Does insurance cover urinary catheters? The short answer is – Yes. In the majority of cases, urinary catheters will be covered by Medicare, Medicaid, or your private insurance provider.
A urinary catheter is a soft hollow tube, which is passed into the bladder to drain urine. Catheters are sometimes necessary for people, who for a variety of reasons, cannot empty their bladder in the usual way. These individuals may have trouble urinating, have mobility issues, or other medical conditions.
Types of Urinary Catheters
It’s helpful to know the types of urinary catheters that are most frequently used. However, your doctor will prescribe the correct product for your needs.
- Indwelling Catheter – This is a continuous use urinary catheter that is inserted into the urethra or a hole in the stomach and connects directly to the bladder and drains into a bag. It can be used by men or women.
- Intermittent Catheter – Similar to the indwelling style, this urinary catheter is also for men and women but is used as-needed instead of continuously.
- Condom Catheter – As the name suggests, this urinary catheter is for men only. It’s not inserted into the urethra, it’s a sheath that allows the bladder to drain into a bag from the tip of the catheter. It must be changed daily. This type of catheter does not require a prescription.
- Closed System Catheter – This is a type of intermittent catheter that comes in a self-contained, sterile collection bag. It’s the most sanitary option because the catheter tube does not have to be touched directly.
Are Urinary Catheters Covered by Insurance?
Yes, most urinary catheters and related supplies are covered by either Medicare, Medicaid, or private insurance. It all depends on your medical condition and the type of catheter your doctor has prescribed. The cost of urinary catheters depends on which health insurance plan you have. While most insurance providers cover the full cost of sterile, single-use catheters, others may have a deductible you need to meet before they begin covering the cost.
- Medicare – Medicare Part A covers urinary catheters when they are used during hospitalization. Medicare Part B covers most outpatient catheters and related supplies up to 80% for patients with temporary or permanent bladder conditions. Part B covers one indwelling catheter per month, 200 intermittent catheters per month, or 35 condom catheters per month.
- Medicaid – Medicaid coverage varies from state to state. It’s best to check your state’s requirements to see if they offer supplies at low or no cost.
- Private Insurance – Coverage of urinary catheters and supplies vary based on the insurance company and individual insurance plans. If you have both private insurance and Medicare, the supplemental private insurance may cover the remaining 20% of the catheter costs.
Requirements for Coverage
In all insurance scenarios, you must have a proper, official diagnosis from your doctor as well as a prescription and other supporting medical documentation to get urinary catheters and related supplies you need and have them covered by your insurance plans.
We Can Help
Ready to contact ActivStyle to see if you can get your urinary catheter supplies through your insurance plan? Call toll-free at 888-280-8632, Monday-Friday, 8:00 AM – 7:00 PM CST. ActivStyle’s helpful Product Experts are ready to provide a complimentary, discreet, consultation and explain our convenient home delivery of catheter supplies. They’ll tell you if ActivStyle is in-network with your health insurance plan and what is covered by your plan. Then we’ll do all the work with the insurance company and your doctor to get the required documentation and ship your supplies out to you quickly.
