Medicare's coverage regarding external catheters, specifically the PureWick brand, is under question.
Laid-back Guide to Medicare Coverage for PureWick External Catheters
In the realm of managing incontinence, innovations like the PureWick system are shaking things up, particularly for females. This bedtime buddy consists of an external catheter that snakes from the vula to the buttocks, connecting to a collection container that can be conveniently placed on a nightstand or table.
The Cat's Pajamas, aka the Centers for Medicare & Medicaid Services (CMS), deemed the PureWick system eligible for coverage under the durable medical equipment (DME) benefit of Part B in 2024. Yes, you read that right – Medicare is stepping up to foot the bill for this bad boy.
But before you start thinking about all the fun duvet days ahead, remember that the fine print still applies. A certified Medicare-enrolled doc or healthcare pro will need to prescribe this babymaker for you to score one. And if you're already rocking an indwelling catheter, forget about double-dipping – Medicare won't play ball. Plus, for female catheters, Medicare caps usage at one metal cup or pouch per week.
So, how much will the government cough up for this thing? According to the manufacturer's website, a box of 30 catheters will set you back around $209 if you don't have insurance; however, buy in bulk, and you'll net some savings. Once you've met the annual deductible of $257 and paid the monthly premium of $185 (as of 2025), Part B will cover 80% of the costs, leaving you with the remaining 20%.
Now, let's not forget about the almighty Part A. Most folks are off the hook for premiums, but they're not entirely out of the woods – they still need to drop $1,676 before Part A steps in to cover hospital expenses and medical devices during that period, fully, for the first 60 days. Lastly, Medicare Advantage (Part C) plans may offer varying premiums, deductibles, and coinsurance based on your chosen plan.
Of course, there's a shed-load of jargon floating around all this, so let's simplify things: Out-of-pocket cost refers to what you pay out of your own pocket if Medicare doesn't cover everything; premium is the monthly fee you pay for Medicare coverage; deductible is the yearly amount you must spend before Medicare starts chipping in; coinsurance is the percentage of costs you must cover yourself; and a copayment is a flat fee you may pay for certain treatments.
[1] Center for Medicare and Medicaid Services[2] National Council on Aging[3] Medicare Learning Network[4] Medicare.gov[5] National Association for Continence
- The Centers for Medicare & Medicaid Services (CMS) has approved PureWick external catheters as eligible for coverage under the durable medical equipment (DME) benefit of Medicare Part B, starting in 2024.
- It's essential to note that, despite Medicare coverage, a certified Medicare-enrolled doctor or healthcare professional will still need to prescribe the PureWick system for you to obtain one.
- For female users, Medicare caps the usage of the PureWick system at one metal cup or pouch per week.
- Numerous medical-conditions relating to health-and-wellness, including women's health, may be managed better with the aid of modern healthsystems and solutions like the PureWick external catheter, thanks to advancements in science and medical-conditions research.
