Does Medicare Cover Incontinence Products

Coverage Under Medicare Advantage

Because Part C plans, such as Kaisers Medicare Advantage policies, legally must provide the same minimum benefits an Original Medicare beneficiary receives, these policies must cover the cost of intermittent or closed-system catheters for participants who have been diagnosed with a qualifying illness, such as permanent urinary incontinence or incomplete bladder emptying. To receive coverage, plan participants typically need to obtain a physicians prescription and accompanying documentation of medical necessity. Documentation requirements may include:

• Diagnosis of an approved condition
• The patients prognosis
• The patients functional limitations
• The patients past experience with catheters
• Physicians notes
• Any other relevant information

Sterile coudé catheters may also be approved for individuals who are unable to use a straight catheter.

How Do I Know If Im Covered

Aeroflow Urology, a provider of continence care supplies through insurance, can help you determine your coverage for incontinence products. They take the hassle out of working with your insurance company and will handle all of the communication and paperwork on your behalf. Theyâll even work with your healthcare provider to confirm your specific needs and get the appropriate documentation to ensure your supplies are fully covered.

The process to work with Aeroflow Urology is simple.Fill out their quick, two-step formand theyâll take care of the rest . If you prefer to talk with someone over the phone, you can call Aeroflow Urology at 844-276-5588 and speak with a specially trained Continence Care Specialist.

Once your information is received, you will be assigned a dedicated Continence Care Specialist who will begin working to verify your coverage. They will contact you via phone or email to review your benefits and will then work with you to determine the brand and product type that will work best for you.

How Can I Get Free Incontinence Supplies

If youre able to verify income status i.e. on Medicaid, Food Stamps you may be able to receive assistance from a community diaper bank designed to deliver these products for free to individuals in need.

If youre a caregiver for someone with low-income status, you may be able to apply for a caregiver grant, which provides funds that can pay for adult diapers. Options like the National Family Caregiver Support Program may be able to help.

What extra benefits and savings do you qualify for?

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Q: Does Medicaid Cover Incontinence Supplies Does Florida Medicaid Cover Incontinence Supplies

A: Yes, frequently Medicaid does cover incontinence supplies. While most medicaid plans will cover incontinence supplies, it does ultimately depend on your state. However odds are good that your state is accommodating as 45 out of the 50 states cover incontinence products. This includes Texas, Florida, New York, Massachusetts, and California, to name a few. You can look at each states coverage guide, which is generally easy to find online, in order to determine if your incontinence supplies will be covered. Though there are varying requirements by state, for example the requirement for a doctor recommendation to be eligible for reimbursement.

Does Medicare Cover Depends Undergarments

Depends is a well-known brand name of Adult diapers. If you need a special brand of incontinence supplies, its unlikely youll have coverage. Since insurance doesnt cover disposable supplies, these are your responsibility.

Youll pay the full cost of depends underwear unless you have a Medicare Advantage plan that covers this benefit. Also, those with Medicaid may have coverage for adult diapers, but there are most likely brand limitations.

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While Medicare wont help you pay for your Depends, some state Medicaid programs help cover the cost incontinence supplies.

Youll want to contact your state Medicaid office or the Medicare Advantage plan to identify your options. Those with Medicare and Medicaid can select a Dual-Eligible policy to increase benefits.

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Incontinence Products: How To Shop For The Best Deal

If you are unsure if incontinence products are covered by insurance, you should consult with your doctor. As a result, if youre looking to buy incontinence products, dont pass up the opportunity to shop around and compare prices. You might also want to look into using a prescription drug discount card in addition to saving money on prescription drugs.

Veterans Home And Community Based Services

For some veterans, Home and Community Based Services, also called Veterans Directed Care is an option. This program provides financial assistance for care and the flexibility to direct the financial assistance as the veteran feels is best for their needs. Incontinence supplies would most certainly be an eligible expense. However, this description over-simplifies the program. For more details, read here.

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Mandatory Medicaid Benefits Include:

• Speech, hearing and language disorder services
• Prescription drug coverage

View the full list of mandatory and optional Medicaid benefits here. To understand all the specific services and benefits that are covered in your state, we recommend contacting your state-provided plan, your insurance provider or conducting research on your states Medicaid website.

What Health Insurance Plans Cover People With Diabetes

Health insurance helps pay for medical care, including the cost of diabetes care. Your health insurance options are

• private health insurance, which includes group and individual health insurance
• government health insurance, such as Medicare, Medicaid, the Childrens Health Insurance Program , TRICARE, and veterans health care programs

Under current law, health insurance companies cant refuse to cover you or charge you more just because you have a pre-existing conditionthat is, a health problem you had before the date that new health coverage starts.

Changes to insurance rules happen often and may affect your health insurance choices. Learn more or get help with your health insurance questions through

• HealthCare.gov , the federal marketplace, 1-800-318-2596, TTY: 1-855-889-4325

• copayments and deductibles
• health care providersdo your providers participate in the plan, or will you have to change providers or pay more to see your current providers because they are out of network?

