Inquiries about Medicare coverage for PureWick external catheters?
Managing incontinence just got a whole lot easier, thanks to innovative solutions like the PureWick system, designed specifically for females during sleep or rest. This system includes an external catheter that extends from the vulva to the buttocks, connected to a tube leading to a collection container.
After a 2024 decision by the Centers for Medicare & Medicaid Services (CMS), Medicare now covers the PureWick system under the durable medical equipment (DME) benefit of Part B. To get a qualifying device, one needs a Medicare-enrolled doctor or healthcare professional to prescribe it for home use—part of the essential medical items Medicare Part B offers coverage for, including hospital beds, walkers, and oxygen supplies.
However, it's essential to note that if an individual already has an indwelling catheter, Medicare won't cover the PureWick system. Moreover, for female catheters, Medicare caps usage to no more than one metal cup or pouch per week. In a hospital setting, catheters would still be covered by Part A.
As for the costs, a box of 30 catheters typically costs around $209 out-of-pocket without insurance. As of 2025, those enrolled in Medicare Part B must meet an annual deductible of $257 and pay a monthly premium of $185. Once these conditions are met, Part B will cover 80% of the approved treatments or services.
Medicare Advantage (Part C) plans, which provide the same benefits as Original Medicare, have premiums, deductibles, and coinsurance that depend on the specific plan. Although most people are exempt from paying a premium for Part A, they must meet a deductible of $1,676, after which Part A will cover their hospital stay and medical devices during that period completely for the first 60 days.
Glossary of Medicare terms
- Out-of-pocket cost: The amount a person must pay for care when Medicare does not cover the total cost or provide coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount someone pays for Medicare coverage.
- Deductible: The annual amount a person must spend out-of-pocket within a certain period before Medicare starts funding their treatments.
- Coinsurance: The percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: A fixed dollar amount a person with insurance pays for certain treatments. For Medicare, this usually applies to prescription drugs.
[1] Medicare coverage for the PureWick external catheter system is available under certain conditions. As of a ruling in 2024 by the Centers for Medicare & Medicaid Services (CMS), Medicare can cover the PureWick system as a form of durable medical equipment. This coverage is typically provided if the device is deemed medically necessary for managing urinary incontinence. Coverage may involve out-of-pocket costs such as deductibles, coinsurance, or copayments. (Source: Enrichment Data)
- Medicare Part B now covers the PureWick external catheter system under the durable medical equipment (DME) benefit.
- To get a qualifying device, a Medicare-enrolled doctor or healthcare professional should prescribe it for home use.
- However, if an individual already has an indwelling catheter, Medicare won't cover the PureWick system, and for female catheters, Medicare caps usage to one metal cup or pouch per week.
- A box of 30 catheters typically costs around $209 out-of-pocket without insurance, and as of 2025, those enrolled in Medicare Part B must meet an annual deductible of $257 and pay a monthly premium of $185.
- Medicare Advantage plans, which provide the same benefits as Original Medicare, have premiums, deductibles, and coinsurance that depend on the specific plan.
- Out-of-pocket costs, premiums, deductibles, coinsurance, and copayments are important Medicare terms that an individual should understand when managing healthcare expenses related to the PureWick system.
