Does Medicare Cover Catheters?

Medicare Part B may cover catheters, but usually only if it is due to a permanent condition and under certain circumstances, such as during hospice care.

A catheter can be used to relieve symptoms related to urinary retention, urinary incontinence, prostate or genital surgery and various other medical conditions.

Medicare Advantage (Part C) plans may also cover catheters that are deemed medically necessary by your doctor.

Some Medicare Advantage plans may also cover other things that Original Medicare (Part A and Part B) doesn’t cover, such as prescription drugs or certain modifications to your home for in-home care.

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What medical supplies are covered by Medicare?

Medicare Part B medical insurance covers certain devices and equipment that are classified as durable medical equipment (DME).

Catheters and incontinence supplies are not typically considered durable, because they don’t withstand repeated use.

Catheters can be covered by Medicare, however, when they are considered a prosthetic device that is ordered by your doctor to treat permanent urinary incontinence. This type of catheter is commonly called a Foley catheter, or an indwelling catheter.

  • If you have a permanent urinary condition, Original Medicare may cover one indwelling catheter each month.

  • Medicare may also cover up to 35 external catheters per month for men, and no more than one metal cup per week (or one pouch per day) for women.

Depending on whether your catheter is used while as an inpatient in the hospital or used while at home, Part A or Part B may cover the costs of your catheter.

  • The hospital and inpatient care costs related to the catheter and catheter placement are typically covered by Medicare Part A (hospital insurance).

  • Any doctor’s services related to the catheter or catheter placement are typically covered by Medicare Part B.

How much does a catheter cost with Medicare?

Even if Medicare covers your catheter, there are some out-of-pocket costs you should expect to pay, which may include:

  • Part A deductible
    The Medicare Part A deductible is $1,364 per benefit period in 2019.

You could potentially experience more than one benefit period in a given calendar year, since the Part A deductible is not based on an annual period.

  • Part B deductible
    Medicare Part B deductible in 2019 is $185 per year. You must meet the deductible before your Part B coverage kicks in.

  • Part B coinsurance or copayment
    Once you meet your Part B deductible, you typically pay 20 percent of the Medicare-approved amount for most doctor’s services.

    There is no limit annually on how much you could pay for the Part B coinsurance in a specific year.

Talk to your doctor directly for specific cost and coverage information related to your catheter.

Medicare Advantage plans may cover catheters

Medicare Advantage plans are sold by private insurance companies and are required by law to cover everything that Part A and Part B cover.

If your catheter is covered by Original Medicare, it will also be covered by a Medicare Advantage plan.

Most Medicare Advantage plans offer prescription drug coverage. Some Medicare Advantage plans also offer additional benefits, such as:

Call to speak with a licensed insurance agent to learn more about Medicare Advantage plans that are available where you live and how they may be able to cover some of your health care costs. Not all plans or benefits are available in all areas.

 

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