Does Wellcare Cover Incontinence Supplies?
- Wellcare covers incontinence supplies for Medicaid and Medicare Part C enrollees, but guidelines vary. Understand your coverage to maximize your benefits.
Urinary or bowel leakage caused by illness or injury can affect a person's ability to engage in daily activities, but incontinence supplies, such as adult diapers, may help by managing wetness and controlling odor. However, these items can be costly, especially when used every day.
Fortunately, Wellcare covers incontinence supplies for many plan participants, although coverage guidelines vary depending on whether they're enrolled through Medicaid or Medicare Advantage. If you have medical insurance through Wellcare, here’s what you should know, so you can get the most from your coverage. And if you're ready to go ahead and start shopping, just click the button below.
Does Wellcare Cover Incontinence Supplies?
Wellcare provides medical insurance through government-sponsored healthcare programs. Because these programs typically follow federal or state coverage guidelines, your benefits will vary depending on whether you’re enrolled through Medicaid or Medicare.
Coverage Under Wellcare Medicaid
Although Medicaid benefits vary by state, Wellcare's Medicaid policies typically include coverage for services and supports that are deemed medically necessary by a program-approved physician. An enrollee may be approved for coverage for disposable incontinence supplies, such as protective undergarments and bladder control pads, if they:
- Are between 3 and 20 years old
- Have been diagnosed with chronic incontinence caused by a permanent condition, such as cerebral palsy
- Have had a physical exam and medical history to detect treatable, contributing environmental, medical or situational conditions, such as medication regimens, excessive beverage intake or urinary tract infections
Coverage Under Wellcare Medicare Advantage
Wellcare’s Medicare Advantage plans include an over-the-counter benefit, which provides enrollees with an allowance to spend on OTC products, such as incontinence supplies. Although this allowance may vary by specific plan or region, it may be used to purchase various incontinence products from the company's catalog, including:
- Bladder control pads
- Reusable bed pads
- Male guards
- Adult briefs and other protective undergarments
Beneficiaries may only place one order per month, and products are shipped directly to your home. Any remaining funds are forfeited at the end of the benefit period, which is defined in your contract.
Are Incontinence Products and Urological Supplies the Same?
Although incontinence and urological products both provide essential support for individuals with bladder conditions, these items have distinct functions and fall into different coverage categories under most health insurance plans.
Incontinence supplies are designed to support individuals who experience bladder or bowel leakage. These products typically absorb or contain urine or feces and may help to reduce the associated odor. Incontinence products may include:
- Protective underwear: These disposable undergarments are worn in place of traditional underwear. Because they provide a larger absorbent area and can handle moderate bladder leakage, they may be ideal for overnight use.
- Incontinence briefs: Incontinence briefs, which are often referred to as adult diapers, can be worn under clothing. They’re designed to accommodate both bladder and bowel leakage, and they can handle heavy flow. These garments typically provide a larger coverage area than most protective underwear.
- Bladder control pads: Often thin and discreet, bladder control pads typically have an adhesive backing, so they can be fastened in standard undergarments to handle light urine leakage.
- Male guards: Designed to handle light leakage, male guards are similar to standard bladder control pads but are shaped to suit a man’s needs.
- Booster pads: Booster pads add an extra layer of protection to an existing bladder control product to increase absorbency. They typically don’t have a waterproof side and aren’t meant to be worn alone.
- Penile sheath catheters: Also known as condom catheters, these devices fit over the penis and channel leaked urine into a collection bag, which may be emptied and reused or discarded, depending on the model.
- Bed pads: These large, absorbent sheets can be placed on beds, chairs and other furniture to protect them from leaks. While most bed pads are disposable, some models may be washed and reused.
Urological products are designed for individuals who retain urine and need help eliminating it from the body. Urological products may include:
- Catheters: These narrow tubes are inserted through the urethra, into the bladder, to help trapped urine leave the body. Various types of catheters are available to accommodate different medical needs.
- Drainage bags: Catheters channel urine into these collection bags, which are often designed to be strapped to a leg, so they can be worn by active individuals. Bedside bags, which have a larger capacity, are also available for overnight use or for individuals confined to bed.
- Insertion trays: These kits typically include everything needed to insert a catheter. They often include lubricant, gloves, antiseptic wipes and a disposable under-pad.
Depending on the reason for their use, penile sheath catheters may sometimes be classified as urological supplies, rather than incontinence supplies.
Does Wellcare Medicare Advantage Cover Urological Supplies?
Wellcare’s Medicare Advantage policies must adhere to federal Medicare guidelines, which state that Part C plans must provide benefits equal to or greater than those of Original Medicare. Under these rules, Wellcare MA plans must cover at least 80% of the cost of medically necessary urological supplies if an enrollee has received a qualifying diagnosis, such as permanent urinary incontinence, and has met the applicable annual deductible.
To receive coverage, a beneficiary typically must have a prescription from a physician and may need to provide documentation of medical necessity, including:
- A diagnosis and prognosis
- Prior or current treatments, including actual or anticipated outcomes
- Prior history of urinary catheter use
- Relevant physicians’ notes
Medicare Advantage plans may vary significantly by region and policy type. To find out what your plan covers, you should contact an authorized Wellcare representative.
Does Wellcare Medicaid Cover Urological Supplies
Medicaid guidelines vary by state, so depending on where you live, Wellcare Medicaid may cover incontinence supplies if they’re medically necessary, as assessed by a plan-approved physician. In some areas, Medicaid may also cover supplemental items for incontinence care, such as gloves and antibacterial wipes. To find out more about what Wellcare Medicaid covers in your area, you may contact an authorized Wellcare agent or a local Medicaid representative.
What Organizations Provide Financial Assistance for Incontinence Supplies?
If your insurance doesn’t cover the cost of incontinence supplies, you may be able to get help through the following federal or local resources:
- S. Department of Veterans Affairs: Veterans who demonstrate a medical need for incontinence supplies may receive financial assistance purchasing products, such as adult diapers, through their VA benefits. To find out how to qualify, visit the U.S. Department of Veterans Affairs online or make an appointment at your local benefits office.
- Adult diaper banks: In many cities, adult diaper banks supply incontinence products to low-income individuals. To qualify for assistance, you may be required to demonstrate financial need. Interested parties may visit the Directory of U.S. Diaper Banks to find help in their area.
Seniors who don’t qualify for assistance through one of the aforementioned organizations should contact their local aging services organization or social services office for help finding additional resources in their area of residence.