Medicare's coverage for PureWick external catheters: A query examined
Managing Incontinence with PureWick: A Guide to Medicare Coverage
Say goodbye to messy mishaps with urinary incontinence! One innovative solution is the PureWick system, designed with females in mind for use during sleep or rest. This system consists of an external catheter extending from the vulva to the buttocks, connected to a tube leading to a collection container that can be positioned on a nightstand or table.
Good news for those who need this lifesaver—as of a 2024 ruling by the Centers for Medicare & Medicaid Services (CMS), the PureWick system falls under the durable medical equipment (DME) benefit of Medicare Part B.
But wait, there's more! Here’s what you should know:
PureWick: Who, What, and When
Sleep better knowing your PureWick system is covered by Medicare and classified as DME, including essential medical items like oxygen supplies and hospital beds. A qualified doctor's prescription is needed, and coverage is available for home use.
DME may cover external catheters for individuals with permanent urinary incontinence, with the PureWick system becoming part of the coverage circle as of 2024.
However, be mindful that Medicare won't cover the device if you also have an indwelling catheter. Also, for female catheters, Medicare limits usage to one metal cup or pouch per week. In a hospital setting, catheters will be covered by Part A.
Glossary
- Out-of-pocket cost: Payment from the beneficiary for care when Medicare doesn't cover everything.
- Premium: Amount paid per month for Medicare coverage.
- Deductible: Amount paid out of pocket each year for treatments.
- Coinsurance: Percentage of treatment costs paid by the beneficiary.
- Copayment: Fixed dollar amount paid per treatment by the beneficiary.
Unlocking PureWick's Price Tag
The manufacturer's website lists a box of 30 catheters at approximately $209 out-of-pocket without insurance. Bulk purchases can save you some cash! As of 2025:
- Medicare Part B enrollees must meet the annual deductible of $257 and pay a monthly premium of $185. Afterward, Part B covers 80% of approved treatments or services.
- Most Medicare Part A enrollees are exempt from paying a premium but must meet a deductible of $1,676. Afterward, Part A covers their hospital stay and any necessary medical devices during that period, fully for the first 60 days.
- Medicare Advantage (Part C) plans provide the same benefits but have premiums, deductibles, and coinsurance that vary depending on the plan.
The Bigger Picture
In 2024, CMS confirmed that Medical can cover the PureWick external catheter system, typically under the DME category. To qualify, the PureWick system must be prescribed by a physician and deemed medically necessary for urinary incontinence management. You can expect out-of-pocket costs, including the Medicare Part B deductible and 20% coinsurance for DME.
Some suppliers help beneficiaries navigate insurance coverage processes, like RA Fischer, making it easier to obtain approvals and reimbursements. Depending on your state, policy clarification documents may reference the PureWick system as an external catheter for documentation purposes.
- As of a 2024 CMS ruling, the PureWick system is classified as durable medical equipment (DME) and falls under the Medicare Part B coverage for those managing urinary incontinence.
- A qualified doctor's prescription is required to secure Medicare coverage for the PureWick system, which is considered an essential medical item, like oxygen supplies and hospital beds.
- Coverage for the PureWick system at home is available for those with permanent urinary incontinence, but it does not cover use if an indwelling catheter is already in place.
- For female catheter users, Medicare limits the usage of one metal cup or pouch per week, keeping costs in check.
- As of 2025, Medicare Part B enrollees must pay an annual deductible of $257, a monthly premium of $185, and then Part B covers 80% of the costs for the PureWick system.
- Some suppliers, like RA Fischer, exist to help Medicare beneficiaries navigate the insurance coverage process for products like the PureWick system, making it easier to obtain approvals and reimbursements.
