Does Medicare Cover UTI Treatment?

Medicare Benefits Solutions

Aug 13, 2020

Urinary tract infections (UTI) are common conditions, especially for women. You can get a UTI in any part of your urinary tract, including the kidneys, bladder, and urethra, although it is most common in the bladder and urethra. 

Urinary Tract Infection Symptoms

You might have a UTI if you experience some of these symptoms:

• A sudden urge to urinate, or the need to urinate more often than usual
• A burning sensation, or pain while urinating
• Your urine has an unusual, unpleasant smell and/or is cloudy
• Blood in your urine
• Pain and/or pressure in your lower abdomen
• A discharge in your urine
• You feel ill and tired
• In extreme cases: fever, chills, nausea or vomiting, and pain in your lower back or side

If you are caring for someone, you might see changes in behavior like confusion and agitation.

If you have never had a UTI before, if you are male and have symptoms lasting for more than three days, or if you are caring for someone who shows signs of a UTI, you should make an appointment with your healthcare provider as soon as possible. Early treatment for UTIs can help you avoid potentially more severe problems later on.

Does Medicare Cover Urinary Tract Infections?

If you suspect you may have a UTI and you visit your healthcare provider because of it, here’s a look at how your Medicare insurance covers the expense.

Original Medicare Part B (medical insurance) covers medically necessary services that you might need for diagnosing and treating a condition if it meets the criteria set by your Medicare insurance.

In the case of a UTI, your Medicare coverage includes visits to your healthcare provider as long as they accept Medicare assignment.

If your healthcare provider suspects you have a UTI, a sample of your urine is tested for bacteria and white blood cells. Medicare Part B insurance also covers these clinical diagnostic lab exams needed to diagnose the UTI. 

In most cases of UTIs, physicians treat them with antibiotics. The type and severity of the UTI dictate what antibiotic you get. If you have a Medicare Part D Prescription Drug Plan or a Medicare Advantage (Part C) plan that includes prescription drug coverage, your plan’s formulary will most likely include the antibiotic you need.

The amount you pay out-of-pocket for your prescription depends on your plan’s copayment or coinsurance structure, as well as the tier that your plan has categorized your drug. There may be a generic version of the antibiotic your healthcare provider prescribes. Discuss your options with your doctor or call your plan directly for more specific questions.  

Most UTIs go away with treatment by antibiotics, but if you need to go to the hospital for inpatient treatment because you are immunocompromised or have serious complications, Medicare Part A (hospital insurance) covers your care in a hospital or medical facility that accepts Medicare assignment. Any drugs you get to treat your condition while you are an inpatient are also included in your Part A coverage.

Are You at Risk of Getting an UTI?

If you are a woman you have a one in two chance of getting a UTI at least once during your lifetime. For men, the chance is lower – one out of ten. There are some things you can do at home to treat a very mild UTI or to keep yourself safe from getting one in the first place, but they should not be used in place of seeing your healthcare provider if you suspect you have a UTI. Here’s a list of some home remedies:

• Drink enough liquid to stay hydrated
• Pee whenever you get the urge, don’t hold it in
• Drink cranberry juice
• Use probiotics found in yogurt, kefir, sauerkraut, and some cheeses
• Take vitamin C to give your immune system a boost
• Keep your “down under” clean

If you leave a UTI untreated in the early stages, it could become a more serious problem later. The most common complication is the spread of bacteria into the kidneys. If this happens, you could lose kidney function, or it could lead to kidney failure if you already have kidney problems.

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