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Wondering why Medicare stopped covering Purewick catheters and what that means for you? You’re not alone. This change hits women especially hard, as Medicare isn’t covering any other similar external catheters for women right now.
We know figuring out healthcare costs can be a headache, so we’re here to break it down for you. In this article, you’ll learn:
- Why Medicare decided to stop paying for Purewick and who’s most affected.
- What kind of catheter Medicare coverage can you expect from different Medicare plans?
- The actual cost of Purewick catheters and how they compare to other options.
- How Purewick can help with urinary issues and why you might still want to consider it
So if you want to get a handle on this change and see what your options are, keep reading. We’ve got the info you need.
Table of Contents
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. Hopefully, they’ll get this soon and provide coverage again.
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 similar 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.
Medicare Advantage (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?
The cost of a single Purewick catheter typically ranges from $16 to $20. If you’re looking to buy in bulk, a pack of 30 can set you back between $450 and $600. Keep in mind that these prices can differ depending on where you buy them.
PureWick: What It Is and Why It’s Needed
The PureWick system is used to manage urinary leaks in women without invasive methods. It features a soft, flexible wick that directs urine into a sealed container.
The wick is attached close to the urinary opening with an adhesive strip, and the container can be secured to the leg or abdomen for later emptying.
Pros and Cons
The PureWick system is easy to use and can be worn for up to 8 hours. It’s also discreet enough to wear under clothes and helps keep your skin dry. But it’s not perfect.
It can be uncomfortable, may leak if not put on right, and might not work well for people with really bad bladder issues.
The PureWick system is commonly used by women facing various bladder control issues. This includes those who have stress urinary incontinence (SUI) or urge urinary incontinence (UUI).
The system is also an option for individuals who cannot use other bladder control products due to past surgeries or severe issues.
How Does The Purewick Female External Catheter System Work?
- The first thing you must do is 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 the 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.
Alternatives to PureWick
Devices like PureWick, PrimaFit, and Versette are designed to collect urine in a bag and are called external collection devices. These offer a simpler alternative to internal catheters and may reduce the risk of urinary tract infections.
Costs can vary by brand, and Medicare Part B generally covers some of the expense, although some out-of-pocket costs may still apply.
Both men and women can use urinals, which are straightforward tools for collecting pee in a bottle or bag. They work well for people who can stand or sit up but might not be good for those who have to stay in bed or can’t move around easily.
They’re not too expensive, and Medicare Part B can help pay for them, although you might still have some costs.
Absorbent products like adult diapers and pads are options for managing bladder control issues, but they can become costly if used long-term.
These products are generally effective, although they may not be the right fit for individuals with severe bladder problems or those who have skin concerns. It’s worth noting that Medicare Part B doesn’t cover the cost of these items.
Medicare stopped paying for Purewick catheters in July 2021. This is a big deal for women because Medicare isn’t covering any other external catheter options like Purewick for them right now.
We also looked at what other help you might get from different Medicare plans. Plus, we talked about how much Purewick catheters can cost you out-of-pocket. All this info can really help you decide what to do next if you’re dealing with bladder issues.
Understanding available healthcare options is important, especially in light of Medicare’s withdrawal of support for Purewick.
Whether examining different types of catheters or other insurance plans, the information provided here is pertinent for those who rely on urinary incontinence solutions.
If this article has been informative, consider sharing it or leaving a comment below to discuss experiences or thoughts on navigating Medicare coverage.
Frequently Asked Questions
Will Medicare Cover Other External Female Catheters?
Possibly. Medicare states it will cover external catheters for women as an alternative to an indwelling catheter. This is allowed for those who have permanent urinary incontinence.
Who Shouldn’t Use Purewick?
People who are anxious, uncooperative, or prone to remove the device should not use Purewick. It’s also not advised for persons with recurrent gastrointestinal troubles without a management system or skin sensitivity at the application site. Use caution to avoid skin damage during placement or removal.
How Many Catheters Will Medicare Pay for Each Month?
Medicare usually covers up to 200 catheters each month, or one per time you need to use it. Different insurance plans might offer different amounts, so make sure to check with your own plan to see how many catheters they will cover for you each month.
Do You Have to Get a Prescription in Order to Get External Catheters?
Some pharmacies may need to order catheters and drainage bags if a doctor recommends them. It’s best to keep plenty on hand while waiting for the next order.
Will Medicare Cover In-Home Catheter Care?
Yes, Medicare can pay for home health care if you meet certain rules. They can cover skilled nursing help like giving shots, catheter, changing tubes, checking your health, and treating wounds.
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
Also, you can check out other articles in this series on topics such as Medicare coverage for deviated septum surgery and does Medicare cover laser toenail fungus treatment.