by Russell Noga | Updated January 1st, 2024
Is Purewick Covered by Medicare?
Imagine waking up in the middle of the night to find yourself in a puddle of urine.
The embarrassment, frustration, and discomfort are all too familiar for those dealing with urinary incontinence.
Purewick catheters can be a game-changer in managing this condition, but is Purewick covered by Medicare?
In this blog post, we’ll explore the ins and outs of Purewick coverage under Medicare and provide tips on how to save money on this innovative solution.
Key Takeaways
- Understanding Medicare coverage for Purewick catheters requires consulting healthcare provider and insurance plan.
- Original Medicare does not cover Purewick, but covers certain other types based on medical necessity.
- Alternatives to Purewick covered by Medicare are available such as intermittent and indwelling catheters, adult diapers/briefs. Cost savings strategies include discounts/deals and bulk purchasing.
Understanding Medicare Coverage for Purewick
Urinary incontinence is a common problem, and Medicare coverage for the Purewick catheter system isn’t straightforward. While Original Medicare doesn’t cover Purewick catheters, some Medicare Advantage plans could offer this coverage.
It’s vital to grasp the intricacies of Medicare coverage and consult both your healthcare provider and insurance plan to understand your alternatives.
Original Medicare and Purewick
Original Medicare, which includes Medicare Part A and Part B, does not cover Purewick catheters.
This is because Purewick is considered an external catheter used for urine management, and Medicare only covers certain types of catheters, such as foley catheters, for incontinent patients.
However, Original Medicare does cover other types of catheters based on medical necessity, such as intermittent and indwelling catheters. For a catheter to be covered under Original Medicare, it must be medically necessary, prescribed by a doctor, and supported by medical records.
So, while Purewick may not be an option under Original Medicare, there are other catheter alternatives that could be covered to help manage urinary incontinence.
Medicare Advantage Plans and Purewick
Private companies approved by Medicare offer Medicare Advantage plans, also known as Part C. These plans provide coverage for the same services as Original Medicare, including Medicare Part B, and may offer additional benefits such as vision, hearing, and dental coverage.
Coverage for Purewick catheters under Medicare Advantage plans varies from plan to plan, so it’s crucial to check with your specific plan for details.
The cost-sharing for Purewick catheters under Medicare Advantage plans also varies. Some plans may cover the cost of the catheter. Others only reimburse costs for related supplies and services.
To get a clear picture of your Medicare Advantage plan’s coverage for Purewick catheters, visit the plan’s website or contact their customer service.
Doing so will enable you to make an informed decision on whether the Purewick catheter system is a practical solution for managing your urinary incontinence.
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Alternatives to Purewick Covered by Medicare
Don’t worry if your Medicare plan doesn’t cover Purewick catheters. Medicare does cover various alternatives to Purewick, including intermittent catheters, indwelling catheters, and adult diapers or briefs.
Each of these options has its own set of benefits and drawbacks, and the best choice will depend on your individual needs and preferences.
Intermittent Catheters
Intermittent catheters are an option available to both male and female patients. These catheters are used on a part-time or full-time basis, as needed by the patient, rather than being used continuously.
Medicare provides coverage for intermittent catheters when they are deemed medically necessary, and the coverage allows for up to 200 sterile intermittent catheters per month.
Intermittent catheters can be a great alternative to Purewick catheters for those who require short-term relief of urinary retention.
They are typically less expensive than Purewick catheters and are covered by Medicare. Nevertheless, you should consult your healthcare provider to ascertain if intermittent catheters are suitable for your unique needs.
Indwelling Catheters
Indwelling catheters are a type of medical device that is inserted into the urinary tract and can be used by both genders.
The bladder has direct contact with the catheter, allowing for the contents to be drained in reusable bags. Medicare covers indwelling catheters for patients who require long-term catheterization.
While indwelling catheters might serve as a suitable substitute for Purewick catheters, they carry potential risks and side effects such as urinary tract infections (UTIs), catheter-related infections, and immobilization.
It’s important to weigh the pros and cons of each catheter type and consult with your healthcare provider to determine the most appropriate solution for managing your urinary incontinence.
Adult Diapers and Briefs
Unfortunately, Medicare does not cover adult diapers or briefs, so you will be responsible for the full cost of these supplies. However, depending on the extent of your urinary incontinence, adult diapers or briefs may still be a more cost-effective solution than Purewick catheters.
If you’re contemplating this alternative, compare the cost and convenience of adult diapers or briefs with Purewick catheters to make the best choice for your situation.
Cost of Purewick Catheter System
The cost of the Purewick catheter system can be quite an investment, ranging from $3,000 to $8,000, depending on the model.
Although insurance providers may cover the system, you should reach out to your specific insurance provider to confirm coverage and discuss any extra costs associated with using a Purewick catheter system.
Purewick at Home
Purewick at Home, a purewick system, is an external urine collection device designed for comfortable and discreet use, effectively managing urine output. The Purewick at Home kit includes:
- Suction pump with rechargeable lithium-ion battery
- 2000cc collection canister with lid
- Pump tubing
- Collector tubing with elbow connector
- Two privacy covers
Price: $13.05 per piece.
Despite the initial high cost, the benefits of using Purewick at Home can justify the investment. The device allows for a comfortable, non-invasive solution for managing urinary incontinence without the risks associated with other types of catheters.
In addition, it’s easy to clean and maintain, making it a convenient option for long-term use.
Insurance Provider Coverage
Coverage for Purewick catheters varies significantly among insurance providers.
Some insurance providers may not provide coverage for Purewick catheters at all, as they may consider the Purewick urine collection system to be unproven and not medically necessary for managing urinary incontinence.
