Trying to find out is Purewick covered by Medicare? The answer to that question changed in 2021. Below you’ll find the information you need to know about these changes.
The Purewick System is a urine collection system or a catheter. Unlike traditional catheters, Purewick System catheters work on the outside. The Purewick System is designed to keep the skin dry by pulling the urine from the catheter into a sealed collection canister.
If this is something that has been suggested to you, you may be wondering “does Medicare cover Purewick?” In this article, we answer that question in clear, plain English. You will also find the average costs of Purewick catheters and other helpful info.
Does Medicare Cover Purewick?
The short answer is no. While Medicare used to cover them, they unfortunately no longer do. In July 2021, Medicare made the decision to stop covering the cost of Purewick catheters. The reason for this change is said to be that, due to the high cost of the product, Medicare wants more research into how effective/medically necessary the product is.
The device has been very helpful for those who use it and many are, understandably, quite upset at this ruling. The burden of this ruling falls more on women than men. Because, with Purewick external catheters no longer being covered, there are currently no external female catheters that Medicare covers.
Original Medicare (Medicare Part A and Part B) does not provide coverage for Purewick catheters. However, other types of catheters are available under Parts A and B. The catheters must be considered medically necessary in order to be eligible for coverage. Typically, your supply must also be first ordered by your healthcare provider for Original Medicare to provide coverage.
Coverage for catheters is provided by Medicare Part A if the patient is staying in a hospital or an inpatient setting. On the other hand, coverage for catheters is provided by Medicare Part B if it takes place in an outpatient setting.
For male patients, Medicare provides coverage for up to 35 external catheters per month. For women, Medicare will cover one pouch per day (or a metal cup each week).
Under Medicare Part B, Medicare will generally cover catheters if you need them because of a permanent condition. When the catheter is considered to be a prosthetic device, Medicare will usually provide coverage. They will also typically cover them in some other situations, such as hospice care.
Medicare Part B covers 80 percent of the costs of your Purewick catheters. You will pay for the remaining 20 percent as coinsurance.
Part C Coverage for Purewick
Medicare Advantage plans (Medicare Part C) may provide coverage for Purewick catheters. These plans have to cover everything Original Medicare covers. However, they will provide additional benefits as well. What additional benefits they provide and what the costs for these added benefits are will depend on what plan you have.
So, when it comes to Medicare coverage for Purewick, you will need to contact your Part C provider (or, if you are shopping for a Part C plan, the plans you are considering) to see if they will cover Purewick for you.
How Much Does The Purewick Catheter System Cost?
Purewick generally cost between $16 and $20 each. A pack of 30 female external catheters will run anywhere between $450 and $600. This price will vary by vendor.
How Does The Purewick Female External Catheter System Work?
- The first thing you must do is to plug the power cord into the device outlet and into the A/C outlet. Make sure the power switch is off.
- For the second step, place the collection canister in the base. Fully seal the lid by pressing down firmly on the lid of the device.
- You may slip a privacy cover onto the canister before you put the canister into the base. This step is optional.
- Now, attach pump tubing to the Purewick Female External Catheter connector port and the connector port on the collection canister lid.
- Then attach the elbow connector to the collector tubing and connect the elbow connector to the connector port on the collection canister lid.
- Lastly, connect the other end of the collector tubing to the Purewick Female External Catheter.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
Additional Info on Medicare Coverage
This article is part of our series on “What does Medicare cover?”
Also, you can check out other articles in this series including: Does Medicare cover Botox for hyperhidrosis?