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Does Medicare Cover Catheters


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.

Indwelling Catheter

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 Catheter

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.

Condom Catheter

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 their 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 consider 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 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.

Lindsay Malzone

Lindsay Malzone is the Medicare expert for MedicareFAQ. She has been working in the Medicare industry since 2017. She is featured in many publications as well as writes regularly for other expert columns regarding Medicare. You can also find her over on our Medicare Channel on YouTube as well as contributing to our Medicare Community on Facebook.

19 thoughts on “Does Medicare Cover Catheters

  1. Will Medicare pay for Catheters for a 86 year old man that had a stroke and now has incontinence .. We live in Mississippi and they won’t cover diapers, so I pray they will cover the Catheters.. ???

  2. It is discrimination that Medicare will cover condom (external) catheters for men, but they will not cover external (Purewick) catheters for women!

  3. Will Medicare cover a PureWick Female External Catheter system for a morbidly obese diabetic bed-bound woman who lives in an ALF? She has horrible skin breakdown issues as a result of both urine incontinence and pressure on her buttock/coccyx. I have an order written for this, but need to know about insurance coverage before proceeding with the order.

    1. Hi Karen. Unfortunately, Medicare announced last month they’re no longer covering the PureWick catheter.

      1. I don’t understand this, Medicare paid for my mother to get the system and her first 30 days of supplies, now they no longer cover them. It just cost her $195 for a month’s supply.

      2. Hi Janine. Unfortunately, Medicare updated its coverage guidelines to no longer cover PureWick. We have been unable to find out the reason why.

  4. Will medicare cover a system like the pure wick if it is a medical necessity? Where might I get one from an approved source?

  5. Our issue is that the only supplier we can locate (Liberator Medical) is not approved by Medicare for reimbursement. Even DMR are denied due to not being an approved supplier. Any suggestions?

  6. Will Medicare cover external condom catheters for incontinence. I had prostate surgery for cancer 12 weeks ago and I have a new city parks mowing job this summer that requires me to be outside and away from restrooms for 5-6 hours at at a time. I have been using pull-.ups and pads but they don’t handle my the incontinence very well. The length of my incontinence is uncertain at this point but it does not seem to have improved since the surgery.

    1. Hi Rod! Yes, Medicare will cover 35 external catheters per month for men. These benefits would fall under Part B. I hope this helps!

  7. I am permanently paralyzed from chest down and transfer to bed to cath six times daily. I can not transfer to toilet to cath. Will Medicare cover enclosed system cathers?

    1. Hi Michelle. Yes, if your doctor says it’s medically necessary then Medicare will cover it. Part B covers up 200 sterile-use intermittent catheters and individual packets of sterile lubrication per month.

    1. Hi Monica! Yes, Medicare will reimburse you for PleurX costs for both short-term and long-term patient needs. How much you’re reimbursed depends on your specific situation. Your doctor should be able to help give you an estimate on how much you will pay upfront and how much Medicare will reimburse you.

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