Medicare's coverage of PureWick external catheters: a question answered?
Managing incontinence just got a whole lot easier, thanks to the PureWick system, an invention that's specifically designed for women to utilize during sleep or rest. This innovative setup consists of an external catheter that extends from the vulva to the buttocks, connected to a tube leading to a collection container that can be placed on a nightstand or table.
The Centers for Medicare & Medicaid Services (CMS) made a significant move in 2024, declaring that the PureWick system would be covered under the durable medical equipment (DME) benefit of Medicare Part B. This means that if a Medicare-enrolled healthcare provider prescribes the PureWick system for home use, it is considered a qualifying device and covered by Medicare.
However, it's essential to note that the PureWick system will not be covered when an individual already has an indwelling catheter or if they exceed the Medicare-imposed limit of one metal cup or pouch per week for female catheters. In a hospital setting, catheters are covered under Medicare Part A.
Now, let's talk numbers. A box of 30 PureWick catheters costs about $209 for those paying out-of-pocket without insurance, but purchasing them in bulk can save money. As for Medicare, enrolled individuals 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 costs for the device.
It's also worth mentioning that Part A coverage comes with its own costs, including a deductible of $1,676, but after this deductible is met, Part A covers the hospital stay and any necessary medical devices during that period fully for the first 60 days.
Medicare Advantage (Part C) plans, which are private plans that must provide the same benefits as Original Medicare, may have different premiums, deductibles, and coinsurance amounts depending on the chosen plan.
Lastly, here's a glossary of Medicare terms:
- Out-of-pocket cost: The amount an individual must pay for care when Medicare does not cover the total amount or the care in question. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: The monthly amount a person pays for Medicare coverage.
- Deductible: The annual amount an individual must spend out-of-pocket before Medicare starts to pay for their treatments.
- Coinsurance: The percentage of treatment costs an individual must self-fund.
- Copayment: A fixed dollar amount an individual with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
- The PureWick system, designed for managing incontinence, will be covered under Medicare Part B's durable medical equipment (DME) benefit starting in 2024.
- If a Medicare-enrolled healthcare provider prescribes the PureWick system for home use, it becomes a qualifying device that is covered by Medicare.
- However, the PureWick system will not be covered if an individual already has an indwelling catheter or exceeds the Medicare-imposed limit of one metal cup or pouch per week for female catheters.
- A box of 30 PureWick catheters costs approximately $209 without insurance, but buying in bulk can help save money.
- Medicare enrolled individuals must meet an annual deductible of $257 and a monthly premium of $185, after which Part B covers 80% of the approved costs for the device.
- It's important to note that out-of-pocket costs, premiums, deductibles, coinsurance, and copayments are key components of understanding the financial implications of Medicare coverage for health systems, medical conditions, health-and-wellness, women's health, and other medical devices.
