approximately $209 is the cost of a box of 30 catheters for individuals paying out-of-pocket without insurance. Buying in bulk can help save some cash.
As of 2025, those enrolled in Medicare Part B must first meet an annual deductible of $257 and pay a monthly premium of $185. Meeting these conditions will allow Part B to cover 80% of approved treatments or services.
A group of people exempted from paying a premium for Part A, but they must meet a deductible of $1,676. Once they meet this, Part A will cover all hospital expenses and necessary medical devices during that period for the initial 60 days.
Medicare Advantage plans (Part C) are private insurance plans that need to provide the same benefits as Original Medicare. Premiums, deductibles, and coinsurance vary based on the plan.
Glossary of Medicare Terms
- Out-of-pocket cost: The amount an individual must pay for treatment when Medicare does not foot the entire bill or offer coverage. Costs include deductibles, coinsurance, copayments, and premiums.
- Premium: The money a person pays each month for Medicare coverage.
- Deductible: An annual amount an individual must spend out-of-pocket within a specific period before Medicare kicks in to fund their treatments.
- Coinsurance: The percentage of treatment costs an individual must cover independently. For Medicare Part B, that percentage is 20%.
- Copayment: A fixed dollar amount an insured individual must pay for specific treatments. Under Medicare, this usually applies to prescription drugs.
- The PureWick external catheter system, designed for women's health, is covered by Medicare Part B under the Durable Medical Equipment (DME) benefit, offering a solution for individuals dealing with permanent urinary incontinence.
- Although Medicare Part B covers 80% of the cost of approved treatments or services for those enrolled, individuals must first meet an annual deductible of $257 and pay a monthly premium of $185 before this coverage takes effect.
- In the case of PureWick external catheters, Medicare does not cover the use of these devices if an individual is already using an indwelling catheter, and female catheters are limited to one metal cup or pouch per week.
- It's important to remember that while Medicare Part A does cover the cost of catheters in a hospital setting, those facing out-of-pocket costs should consider buying in bulk to save on expenses such as the $209 cost of a box of 30 PureWick catheters.
