Medicare covers urinary catheters and other medical supplies that a doctor says is medically necessary. Health care professionals may suggest a urinary catheter for certain health conditions.
The U.S. National Library of Medicine classifies a urinary catheter as a tube which drains urine from an individual’s bladder.
Some of these conditions include urinary incontinence, prostate or genital surgery, spinal cord injury and urinary retention. Diseases like MS (multiple sclerosis), dementia and others can cause complications with urinating.
Does Medicare Cover Urinary Catheters
The medical conditions associated with the need for urinary catheters increase with age. Most adults nationwide have Medicare health insurance coverage once they turn 65. So, what does Medicare cover for urinary catheters?
Medicare is always changing and adjusting their coverage and reimbursement guidelines. This makes it difficult for beneficiaries to understand their catheter coverage through Medicare.
Coverage depends on the type of catheter and the medical reason for it. Although, the type of facility may also determine what benefits are available.
Benefits include other catheter supplies like irrigation kits, bedside drain bags, leg bags, irrigation syringes, and extension tubing.
Types of Urinary Catheters
Before talking to a health care provider about the right device, patients should understand the different types of catheters available. For some, there may be possible options when deciding.
Medicare offers coverage for many types and different styles of urinary catheters. Patients with permanent (or conditions last 3+ months) urinary incontinence or urinary retention may receive coverage for catheters.
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.
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. 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 the 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 (while on intermittent cath.), and pregnant females with spinal cord injuries with neurogenic bladders.
Medicare Coverage for Urinary Catheters
Many health insurance companies provide benefits for each type of catheter and some insertion supplies. Original Medicare (Parts A and B) and some Medicaid state programs may help pay for a certain amount of these costs each month.
Supplement or Medigap plans may cover all or most out-of-pocket expenses for urinary catheters. Many beneficiaries enroll in a Medigap policy to help cover gaps for what Parts A and B don’t pay for.
Part A & Part B for Urinary Catheters
When using a catheter during a formal hospital admission, at a Medicare participating facility, Part A (hospital insurance) may cover the costs. This includes inpatient surgery.
Although, Part B (medical insurance) includes expenses that are part of medical procedures. However, they must be given to the patient 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 pays any costs when it’s a medical necessity. Patients receiving home health care may find the cost of a catheter is part of their overall home health care benefits.
Alternative Coverage for Urinary Catheters
Other options such as a Medicare Advantage plan or a Medicare Supplement (Medigap) plan may pay for urinary catheter expenses. The level of benefits depends on the beneficiary’s individual situation or circumstance.
Enrolling in a Medigap plan often comes with extra coverage for some out-of-pocket costs. Including, copayments coinsurance and deductible amounts. However, the costs of both Medigap and Advantage plans will vary among the carrier.
Enrollees should contact their Medicare agent or plan directly to ask about coverage options. If you’re still unsure if your services or health care needs are covered by your plan, we understand. Better yet, we can clear up any confusion, at no additional cost to you.
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Give one of our licensed Medicare agents a call today at the number above. We can help you find the best catheter option for your medical needs. Using an agent can help ensure you’re getting all the health insurance benefits available.
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