Ask for a Summary of Benefits and Coverage, which explains the plan in plain language, including free preventive services. This summary may include a coverage example for managing diabetes.

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Coverage Under Original Medicare

Original Medicare doesnt typically cover the cost of incontinence supplies for seniors. However, if an individual who has Medicare Part A is diagnosed with a terminal illness, medical supplies, such as catheters, may be covered under Medicares hospice benefit.

The terms of coverage under this benefit may vary, depending on the specific illness and the beneficiarys individual care plan.

Are Incontinence Supplies Covered By Medicare

Incontinence Supplies and Medicare Coverage is limited, but not impossible.Despite the number of people who live with incontinence, traditional Medicare does not cover any incontinence supplies like diapers and pads. However, depending on your financial circumstances and the type of medical insurance you choose, the cost of incontinence essentials may be reimbursed or at least be a tax-deductible expense. Here are the options that may be available to you.

Also Check: Does Medicare Cover The Urolift Procedure

How To Get The Best Incontinence Products Covered Under Medicaid

Medicaid recipients who are older or disabled typically have a case manager assigned to help support their needs and navigate Medicaid benefits and services. If you, your parent, or your disabled child has incontinence and has taken the steps to receive incontinence supplies under Medicaid, you may be receiving a default absorbent product from your medical supply provider. These default products tend to be lower-quality, generic products that may work well for those with light incontinence but cause significant challenges for those with moderate to heavy incontinence. Leaking products, clothing and bedding changes, and fear of an accident do not have to be a normal part of living with incontinence. Better solutions are available.

The best way to obtain higher-quality absorbent products is to ask for them by name!

When contacting your pharmacy or medical supply provider, ask them to change your Medicaid order to the specific product or brand of product that you desire. Should they push back or deny your request, contact Tranquility or another medical supply provider. The incontinence supplies benefit belongs to you, the Medicaid recipient. Dont settle for a default product if it is not performing. If your provider will not cover the products available to you in your state, find another supplier. You could be eligible for better products you just have to ask for them!

Medicare Advantage Coverage For Adult Diapers

Yes, Medicare Advantage plans may cover adult diapers. Some plans will include coverage through an over-the-counter benefit. Although, there may be limitations to how much you can get, the brand, and where you can buy it. Before enrollment, talk with an insurance agent about the plans available and the benefits that best suit your lifestyle.

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Boost Protection With Medicaid

If you or someone you care for are currently wearing medically necessary incontinence products covered by Medicaid, such as adult diapers/disposable briefs or pull-on underwear, yet are still experiencing leakage, odors or uncomfortable wetness, booster pads may be a great solution to boost absorbent protection. Booster pads are a type of bladder control pads, which continue to grow in popularity as individuals and caregivers are learning how they can make incontinence care more manageable. Plus, like other incontinence care supplies, they are typically covered under Medicaid in most states.

Lets take a look at how you or someone in your care can receive medically necessary booster pads through Medicaid, as well as the best ways to use booster pads to provide additional security and protection.

How Booster Pads Work

Once you have begun to receive incontinence supplies through Medicaid, you may learn that your Medicaid supply providers only offer generic, low-absorbency adult diapers/disposable briefs and pull-on underwear, which may not provide enough protection for those with heavy incontinence or who regularly experience leakage. If this is the case, adding a medically necessary booster pad could be extremely helpful. If booster pads are covered under your state Medicaid plan or other insurance provider, we recommend that you make the most of your incontinence product coverage by giving boosters a try.

How Can You Money On Incontinence Supplies

Because Medicare does not pay for incontinence products, buying them for yourself or someone you care for can get expensive quickly.

Here are some tips for spending less on the products you need:

• Buy in bulkPlenty of retailers will sell supplies for less when you purchase a large amount at one time. Check online for bulk specials to ensure youre getting the best deal.

• Buy onlineLarge retailers will sometimes offer discount programs to shoppers buying online. Plus, as an added bonus, the products will be delivered discreetly and conveniently to your home.

• Consider washablesAlthough most people prefer disposable pads, washable products can be even more comfortable and provide better protection than disposable products. By trying a combination of washables and disposables, you can create less waste and save more money.

• Switch to genericIf you have one brand that you are comfortable with that you know works best for you, you can skip this one. But if you tend to buy different brands or arent picky about your product, switching to a cheaper, generic brand can save you big bucks over time.

• Check for promotionsSome brands will send you a free sample of a product before you buy it or offer discounts for first time buyers. A quick internet search can help you find some of these offers when they are available.