To determine if your insurance provider offers coverage for Purewick catheters, you may contact their customer service number and inquire about coverage for this specific catheter, or fill out a qualification form on the insurance provider’s website.
It’s important to note that while some insurance providers may not cover the cost of Purewick catheters, they may still cover other types of catheters or incontinence supplies.
Be sure to explore all your options and discuss them with your healthcare provider to determine the most appropriate solution for managing your urinary incontinence.
Navigating the Medicare Application Process for Catheter Coverage
The process of applying for Medicare catheter coverage, which is one of the many medical procedures covered, may appear overwhelming, but dividing it into manageable steps can make it less daunting.
The essential steps involve determining eligibility, gathering documentation, and submitting the application to Medicare.
Let’s delve into each of these steps in greater depth.
Determining Eligibility
To determine eligibility for catheter coverage, consult your healthcare provider and review Medicare’s coverage guidelines.
Medicare covers catheters and related medical supplies that are considered medically necessary by a physician.
The coverage is contingent upon the type of catheter and the particular medical condition necessitating its use. A valid prescription is necessary to obtain catheter supplies through Medicare.
Bear in mind that:
- Original Medicare does not cover Purewick catheters, if you’re considering them.
- However, some Medicare Advantage plans might provide coverage for Purewick catheters.
- Be sure to contact your specific insurance provider to confirm coverage.
Gathering Documentation
Once you’ve determined your eligibility for catheter coverage, it’s time to gather the necessary documentation to support your application. You need to have a valid prescription from your doctor.
Additionally, you should submit a completed Medicare application form along with any relevant medical records.
Be sure to include documentation of the medical necessity for the utilization of the catheter, such as a physician’s order or prescription, in your medical records. Additionally, it may be beneficial to include clinical notes or documentation of your condition that necessitates the use of the catheter.
Submitting the Application
With your eligibility determined and documentation in hand, you’re ready to submit your application for catheter coverage to Medicare. The procedure typically entails:
- Visiting your healthcare provider
- Obtaining a prescription
- Completing the application
- Awaiting approval
The approval process for catheter coverage can take several weeks, so it’s essential to be patient while awaiting a response. If your application is denied, remember that it’s possible to reapply for coverage or file an appeal in response to the denial.
Be sure to consult with your healthcare provider and insurance plan for guidance on how to proceed.
How to Save Money on Purewick Catheters
If you’re thinking about a Purewick catheter system, you might naturally be worried about the cost.
But don’t worry, there are ways to save money on Purewick catheters, including looking for discounts and deals, purchasing in bulk, or considering alternative incontinence solutions.
Let’s delve deeper into these options.
Discounts and Deals
Looking for discounts and deals from various retailers and online stores is one way to save money on Purewick catheters. For example, you can find discounts on AutoShip orders and first-time orders on PureWickathome.com.
Additionally, you can investigate discount websites such as WorthEPenny and Dealspotr for promotional codes and offers.
Several online stores that offer discounted Purewick catheters include:
- Amazon
- eBay
- Personally Delivered
- Vitality Medical
Be sure to compare prices from multiple suppliers to find the best deal and maximize your savings on this essential incontinence management tool.
Bulk Purchasing
Purchasing Purewick catheters in bulk is another way to save money. The price of Purewick catheters may be reduced when procuring them in bulk through the AutoShip program at Purewickathome.com, where you may avail up to a 10% discount on retail pricing.
Additionally, several stores offer the option to purchase Purewick catheters in bulk. These include:
- Purewickathome.com
- Medicalmonks.com
- Pocketnurse.com
- Amazon.com
- Shopcatheters.com
- Carewell.com
By opting to purchase in bulk, you can ensure a steady supply of catheters while also saving money in the long run.
Alternative Incontinence Solutions
If Purewick catheters are beyond your budget or not covered by your insurance plan, considering alternative incontinence solutions might be worthwhile.
These alternatives include:
- male external catheters,
- external collection devices (ECD),
- and other types of external female catheters.
These non-invasive options can be just as effective in managing urinary incontinence without the hefty price tag associated with Purewick catheters.
Another cost-effective alternative to Purewick catheters is adult diapers or briefs. While they are not covered by Medicare, the cost of adult diapers or briefs may still be lower than that of Purewick catheters, depending on the severity of your urinary incontinence and the quality of the product.
Consult with your healthcare provider to explore all your options and determine the most suitable solution for your needs.
Summary
In conclusion, while Purewick catheters can be an effective solution for managing urinary incontinence, they are not typically covered by Original Medicare.
However, some Medicare Advantage plans may offer coverage, and there are alternative incontinence solutions that may be more cost-effective.
By researching and comparing your options, consulting with your healthcare provider, and navigating the Medicare application process, you can find the best solution for your needs and potentially save money on your incontinence management tools.
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Frequently Asked Questions
Is the PureWick covered by Medicare?
The PureWick system is not covered by Medicare, Medicaid or commercial insurance; thus, it is a cash sale only. To purchase the equipment, you will need to get a prescription from your doctor.
Who should not use PureWick?
PureWick is not recommended for patients who are agitated, combative or uncooperative, have frequent bowel incontinence without fecal management, or have skin breakdown, irritation, or menstruation.
How often do you need to clean a PureWick?
For optimal hygiene, the PureWickTM should be replaced every 8-12 hours or if it’s soiled with feces or blood. The collection canister, canister lid, and all tubing should also be cleaned daily.
Do hospitals use PureWick?
Yes, many hospitals use PureWick as it is used in over 2,000 hospitals and rehab facilities today.
How does purewick work?
The PureWickTM System works by using the PureWickTM Female External Catheter to pull urine away from the body with low pressure wall suction, wicking it into a designated collection canister.
The soft and flexible wick helps keep the skin dry while collecting the urine for safe and effective management of urinary incontinence.
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Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.