Managing Female Incontinence with PureWick: Your Guide to Medicare Coverage
Can Medicare reimburse for PureWick external urinary catheters?
Navigating urinary incontinence can be tricky, but the PureWick system offers a solution. This innovative external catheter system is designed for women, providing comfort during sleep or rest periods. Here’s a lowdown on how Medicare can help you cover the costs.
The PureWick system consists of an external catheter extending from the vulva to the buttocks, connected to a tube leading to a collection container, which can be placed on a nightstand or table. Thanks to a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS), Medicare now covers the PureWick system under its Durable Medical Equipment (DME) benefit of Part B.
Sex and gender are complex topics that exist on a spectrum. In this article, we use the terms "male" and "female" for simplicity’s sake. For a deeper understanding, learn more about sex and gender.
When is Medicare Coverage for PureWick Triggered?
Medicare Part B offers coverage for DME, which includes vital medical items such as oxygen supplies, walkers, and hospital beds. As long as your healthcare provider is Medicare-enrolled and prescribes a qualifying device for home use, a Medicare-enrolled individual can obtain one.
DME can include external catheters for individuals with permanent urinary incontinence, and as of 2024, Medicare recognizes the PureWick system in this coverage. That said, Medicare will not approve coverage if the individual is using an indwelling catheter simultaneously. Plus, for female catheters, Medicare only allows one metal cup or pouch per week. In a hospital setting, catheters are covered by Part A.
How Much is Medicare's Contribution Towards PureWick?
As per the manufacturer’s website, a box of 30 catheters retails around $209 for those without insurance. Buying in bulk can lead to savings.
In 2025, those enrolled in Medicare Part B will initially need to pay the annual deductible of $257 and then a monthly premium of $185. Once these prerequisites are met, Part B will cover 80% of approved treatments or services.
While Part A usually doesn’t involve a premium for most, a deductible of $1,676 applies. Post this, Part A will cover the patient’s hospital stay, including necessary medical devices during the initial 60 days, completely.
Medicare Advantage (Part C) plans are private plans that equal or surpass the offerings of Original Medicare. The premiums, deductibles, and coinsurance can vary based on the plan selected.
What you should know about Medicare terms:
- Out-of-pocket Costs: These are amounts that individuals must pay for treatments when Medicare does not cover the entire expense. Expenses can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the regular amount individuals pay for Medicare coverage monthly.
- Deductible: This is the annual amount an individual must spend out-of-pocket before Medicare starts to fund treatments.
- Coinsurance: This is the percentage that an individual must pay for treatments once the deductible is met. For Medicare Part B, the coinsurance amounts to 20%.
- Copayment: This is a fixed dollar amount individuals with insurance must pay when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Further Insights:
- Medicare Part B covers the PureWick system under the DME benefit when the device is medically necessary and is ordered by a physician.
- To be eligible for coverage, individuals must meet Medicare’s criteria for using external catheters and have a physician’s order.
- Out-of-pocket costs can depend on whether the supplier participates in Medicare and if you have a Medicare Supplement Insurance (Medigap) policy, as it may cover some or all of the Part B coinsurance, reducing your expenses.
For specific and accurate out-of-pocket costs, reach out to Medicare directly or consult with a Medicare representative. The expenses can vary based on individual circumstances and local suppliers.
- Medicare Part B offers coverage for the PureWick system under its Durable Medical Equipment (DME) benefit, with coverage triggered when a healthcare provider prescribes the device for home use.
- Medicare only allows one metal cup or pouch for female catheters per week, and will not approve coverage if the individual is using an indwelling catheter simultaneously.
- As of 2025, individuals enrolled in Medicare Part B will initially need to pay an annual deductible of $257 and then a monthly premium of $185, before Medicare starts to fund 80% of the approved costs for the PureWick system.
