This piece has been reviewed by Mica Phillips, Director of Aeroflow Urology.
With Medicare’s ever-changing guidelines for coverage criteria and reimbursement, people often have trouble knowing the specifics of what is covered through their Medicare plan. This is particularly evident in urinary incontinence products, given the wide variety of catheters available. Whether you need an intermittent catheter, an external catheter, or a Foley catheter, Aeroflow Urology can assist you with all of your urological supplies.
200 / month
35 / month
1 / month
1 / month
2 / month
Intermittent Urinary Catheters Through Medicare
Broadly, Medicare covers 200 intermittent single-use catheters each month (straight tip or coudé-tip). This also includes “closed-system” catheters, or catheters with sterile insertion supplies.
200 catheters per month allows for the catheter user to change their catheter at least 6 times a day with additional catheters leftover, should any difficulties with insertion arise.
One of the greatest barriers to regular catheter use is the discomfort of insertion. For this reason, we recommend a hydrophilic catheter through Medicare. Hydrophilic catheters decrease the possibility of failed insertions due to their sterile saline lubrication. They can also reduce the buildup of scar tissue from catheterization over time, which can be especially helpful for patients whose need to catheterize is lifelong or chronic. By eliminating difficulties to reliable and regular catheterization, individuals can experience an increase in the effectiveness of their treatment and their quality of life.
In order for Medicare to cover the coudé tip catheter, a medical need that inhibits the user from using a straight tip catheter must be demonstrated. This type of catheter can be especially beneficial for male patients with BPH (benign prostatic hyperplasia), also known as an enlarged prostate.
Aside from standard intermittent catheters, Medicare will also cover 1 indwelling catheter, or Foley catheter, each month. A coudé tip indwelling catheter or Foley catheter is also available, if the user can demonstrate a medical necessity for this variation. Foley catheters come in both silicone and natural rubber latex options. If you have a latex allergy, your healthcare provider will need to document this in your medical records to be eligible for the latex-free variety of Foley catheter. Medicare additionally has a provision to cover 2-4 Foley catheters per month if an individual presents with insertion difficulties such as encrustation or frequent mucus plugs that necessitate changing the catheter more often.
Additionally, Medicare covers up to 35 external catheters for men. These can also be known as Texas catheters, or MEC’s (male external catheters).
Closed Catheter Systems
One of the most common questions we receive relating to urinary catheter coverage is on the eligibility to receive a closed catheter system. Medicare provides a closed catheter system if the individual meets the below strict criteria.
Individuals that May Qualify for a Closed Catheter System:
- Individuals with recurrent urinary tract infections (UTIs) while on a program of sterile intermittent catheterization, twice within the 12 months prior to the initiation of sterile intermittent catheter kits.
- Individuals in a nursing facilities
- Individuals that are immunocompromised
- Individuals with vesicoureteral reflux while on a program of intermittent catheterization
- Individuals that are pregnant with a spinal cord injury that has caused neurogenic bladder
Catheter Supplies Through Medicare
Medicare provides for more than just strictly catheter needs when it comes to catheter supplies. Medicare will also cover a variety of irrigation kits, bedside drain bags, leg bags, irrigation syringes, and extension tubing. Medicare will also cover irrigation fluid for bladder irrigation as part of indwelling catheter use, such as sterile water or saline. For indwelling and Foley catheters, Medicare will also cover various administration and sanitation products such as cath strips, leg straps, tape, and anchor devices.
When choosing what is right for your personal medical needs, trust Aeroflow Urology to be with you every step of the way. To receive catheters at a discounted cost through your Medicare plan, fill out our simple, 2-step form. We’ll take care of all of the paperwork - from your prescription to processing your insurance information.
Information provided on the Aeroflow Urology blog is not intended as a substitute to medical advice or care from a healthcare professional. Aeroflow recommends consulting your healthcare provider if you are experiencing medical issues relating to incontinence.