Medicare's coverage for PureWick external catheters: An investigation?
Managing Incontinence Just Got Easier: The PureWick System
Are you tired of dealing with incontinence issues while sleeping or resting? Look no further than the PureWick system, a revolutionary new product designed specifically for women. This innovative device includes an external catheter that extends from the vulva to the buttocks, connecting to a collection container. You can conveniently place the collection container on a nightstand or table.
Good news for Medicare beneficiaries! As of 2024, thanks to a ruling by the Centers for Medicare & Medicaid Services (CMS), the PureWick system falls under the durable medical equipment (DME) benefit of Part B.
Now, let's bust some myths. Sex and gender exist on spectrums, and in this article, we'll use "male" and "female" to refer to the sex assigned at birth. Take a look to learn more.
When Does Medicare Cover the PureWick System?
Medicare Part B offers coverage for DME, which includes essential medical items like oxygen supplies, walkers, and hospital beds. As long as a Medicare-enrolled doctor or healthcare professional prescribes it for home use, you can get a qualifying device.
External catheters can be included in the DME coverage as alternatives to indwelling catheters for individuals with permanent urinary incontinence, and, as of 2024, the PureWick system is part of that coverage. However, Medicare won't approve coverage if the individual already has an indwelling catheter or if the female catheter usage exceeds one metal cup or pouch per week.
In a hospital setting, catheters will be covered by Part A.
How Much Does Medicare Pay for PureWick?
A box of 30 catheters costs approximately $209 for those paying out of pocket without insurance. But worry not, bulk purchases can save you money.
As of 2025, Medicare beneficiaries must meet the annual deductible of $257 and pay a monthly premium of $185. Once they meet these conditions, Part B will cover 80% of approved treatments or services.
Most people with Part A are exempt from paying a premium, but they must meet a deductible of $1,676. Afterward, Part A will cover the hospital stay and any necessary medical devices during that period at no additional cost.
Medicare Advantage (Part C) plans offer the same benefits as Original Medicare, with premiums, deductibles, and coinsurance varying depending on the plan.
Important Terms to Know
- Out-of-pocket cost: the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: the amount of money someone pays each month for Medicare coverage.
- Deductible: an 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.
- After the ruling by the Centers for Medicare & Medicaid Services (CMS) in 2024, the PureWick system will be covered by Medicare Part B under the durable medical equipment (DME) benefit.
- The PureWick system, which includes an external catheter, will be considered a qualifying device for Medicare coverage as long as it is prescribed by a Medicare-enrolled doctor for home use.
- In addition to the PureWick system, essential medical items like oxygen supplies, walkers, and hospital beds are also covered under the Medicare Part B DME benefit.
- If the PureWick system is deemed necessary by a healthcare professional for an individual with permanent urinary incontinence, Medicare will cover 80% of the cost once the annual deductible and monthly premium are met, starting in 2025.