Also Check: How Do I Sign Up For Medicare Advantage Plan

How To Save On Incontinence Supplies Original Medicare Wont Cover

• Written by

  Terry Turner

  Senior Financial Writer and Financial Wellness Facilitator

  Terry Turner has more than 30 years of journalism experience, including covering benefits, spending and congressional action on federal programs such as Social Security and Medicare. He is a Certified Financial Wellness Facilitator through the National Wellness Institute and the Foundation for Financial Wellness and a member of the Association for Financial Counseling & Planning Education .

APATurner, T. . How to Save on Incontinence Supplies Original Medicare Wont Cover. RetireGuide.com. Retrieved December 6, 2022, from https://www.retireguide.com/news/incontinence-supplies-medicare-wont-cover/

MLATurner, Terry. “How to Save on Incontinence Supplies Original Medicare Wont Cover.” RetireGuide.com, 31 May 2022, https://www.retireguide.com/news/incontinence-supplies-medicare-wont-cover/.

ChicagoTurner, Terry. “How to Save on Incontinence Supplies Original Medicare Wont Cover.” RetireGuide.com. Last modified May 31, 2022. https://www.retireguide.com/news/incontinence-supplies-medicare-wont-cover/.

Content created by RetireGuide and sponsored by our partners.

Key Principles

Editorial Independence

Adult diaper prices have increased nearly 9 percent over the past year, and manufactures say more price hikes are imminent.

Are My Incontinence Products Covered By Insurance

One of the first questions that seniors ask us is, Are my incontinence products covered by insurance? Its a valid question considering that people with incontinence spend, on average, about $4,000.00 a year on their care and products? Thats a lot of money considering most people with this condition are seniors and some on fixed incomes.

When we think of incontinence products, adult diapers immediately come to mind but there are so many other supplies that may be needed depending on the severity of the condition. Other items for incontinence care can include bed pans, underpads , catheters, wipes, disposable gloves, and more. It leaves these individuals and their caretakers to wonder how its all going to be paid for.

Will my insurance cover it?

Its best to contact your insurance administrator to be sure, but most private insurance plans follow Medicare guidelines. Medicare, unfortunately, does not cover disposable products such as adult diapers, bed pads, or bed liners.

What does Medicare cover?

Medicare only covers select incontinence care products such as catheters and commode chairs but only if deemed medically necessary by a physician. Within those supply categories, there are only certain catheters and chairs that are fully or partially covered. Your physician and insurance provider should be able to help you choose the proper items that are covered according to your care plan.

How about Medicaid?

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Why Wont Medicare Cover Incontinence Supplies

Medicare will only cover medically necessary things. Since adult pads, diapers, and other supplies arent medically necessary, Medicare wont pay for these things. But, Medicare will cover appointments and procedures relating to the diagnoses and care of incontinence.

Part A will cover any inpatient services. Part B will cover doctor visits as well as Durable Medical Equipment, which could include a catheter.

Its important to note that there may be limitations on the amount of product covered on a monthly basis, either with Medicare Advantage or Medicaid. Further, to gain the coverage you may need to prove the incontinence stems from a specific medical condition.

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What Medicare Plans Cover Incontinence Supplies

There are some supplies that are an exception to the above. Supplies such as catheters might be covered if you provide the proper documentation. These rules apply only to traditional Medicare, so if you have a Medicare Advantage plan, you may be able to receive coverage. Some Advantage plans do provide coverage for incontinence supplies, and if yours does, you will be able to work with your doctor to gain approval.

Medicare Supplement plans won’t cover this expense. If you’re enrolled with a traditional Medicare plan or a Medicare Advantage plan that doesn’t provide coverage, you need to consider other ways to reduce the cost of your incontinence supplies.

Recommended Reading: Does Medicare Part B Cover Incontinence Supplies

What Organizations Provide Financial Assistance For Incontinence Supplies

If your insurance doesnt cover the cost of incontinence supplies, you may be able to get help through the following federal or local resources:

• S. Department of Veterans Affairs: Veterans who demonstrate a medical need for incontinence supplies may receive financial assistance purchasing products, such as adult diapers, through their VA benefits. To find out how to qualify, visit the U.S. Department of Veterans Affairs online or make an appointment at your local benefits office.
• Adult diaper banks: In many cities, adult diaper banks supply incontinence products to low-income individuals. To qualify for assistance, you may be required to demonstrate financial need. Interested parties may visit the Directory of U.S. Diaper Banks to find help in their area.

Seniors who dont qualify for assistance through one of the aforementioned organizations should contact their local aging services organization or social services office for help finding additional resources in their area of residence.

How Do I Get Assistance For Incontinence Supplies

While you cant make Medicare cover incontinence supplies, there are a few ways to save money. There are organizations across the United States that help with the cost of adult diapers. Further, shopping online is a great way to buy in bulk and get a discount.

Plus, shipping means you save time and gas money. Other options include couponing and free samples. The internet is your best friend when looking for deals on incontinence supplies.

Also, some discount prescription drug cards cover medical supplies.

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