Does Medicare Cover Catheters?
- Does Medicare cover catheters and incontinence supplies? Learn what you need to know about your Medicare coverage, copayments, and how to pay for your supplies.
Does Medicare cover catheters? In certain situations, you can definitely receive coverage for a wide range of catheters. In order to be covered, your doctor must document a medical need for steady catheter usage for a period lasting three months or longer. If you require the use of additional supplies for the treatment of urinary incontinence, these supplies are also covered. Those on Medicare Advantage are also covered, but if you’re on an Advantage plan, you should review your policy to learn more about your copayment for these supplies.
What Part of Medicare Covers Catheters?
If you require catheters during a hospital stay, Medicare Part A will cover 80% of the cost after you’ve met your deductible. Medicare Part A also covers catheters if you’re staying in a nursing facility or receiving home health care. If you are prescribed catheters for use outside of inpatient care, you’re covered under Medicare Part B. Just as with Medicare Part A, you must meet your deductible before your copayment comes into effect.
Your deductible and copayment on a Medicare Advantage plan will vary based on the plan you’ve selected. Since Advantage plans are facilitated by private insurers, you may pay less for your supplies than on a Medicare Part A or B plan. Since these supplies are covered under traditional Medicare, all Advantage plans must provide coverage for them.
Medicare Supplement plans can offset the out-of-pocket expenses associated with medical equipment. As you are required to pay 20% of the cost for your supplies, you may wish to enroll in a Medicare Supplement plan for additional coverage. These policies will help you with the 20% copay after you’ve met a certain deductible.
Do I Need a Prescription to Buy Catheters?
You do need a prescription to purchase catheters. They aren’t available over the counter and your doctor will need to provide a reason that they are medically necessary. Your doctor must indicate what type of catheter you need and how many are being prescribed each month in order for you to fill your prescription. There are many suppliers that will send you these supplies on a monthly basis, or in bulk quantities that will last up to three months per shipment.
How Many Catheters Will Medicare Pay for Per Month?
The number of catheters that Medicare will cover depends on the type of catheter and your need for them. Here are some of the different catheters you might be prescribed.
- Closed System Catheters: These catheters are only available for Medicare recipients who have an elevated risk of infection. They are connected to a drainage bag and the catheters themselves are prepared for use out of the package so that you don’t need to touch them directly.
- Indwelling Catheters: Indwelling catheters are inserted by a physician and drain into a bag like closed system catheters. They do not need to be changed frequently, so Medicare will cover one of them each month.
- Single-Use Catheters: As the name suggests, these catheters are for a single-use and are disposed of after they are used. You may be covered for up to 200 single-use catheters each month.
Discuss your need for catheters with your doctor to make sure that you are prescribed a brand and type that works with you and your coverage. If you need additional help affording your medical supplies, you can enroll in a Medicare Supplement plan, Medicaid, and local assistance programs for those who need financial help.