Does Medicare Cover Urinary Incontinence Supplies?
Medicare Benefits Solutions
Sep 21, 2022
Urinary incontinence, or involuntary urination, are medical terms used for uncontrolled leaking of urine or an overactive bladder. Urinary incontinence is a condition that is more common for older people, and even more so for women than men.
In fact, 23 percent of women over the age of 60 usually experience one of the four types of incontinence as they age. But even though women are twice as likely to experience urinary incontinence, many men do too.
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How to Tell if You Have Urinary Incontinence
If you’re wondering how to tell if you have urinary incontinence, consider some of the most common signs. You might have an overactive bladder if you’ve been experiencing any of the following symptoms:
- You’ve been having sudden and forceful urges to urinate that are difficult to control
- Accidental leaking of urine after feeling a strong urge to urinate
- More frequent urination than usual (eight or more times during a 24-hour period)
- Waking up more than twice to urinate during the night
If you are experiencing urinary incontinence, you shouldn’t feel embarrassed to talk to your physician about it. Your health care provider can diagnose the type of incontinence you have and offer advice about your treatment or therapy options.
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How Does Medicare Cover Urinary Incontinence?
If you are experiencing urinary incontinence, you should visit your physician or another health care provider. To make a proper diagnosis, she will want to rule out any underlying medical conditions like urinary tract infections, or others, and will most likely order laboratory tests like a urinalysis or blood work.
For visits to physicians and other health care providers who accept Medicare assignment, Original Medicare Part B (outpatient medical insurance) covers 80 percent of the final approved cost. You pay the remaining 20 percent after meeting your Part B annual deductible.
Medicare Part B covers 100 percent of the cost for diagnostic laboratory tests such as certain blood tests, urinalysis, tissue specimen tests, and some screening tests. To get this coverage, you must use a lab that accepts Medicare assignment.
If your lab tests show that you have a urinary tract infection (UTI), your physician may prescribe antibiotics to treat the UTI. You may have coverage for these antibiotics if you have a stand-alone Medicare Part D (prescription drug) plan, or if you have prescription drug coverage through a Medicare Advantage (Part C) plan.
If your Medicare-affiliated physician prescribes catheterization for you to do at home, Original Medicare Part B covers 80 percent of the cost for one indwelling catheter per month, up to 200 single-use catheters per month, and other associated supplies. To qualify for this benefit, you must get your supplies from a durable medical equipment supplier that accepts Medicare assignment. You pay the remaining 20 percent of the cost for these supplies after meeting your annual Part B deductible.
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What Cause Urinary Incontinence in Adults?
As people age, the human body changes. The bladder, which is the hollow organ in the lower abdomen that stores urine coming from the kidneys, as well as the muscles surrounding the bladder, begins to lose strength. Without a strong muscle structure in the abdomen, bladder, or pelvic region, it can become more difficult to maintain control of urine flow.
Urinary incontinence can be a short-term or long-term problem that is caused by other issues such as:
- Urinary tract infections
- Vaginal infections
- Overactive bladder muscle
- Nerve damage caused by conditions such as Parkinson’s, Multiple Sclerosis, or diabetes
- Prolapse of pelvic organs
- Inflammation of the prostate gland (prostatitis)
- Nerve or muscle injury or damage from surgery
- Benign prostate hyperplasia (enlarged prostate)
- Decreased estrogen levels after menopause
- Some medications
- Certain foods
4 Different Types of Urinary Incontinence
What are the four different types of urinary incontinence?
Experiencing urine leakage can be inconvenient, uncomfortable, and embarrassing no matter what the cause is. But because it’s not a “one size fits all” situation, it’s important to find out which of the four types of incontinence you have, so you can get the right kind of urinary incontinence treatment.
Symptoms: Urine leakage occurs when your bladder is under pressure during exercise, or when you sneeze, cough, laugh, or lift something.
This is the most common form of overactive bladder and typically occurs in younger to middle-aged women.
Symptoms: A sudden, severe urge to urinate and difficulty getting to the bathroom in time.
Urge incontinence is most common in people who have diabetes, Alzheimer’s, Parkinson’s, M.S., or who’ve had a stroke.
Symptoms: Urine leakage from a full constantly full bladder that can’t be emptied sufficiently.
This form of incontinence is common in men with an enlarged prostate because it obstructs urine flow through the urethra. It might also occur in people with diabetes or spinal cord injuries.
Even though a person might not have a bladder problem, mobility issues can obstruct movement making it hard to get to the bathroom to urinate.
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What are the Treatments for Incontinence?
Your health care provider can suggest a treatment or therapy plan that addresses the type of incontinence you are experiencing and its severity, and determine an appropriate plan to treat urinary incontinence. You may have several treatment options, so you can choose one that best fits your lifestyle.
Bladder control training
- Pelvic muscle (Kegel) exercises that strengthen the pelvic and bladder muscles
- Urgency suppression techniques like relaxation or distraction
- Scheduling regular bathroom breaks to “train” your bladder
- Various medications
- Estrogen replacement creams applied vaginally
- Medical devices such as catheters to drain urine from a chronically full bladder
- Surgical procedures to correct an organ prolapse or an enlarged prostate
- Quitting smoking
- Losing weight
- Getting more exercise
- Cutting down on alcohol
- Reducing caffeinated drinks and carbonated beverages
You can also minimize discomfort and embarrassing mishaps by using incontinence products like adult diapers or disposable briefs. Today, these products are not as bulky as they once were and can be worn comfortably and discreetly under clothing.
Does Medicare Cover Incontinence Supplies?
diapers, briefs, pads, or liners that you use at home. This is because Medicare doesn’t consider the products to be medically necessary and they do not qualify as durable medical equipment.
On the other hand, when you are an inpatient in a hospital that accepts Medicare assignment and you need incontinence products, Original Medicare Part A (hospital insurance) covers them during your stay in the hospital.
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Qualifying for Incontinence Product Coverage
You may qualify for financial assistance to purchase incontinence supplies if you are eligible for Medicaid alone, or as a dual-eligible beneficiary (both Medicare and Medicaid).
Each of the 50 states has its own Medicaid program allowances, so your eligibility and coverage depend on what your state of residence provides. You can get coverage for incontinence supplies through Medicaid if you have at least one of the following:
- A prescription from a doctor along with the qualifying diagnosis
- Prior authorization
- A letter or certificate of Medical Necessity (LMN)
Medicare Advantage (Part C)
Some Medicare Advantage plans offer a monthly or quarterly allowance for beneficiaries to purchase certain over-the-counter products at specified pharmacies. Most Part C plans that offer this benefit include incontinence supplies on the list of products you can purchase with your allowance. Not all Medicare Advantage plans offer this benefit, so make sure to ask a representative for all the details before you enroll in a Part C plan.
Having an overactive bladder can have a profound effect on your life, especially if you need to make sure you’re always close to a bathroom or wear incontinence products to avoid inconvenient situations. If you’re experiencing any symptoms of an overactive bladder, make sure you talk to your doctor about them so he can help you treat or manage your issues with urinary incontinence.
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