Will Medicare Pay For Incontinence Supplies?

Incontinence is the inability to control the bowels or bladder. Incontinence occurs with aging and certain diseases. Incontinence can require expensive supplies to keep skin and other surfaces clean and dry so skin breakdown and infections can be avoided.

This article explores whether Medicare will pay for incontinence supplies and how to obtain them if the entire cost isn't covered.

What is considered incontinence supplies?

Incontinence supplies are any DME (durable medical equipment) to aid in the management of incontinence. Many incontinence supplies are available, including urine collection devices, such as catheters and absorbent pads, and some offer skin protection. Examples of incontinence supplies include:

• Indwelling catheters
• External catheters-condom/Texas/PureWicks
• Adult diapers
• Depends/incontinence underwear
• Catheter insertion kits
• Urinary drainage bags
• Disposable underpads (Chux)
• Creams/salves/lotions/skin care products

Medicare does not consider all supplies to be medically necessary for the treatment of incontinence. While they may benefit an individual with incontinence, Medicare might not provide coverage.

Are incontinence supplies covered by Medicare?

Incontinence supplies are covered by Medicare only when the item is considered non-disposable and a medically necessary DME. This excludes adult diapers, briefs, and incontinence underpads (Chux). These items are regarded as disposable absorbent pads. Medicare does cover external and indwelling catheter supplies when there is a determination that the products are medically necessary.

The exception to the rule about disposable products is Medicare's hospice benefit. Patients can receive one package of incontinence underpads and one package of adult briefs every two weeks while in hospice care. The patient and caregivers are responsible for purchasing any additional products if needed.

Medicare coverage for incontinence supplies

Incontinence supplies covered by Medicare include non-absorbent supplies. A beneficiary must have a medical necessity for coverage to be provided. Coverage is through the prosthetic benefit provision of Medicare Part B. A beneficiary must have a diagnosis of permanent urinary incontinence or retention. Urinary retention is the inability to empty the bladder effectively. Medicare guidelines require retention or incontinence to last longer than three months.

Medicare covers one drainage bag per month for Medicare patients with urinary incontinence or retention who use indwelling or external catheters with drainage bags. Supplies related to the use of catheters, such as insertion kits and adhesive devices, are also covered.

Does Medicare cover adult diapers?

Medicare does not cover absorbent pads, including adult diapers. The only urinary incontinence products covered by Medicare are non-absorbent supplies deemed medically necessary for managing urinary incontinence. While Original Medicare does not cover adult diapers, some Medicare Advantage (Medicare Part C) plans may.

Does Medicare cover depends?

Depends (disposable underwear for urinary incontinence) are considered absorbent urinary incontinence products. They are disposable and available over the counter and not covered by Medicare. Some Medicare Advantage plans offer coverage for these products, but there may be limits such as the amount allowed or the brand used.

Will Medicare pay for catheters?

Medicare will pay for catheters when deemed medically necessary to manage urinary retention or incontinence. There are multiple different types of urinary catheters that Medicare covers. They include:

• Indwelling-foley
• Suprapubic-catheters (inserted through a surgically made tract in the abdomen)
• External-condom/Texas/Purewick/female meatal cups

Medicare also covers any supplies related to catheter maintenance, including insertion kits, adhesive securement devices, and urinary drainage bags.

Can I get free incontinence supplies with Medicare?

To qualify for free incontinence supplies through Medicare is to have a medical necessity. Urinary incontinence or retention that lasts longer than three months are diagnoses that qualify. Even with these diagnoses, Medicare only covers certain incontinence supplies such as catheters. You'll need to meet with a medical provider to document the need for coverage of a DME.

How else can you pay for incontinence supplies?

Incontinence supplies can be paid out of pocket or with a Medicare Part C plan. Not all Medicare Part C plans offer coverage for disposable DME, and some may have limitations, such as the brand or number of packages in a qualifying period. Paying out of pocket for supplies can be costly, and if you find you will be using supplies long-term, a Medicare Part C plan may be a good option.