Original Medicare does not cover incontinence supplies, but you may have better luck with an Advantage plan, Medicaid, or the VA.
Urinary incontinence can be a significant health problem with considerable social and economic impact. There are large variations in the severity and impact of incontinence, including frequency and predictability, and it can be caused by a variety of things, but it can still be very difficult for those who suffer from it.
In some cases, Medicare beneficiaries may find themselves in need of incontinence supplies. And, they are not alone. It’s estimated that more than 25 million adult Americans experience temporary or chronic urinary incontinence. However, the cost of incontinence products can add up quickly, especially because Medicare doesn’t cover them.
What is urinary incontinence?
Urinary incontinence is the accidental loss of urine. It can happen at any age but is most common in women over age 50. In some cases, it’s a temporary condition that results from an underlying medical condition, and in other cases it can be permanent. Severity can range from slight loss of urine to severe, frequent wetting.
While incontinence is not an inevitable result of aging, it is often caused by specific changes in body function resulting from diseases, use of certain medications, and/or the onset of an illness.
Some examples of incontinence products one may purchase include protective pads, shields, diapers, and specifically designed absorbent underclothing.
Medicare coverage for incontinence products
Neither Medicare Part A nor Part B cover incontinence supplies or adult diapers. You are responsible for 100% of the cost for those products out-of-pocket. This includes products like bladder control pads, adult briefs, and adult diapers. These products are not considered durable medical equipment (DME) or medically necessary.
However, Medicare does cover external catheters and related medical supplies when they are medically necessary, including to manage incontinence needs. Note that the coverage depends on the type of catheter and the medical reason for it, though benefits can include coverage for irrigation kits, bedside drain bags, leg bags, irrigation syringes, and extension tubing. Your doctor will determine whether you need a permanent or temporary catheter and which type is right for you.
Do Medicare Advantage plans cover incontinence products?
Medicare Advantage plans (Part C) are offered by private insurance companies and are required to offer at least everything Part A and Part B do. But most also provide additional benefits for things like prescription drug coverage (Part D), dental, hearing, vision, and fitness programs.
Some Medicare Advantage plans may provide coverage for incontinence supplies. Other plans may offer a monthly or annual allowance to use for over-the-counter and similar health purchases – including incontinence products. Contact the plan directly to learn more.
Do Medigap plans cover incontinence supplies?
Medicare Supplement Insurance, or Medigap, is also sold by private insurance companies. These plans got their name because they are said to fill the “gaps” in Original Medicare. They help pay a variety of out-of-pocket costs associated with Medicare, including deductibles, co-pays, and co-insurance.
However, Medigap plans do not cover additional services, meaning they only help pay for things Medicare does. Because Medicare does not cover incontinence products, Medigap plans will not either.
How to save on incontinence supplies
If you need help paying for incontinence supplies, some options to consider include:
- Medicaid: Medicaid is a state and federally funded program designed for people with limited income and resources to help pay medical bills. In some cases, you may be dual eligible for both Medicare and Medicaid. While each state sets its own rules for what Medicaid will cover, many provide some assistance for things like incontinence supplies. Check with your state’s Medicaid program to learn if you’re eligible and what supplies may be covered.
- Department of Veterans Affairs: The VA does provide adult diapers as part of its health benefits, but it’s typically stand issue type. In order to get a brand-name product, your doctor will have to provide the VA with a prescription or statement of medical necessity.
- Non-profit organizations: Some diaper banks, food banks, senior centers, or other community resources and non-profit organizations may provide adult diapers for no or low cost.
Talk to your doctor about options that may be available to you if you need incontinence supplies but are having trouble paying for them.
Incontinence Supplies & Adult Diapers
External Website Link
What Equipment Does Medicare Pay For?
Internal Website Link
Find a Medicare Plan in your area
It's FREE with no obligation
Speak with a Licensed Insurance Agent
M-F 9:00am-9:00pm | Sat 9:00am-3:00pm EST