Urinary catheters are administered over the course of many different types of health care. Fortunately, Medicare covers these essential tools. It’s important to understand Medicare’s rules for catheter coverage to avoid paying out-of-pocket expenses and to best meet the needs of you or your loved ones. This article will help readers understand the intricacies of Medicare’s policies surrounding urinary catheters.
Does Original Medicare Cover Urinary Catheters?
Original Medicare covers urinary catheters when they’re ordered by a doctor due to medical necessity. Medicare Beneficiaries may also receive coverage for extension tubing, urine collection bags, irrigation kits, and other supplies needed to use a catheter safely.
How Medicare pays for catheters will depend on where the beneficiary is when they need the supplies and whether their need is short or long term. There are some coverage limits for long-term use.
Coverage for In-Patient Hospital Catheters
When a beneficiary is formally admitted into a hospital, their Medicare Part A coverage will pay for catheters as needed for care. They don’t need to do anything to receive this coverage. It will apply automatically along with any other coverage for hospitalized care.
Medicare will typically cover one indwelling catheter per month. These catheters are inserted into the bladder through the urethra or a small incision in the lower abdomen. They can stay in place for longer periods of time and are often used after surgical procedures.
If a beneficiary does not qualify for premium-free Part A, they may need to pay a premium in addition to the deductible. Coinsurance doesn’t apply unless they are admitted for more than 60 days.
Coverage for Outpatient Catheters
Coverage for catheters inserted in a doctor’s office or medical center as an outpatient procedure are covered under Medicare Part B. Part B beneficiaries who need ongoing catheterization can obtain:
- Up to 35 external catheters per month
- Up to 200 single-use intermittent straight catheters per month
- Coude-tip catheters as medically necessary only
Intermittent catheters are used to drain the bladder one time, so they’re often referred to as in-and-out catheters. External catheters fit around the penis and are often used for males with dementia or other mental conditions that may lead to difficulties controlling urination.
Medicare Part B will also cover lubrication, sterilization supplies, and other needed accessories. The number of catheters and amounts of other supplies allowed will depend on the plan of care written by the prescribing doctor.
Medical supply companies can provide all needed catheters and supplies. They’re often knowledgeable about doctor care plans and Medicare coverage limits.
Medicare Supplement Plan Coverage for Catheters
Medicare Supplement (Medigap) plans are designed to pay out-of-pocket expenses not covered by Original Medicare. If a beneficiary is enrolled in a Medigap plan at the time their catheter is ordered, it’s likely their plan will pick up deductibles, coinsurance, and copayments, their Original Medicare policy may not cover.
The only out-of-pocket expense that no Medigap policy can cover is the Part B deductible. Unless the beneficiary enrolled in their plan prior to January 1, 2020, they will still need to pay this deductible for Part B coverage. A Medigap policy can still cover any copayments or coinsurance that may apply to catheter placement or needed at-home supplies.
Advantage Plan Coverage for Catheters
All Medicare Advantage plans are required to include all coverage offered through Original Medicare, Parts A and B. That means your Advantage plan will offer the same coverage for urinary catheters as we detailed above.
Some plans may offer added benefits that you can apply to catheters and other medical supplies. Make sure to check with your plan to understand your benefits fully.
Frequently Asked Questions About Different Types of Urinary Catheters
That general discussion of what Medicare will cover for catheters may leave readers wondering about which types of catheters are most useful to themselves or their loved ones and if those catheters are covered under Medicare. This section is our way of answering some frequently asked questions quickly
- Is Purewick Covered by Medicare? Purewick is a urinary drainage system that works by sucking urine away from the body. Usage requires the purchase of the drainage system plus daily catheter supplies. This system was often referred to as a female external catheter because it doesn’t require insertion into the bladder to work. While Medicare once covered Purewick, the policy changed in 2021. The system was deemed too expensive and was found medically unnecessary when more cost-effective catheter systems are available. If you want to use this system, you still have the option of purchasing the drainage system and catheter supplies out of pocket.
- Does Medicare Cover Female External Catheters? Female external catheter systems like Purewick are no longer covered by Medicare due to their expense and the number of alternatives available at more reasonable cost.
- Does Medicare Cover external catheters for Males? Medicare does cover external catheters for males when medically necessary. In most cases, that means the beneficiary is unable to manage internal catheters due to physical or mental limitations. For more information, refer back to the Medicare catheter coverage for outpatient usage above.
- How to Compare Medigap Policies, Medicare.
- Medicare Premiums, HealthCare.
- Medicare Deductibles, HealthCare.