Medicare covers catheters and related medical supplies that a doctor says is medically necessary. Coverage depends on the type of catheter and the medical reason for it. The type of facility may also determine what benefits are available. Benefits also include catheter supplies like irrigation kits, bedside drain bags, leg bags, irrigation syringes, and extension tubing.
Medicare Catheter Coverage
Some conditions that may need the use of a catheter include urinary incontinence, prostate or genital surgery, spinal cord injury, and urinary retention. Diseases like multiple sclerosis, dementia, and others can cause complications with urinating.
The health condition of a person determines if the use or need is either short or long term. Under certain circumstances, catheters may only be necessary for a short time. Like, during a medical procedure or while staying in the hospital. For some, the bladder function and/or muscles for controlling urination stop working properly. This may require long-term catheter use.
What Types of Catheters Does Medicare Cover?
Medicare covers many types and styles of urinary catheters. Patients with permanent or temporary (conditions last 3+ months) urinary incontinence or urinary retention can receive coverage for catheters.
These are available for both men and women. Insertion is done through the urethra. Sometimes a surgical hole is made in the stomach. this connects with the bladder directly; allowing the bladder to drain into a bag.
Intermittent catheters are an option for both men and women. This type of catheter is more part-time than full-time. Patients use them as they need them rather than continuously. Intermittent styles can vary; some may be a straight or coudè tip.
Styles are only available for men. The reason being, this option is like a sheath nothing is put into the urethra like the other types. This sheath allows the bladder to drain into a bag from a tube at the tip of the catheter. Although, patients must change them daily.
Closed system catheter
Closed systems are another type of intermittent catheter. Systems come in a self-contained, sterile collection bag, pre-lubricated and ready to go. Due to its design, these systems are more sanitary than other options because there’s no need to touch the catheter tube directly. Limiting the risk of urinary tract and bladder contamination and infections.
Medicare offers a closed catheter system only to patients meeting the specific criteria. Common requirements like recurrent urinary tract infections during a program of intermittent cath.
Other qualifying factors include living in a nursing facility, patients with vesicoureteral reflux, and pregnant females with spinal cord injuries with neurogenic bladders.
Inpatient Coverage for Urinary Catheters
When using a catheter during a hospital admission, at a Medicare participating facility, Part A covers the costs. You may be responsible for the deductible of $1,484 unless you have a supplement plan.
Outpatient Coverage for Urinary Catheters
Part B covers procedures done in an outpatient setting, like a doctor’s office. Part B provides coverage for 1 indwelling-catheter per month. For men, up to 35 external catheters are allowable monthly. Benefits may also include different administration and sanitation products like leg straps or anchor devices.
Beneficiaries may receive about 200 intermittent single-use catheters each month. This allows for proper sanitation when changing catheters. Although, the standard is the straight tip catheter; coverage for the Coude-tip is available only when medically necessary.
Some permanent medical conditions requiring a catheter considers it a prosthetic device. Meaning, they need it to properly use a certain part of the body due to lack of ability. In this case, Medicare will help cover the costs when it’s a medical necessity.
How to Get Help with Catheter Coverage with Medicare
Medigap plans will cover all or most out-of-pocket expenses for urinary catheters after Medicare pays their portion. Part B will cover 80% of the cost, and your Medigap plan will cover the remaining 20%. Without a supplemental plan, you’ll be responsible or 20% of the cost of the urinary catheter and supplies.
Give one of our licensed Medicare agents a call today at the number above. We can help you find you an affordable supplement plan to help fill in the gaps in Medicare coverage. We can compare Medicare Supplements, Medicare Advantage, and Part D. If you can’t call us, fill out an online rate comparison form to see all available policies in your area side by side now.