Does Medicare Cover Urinary Catheters?

Does Medicare Cover Urinary Catheters?

If you have a recurring need for urinary catheters, your health insurance should be able to help cover the cost.

Medicare covers urinary catheters under certain circumstances. Your coverage depends on your plan, the type of catheter, where you receive care, and why you need a catheter.

This page walks you through the different types of urinary catheters and how Medicare covers them.

Types of Urinary Catheters

There are three main types of urinary catheters: indwelling, intermittent, and external catheters.

Indwelling catheter

An indwelling catheter is inserted through the urethra or surgical hole in the belly and connects directly with the bladder. The urine goes through a tube and drains into a bag.

An indwelling catheter inserted through the urethra is called a urethral catheter or Foley catheter. A healthcare provider inserts this type of catheter.

The catheter inserted in a surgical hole is called a suprapubic catheter. A suprapubic catheter is inserted during an operation while a person is under a local or a light general anesthetic.

Intermittent catheter

An intermittent catheter can be inserted and removed several times a day to empty the bladder. The urine can drain into a receptacle or external drainage bag. A patient can be taught how to insert their own intermittent catheter.

External catheter (external urinary collection device)

A condom catheter is an external catheter used by men. It fits like a condom over the penis and allows the urine to drain through a tube and into a bag.

A meatal cup is an external urinary collection device used by females. It is a plastic cup that is held in place around the urethra by suction or pressure. The cup is connected to a drainage container.

Conditions that Require a Urinary Catheter

A urinary catheter is used for people who have difficulty urinating naturally. Here are a few reasons a person might require a urinary catheter.

  • Kidney, ureter, or bladder stones
  • Injury to the urethra
  • An enlarged prostate (males)
  • Congenital disabilities affecting the urinary tract
  • Bladder weakness (urinary incontinence)
  • Nerve damage
  • Tumors within the urinary tract or reproductive organs

In short, a urinary catheter helps with urinary retention and incontinence. However, it can also be used during a medical procedure or surgery on the prostate or genitals.

Sometimes a urinary catheter is used for other reasons unrelated to urinary tract health. For example, a urinary catheter may be used for the following:

  • Helping with complications with urinating for those with multiple sclerosis, dementia, and other diseases
  • Accurately measuring urine output
  • Draining the bladder before, during, or after a person has surgery (or after an epidural is administered during childbirth)
  • Emptying the bladder during a hospital stay or while undergoing a medical procedure or treatment

Catheters may only be necessary for the short term in some circumstances.

However, a person’s bladder function sometimes ceases, requiring long-term catheter use. In this case, a catheter may be considered a prosthetic device.

Medicare Coverage for Urinary Catheters

As previously mentioned, Medicare coverage of a urinary catheter is determined by your plan, the type of catheter, where you receive care, and why you need the catheter.

Medicare Part A

Medicare Part A (Hospital Insurance) may cover the cost of a catheter used when a patient is admitted as an inpatient into a Medicare-approved hospital. However, the patient may be responsible for the Part A deductible unless they have a supplement plan.

Medicare Part B

Medicare Part B (Medical Insurance) may cover 80% of the cost of catheters and related supplies as part of your durable medical equipment (DME) benefits. Coverage occurs when the catheter is administered in a doctor’s office or outpatient setting – after you meet your deductible. The specific coverage depends on what type of urinary catheter is used.

For example, Medicare Part B covers one indwelling catheter per month. However, non-routine catheter changes are covered in some cases.

Medicare will pay for an additional urinary catheter if the original one is removed by the patient, malfunctioning, obstructed, or if the patient has a history of obstructions or infections.

Along with the catheter, Medicare will cover urinary catheter supplies and accessories, such as irrigation trays, a catheter stabilization device, a leg band holder, leg bag extension tubes, skin-prep wipes, and drainage bags.

Medicare Part B also covers up to 200 intermittent catheters (and one tube of lubricant) per month if the intermittent catheter is deemed medically necessary.

Finally, Medicare Part B covers external catheters for patients who are experiencing incontinence.

Look for Medicare plans that cover urinary catheters

Condom catheters are limited to 35 per month. However, more may be allowed if documentation shows they are medically necessary. Specialty male external catheters (such as those that inflate or include a faceplate) or extended-wear catheter systems are only covered with the appropriate documentation showing that they are a medical necessity.

Medicare coverage allows for one meatal cup per week and one pouch per day – unless more are deemed medically necessary.

Sometimes, a person may require a catheter as part of their care for a permanent medical condition. In this case, the catheter may be considered a prosthetic – and covered by Medicare.

If a patient receives home health care, the cost of a urinary catheter may be included as part of the overall home health care coverage.

For example, Medicare Part B pays 80% of the approved cost of the urinary catheter supplies – as long as you buy them from a supplier that accepts Medicare. In addition, your healthcare provider must certify and provide documentation showing that using a catheter is medically necessary. The patient is responsible for the remaining 20 percent and your Part B deductible.

Medicare Advantage and Medicare Supplement Insurance

You may have additional coverage if enrolled in a Medicare Advantage plan (Part C). Check with your plan representative directly with any questions regarding the coverage of urinary catheters.

Medicare Supplement plans, more commonly referred to as Medigap, will help pay for the cost of urinary catheters as long as Medicare has approved the service. While Part C plans provide additional benefits (usually), Supplement plans simply help with your out-of-pocket costs. They do not offer additional coverage.

And to compare Medicare plans, use our Find a Plan tool. It's fast and easy to use – just enter your zip code to start comparing costs and benefits of Medicare plans in your area.

Additional resources

Florida native Eric Ruge lives by one rule: Do the right thing. His goal as a Medicare agent is helping people find the right Medicare coverage for their unique medical needs and budget. He believes everyone deserves the peace of mind they get knowing they made the right decision about their Medicare coverage. When he's not working, Eric enjoys spending time with family and friends, watching Tampa sports, and playing the occasional round of golf.


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