No, Original Medicare does not cover incontinence supplies. For many individuals dealing with incontinence, this can pose a significant financial burden. However, it’s important to note that there are alternative avenues to obtain coverage for these essential supplies. One such option is Medicare Advantage, also known as Medicare Part C, which offers additional benefits beyond what Original Medicare provides.
Medicare Advantage plans, offered by private insurance companies approved by Medicare, often include coverage for incontinence supplies as part of their comprehensive benefits package. Exploring these alternative options can help individuals find the coverage they need to manage their incontinence effectively while minimizing out-of-pocket expenses.
Table of Contents
- Incontinence a Common Issue For Older Adults
- Limitations On How Medicare Covers Medical Supplies for Incontinence
- How Does Medicare Advantage Cover Medical Supplies for Incontinence?
- Do Medicare Part D Drug Plans Cover Medical Supplies for Incontinence?
- Alternatives For Medicare-covered Care
- Putting It All Together
Incontinence a Common Issue For Older Adults
People who experience incontinence issues may feel embarrassed, but this condition is prevalent. About 13 million Americans experience urinary incontinence, while more than 5.5 million experience fecal incontinence. Both types of incontinence are more common in older adults.
Older adults can develop bladder control problems for many reasons. For some people, incontinence happens occasionally due to health issues like diarrhea or a urinary tract infection. For others, these problems last longer due to conditions like diabetes, arthritis, or an enlarged prostate. No matter how long the condition lasts, medical supplies for incontinence help provide comfort and relief.
Types of Medical Supplies For Incontinence
Incontinence supplies absorb leaks to help the wearer feel clean and comfortable. They also help prevent the painful rashes and infections that can form on constantly wet skin.
Some common types of incontinence supplies people with Medicare purchase include:
- Incontinence briefs: Also known as adult diapers, these disposable full-coverage products are for people with moderate to severe bladder control problems. A person who uses four to six briefs per day might spend around $100 to $150 per month.
- Protective underwear: These discreet products look and feel like regular underwear and range from light to heavy absorbency. They cost about the same as incontinence briefs.
- Bladder control pads: These absorbent liners are worn inside a person’s regular underwear and guard against light urine leakage. A person who uses four to six pads per day might spend around $35 to $50 per month.
- Underpads: These absorbent sheets help protect furniture, bedding, and other surfaces from heavy uncontrolled urination. A person who uses four to six underpads per day might spend around $70 to $100 per month.
Limitations On How Medicare Covers Medical Supplies for Incontinence
Original Medicare does not offer any coverage for incontinence supplies such as adult diapers, even when these items are medically necessary. In fact, incontinence supplies are expressly excluded from Medicare’s durable medical equipment coverage.
Continence care products do not count as durable medical equipment because they’re disposable and cannot withstand repeated use. Other disposable supplies that people with bladder control issues may need, such as catheters or medical gloves, are excluded for the same reason.
While there’s no Original Medicare coverage for continence care products, some types of Medicare Advantage Plans help pay for these items.
How Does Medicare Advantage Cover Medical Supplies for Incontinence?
Medicare Advantage Plans are private health plans that are required to cover the same services as Original Medicare but often choose to cover extra benefits. In some plans, incontinence supplies are among those extra benefits.
Some plans provide coverage for specific items through an incontinence benefit. Depending on the plan, continence crae products covered by Medicare Advantage can include adult diapers or incontinence cream.
Other Medicare Advantage Plans include an allowance for over-the-counter items, including disposable undergarments. This allowance ranges from $50 to $125 per quarter, depending on the plan. Members typically access this benefit in one of two ways.
With an over-the-counter product catalog, members use their allowance to order items listed in the plan’s catalog. Continence care products covered by Medicare Advantage catalogs may include adult briefs, bladder pads, bedpans, sanitary wipes, underpads, and ointments.
Alternatively, with a Medicare Flex card, members receive a prepaid debit card from their plan to use at participating retailers, such as pharmacies. They have the flexibility to buy their preferred brands of incontinence supplies.
The eligibility requirements for Medicare Advantage covered incontinence products vary from plan to plan. There are generally no eligibility restrictions in plans that cover continence care products through an over-the-counter benefit. However, other plans set specific eligibility criteria, such as having a diagnosis of bladder control problems or needing the level of care provided in a nursing home.
Do Medicare Part D Drug Plans Cover Medical Supplies for Incontinence?
No incontinence supplies are covered by Medicare Part D. These plans add drug coverage to Original Medicare and some types of Medicare Advantage Plans. Their benefits are generally limited to approved prescription drugs.
Each Part D plan covers a specific list of prescription drugs, known as the formulary. They do not cover medical supplies except for certain supplies used to inject insulin, including needles, alcohol swabs, and gauze.
However, Medicare Part D is still valuable for people with incontinence. It helps cover various medications used to treat the condition, such as drugs to calm an overactive bladder or prescription creams to treat skin irritation. Check your plan’s formulary for more details.
Alternatives For Medicare-covered Care
While it is true that not all Medicare Advantage plans offer coverage for absorbent products, it is by no means your only option. There are still various programs, plans, and deals for those managing their incontinence.
Medicaid is a joint state-federal program providing lower-income Americans with free or low-cost health coverage. State Medicaid programs typically offer some coverage for medically necessary continence care products, such as disposable undergarments, bladder pads, or underpads.
Since each state runs its own Medicaid program, eligibility rules and covered incontinence products vary depending on where you live. Contact your state Medicaid agency to learn if the program will pay for your incontinence supplies and if you may meet the eligibility requirements.
Health Savings Accounts (HSA)
HSAs are special savings accounts that work with high-deductible health plans. Consumers contribute pre-tax dollars to their accounts to save up for medical care. Withdrawals are not taxed so long as the funds are used for qualified medical expenses.
People who are enrolled in Medicare cannot contribute to an HSA. However, they can withdraw funds from an existing HSA to pay for services that Original Medicare does not cover, such as absorbent products.
Manufacturer Coupons and Discounts
Consumers can incorporate smart shopping strategies to save money on incontinence aids. Look for coupons for your preferred incontinence products, and browse the weekly specials at local stores to find the lowest prices for the items you use.
Another helpful strategy is buying in bulk. Large packages of incontinence aids typically cost less per unit than small packages. Paying less per item helps consumers save money over time.
In some areas, non-profit agencies known as diaper banks distribute donated continence care products to adults in need. The availability of products varies but may include disposable undergarments and bladder pads.
Other community resources may fill this need in areas without specialized diaper banks. Contact local food banks, senior centers, or places of worship to learn if they provide incontinence supplies.
Putting It All Together
In summary, while Original Medicare may not cover incontinence supplies, individuals have various alternative options to explore. Whether through Medicare Advantage, Medicaid, HSAs, coupons/discounts, or community organizations, it’s essential to research and consider these avenues to find the coverage that best meets individual needs and financial circumstances. By taking advantage of these alternatives, individuals can ensure they have access to the necessary supplies to manage their absorbent products effectively while minimizing the financial strain it may impose.