Does Medicaid cover incontinence supplies and products?
Designed for people and families who might be low-income, elderly, or disabled, Medicaid is the public health insurance program running throughout the country. More than one in five Americans—including those with complicated and expensive care needs—the Medicaid program covers. The biggest single source of health coverage in the United States, Medicaid is relied upon by approximately 74 million Americans. The program guarantees that qualifying people can get healthcare and long-term care services as well as medically required items including urological supplies, incontinence supplies, and other medical needs.
Affecting nearly 25 million Americans, including more than half of all seniors, urinary incontinence is a common disorder. Managing incontinence can be difficult, particularly for those on a low income since the expense of underpads, incontinence briefs, and other bladder control products can soon mount up.
Fortunately, assuming a qualifying medical diagnosis exists, reimbursement for the medical supplies required to properly control incontinence is available for many Medicaid members. This coverage guarantees that people get the required items to keep their quality of life and health intact.
Who Is eligible for Medicaid?
Medicaid mostly benefits three groups: low-income elderly adults, low-income families, and persons with disabilities. For the elderly and those with disabilities, long-term and acute care accounts for most of Medicaid expenditure.
Although the federal government defines general eligibility and benefit criteria, states run the Medicaid program with some latitude under federal direction.
What types of incontinence products does Medicaid cover?
Coverage for incontinence products vary by state, including the brands and varieties of items covered, just as with other Medicaid services. While some states just cover pull-on underwear and adult diapers/tape-tab style briefs, most states cover generic incontinence product brands and kid diapers. Still, most states cover some mix of disposable briefs, pull-on underwear, bladder control pads, reusable and disposable underpads, and other medically required incontinence items.
Medicaid covers incontinence supplies for the elderly, disabled, or children with complex healthcare needs. Under Medicaid, coverage for incontinence supplies normally starts for children between the ages of three and four since this is when they commonly acquire self-toileting habits.
Contact your Medicaid plan or a Medicaid incontinence provider to learn whether incontinence items are covered under your state’s Medicaid program.
How to get the incontinence products you need?
A good place to start is to talk to your doctor about the type of incontinence products Medicaid covers. If you’re new to incontinence, let your doctor know so they can provide you with more information and recommend a range of products.
Considering your amount of mobility, skin sensitivity, and degree of incontinence, doctors are taught to evaluate your particular problem and suggest products that best control your symptoms.
Whether adult diapers, pull-on underwear, bladder control pads, or underpads, your doctor can help you choose the kind of incontinence products best for your circumstances. They can also help you figure out how often you might have to change these products and what extra things—such as barrier creams or skin care wipes—could assist in preventing irritation.
If you are looking for Medicaid coverage for these items, your doctor’s advice will also be very important since they can provide the required prescription or documentation, such as Letter/Certificate of Medical Necessity, to ensure that you get the suitable products under your plan.
Why does Medicaid require a prescription for incontinence supplies?
To have Medicaid covered incontinence products, one must have a prescription written by their doctor. This requirement is in place because Medicaid only covers medically necessary supplies and services. Formal evidence from a healthcare provider, a prescription confirms that, given a particular medical condition, the incontinence products are absolutely necessary for the person’s health and well-being.
Usually, the prescription consists of a diagnosis, specifics on the kind of incontinence supplies are needed, and the projected quantity needed. This data guarantees that the person gets the right products for their needs and that Medicaid monies are used wisely. Additionally, some states may require additional documentation, such as a Letter/Certificate of Medical Necessity or prior authorization, to further confirm the need for these supplies.
Some Medicaid policies call for prior authorization from a doctor before coverage of incontinence supplies is allowed. Prior authorization is the process by which a healthcare provider must get Medicaid clearance before the recommended incontinence products may be reimbursed. Prior authorization helps Medicaid keep quality control, guarantee appropriate use of resources, and give required products to people who really need them.
If you find the process overwhelming, your medical supply company can help sort out all the rules and regulations. They are experienced at working directly with individuals, caregivers, and case managers to navigate insurance provider requirements and state-specific guidelines.
Are Incontinence supplies covered through a Medicaid waiver program?
With a Medicaid waiver, your case manager can help you obtain incontinence products; but this relies on the particular sort of waiver you have and the state you live in. Medicaid waivers are designed to provide services that help individuals stay in their homes or community settings, rather than being placed in institutional care.
Many Medicaid waiver programs—including Home and Community-Based Services (HCBS) waivers—cover incontinence supplies as part of the benefits given to qualified members. Among these things could be adult diapers, liners, underpads, and wipes.
To access these supplies, you would typically need to:
- Discuss with your case manager: Your case manager can help determine if incontinence supplies are covered under your specific Medicaid waiver program. They can also guide you through the process of getting the supplies approved.
- Obtain a prescription: In many cases, you may need a prescription or a letter of medical necessity from your healthcare provider to demonstrate that the supplies are medically necessary.
- Coordinate with suppliers: Once approved, your case manager can help you coordinate with a Medicaid-approved supplier to get the necessary incontinence products delivered to you.
The availability and specific process may vary by state, so it’s important to work closely with your case manager to understand your options.
Does Medicare cover incontinence products?
The short answer to this question is, “No.” Medicare is a federal program offering particular healthcare coverage for those over 65, some younger persons with disabilities, and those with end-stage renal illness. Generally speaking, Medicare does not cover incontinence supplies. Under Medicare, incontinence products such adult diapers, bladder control pads, pull-on underwear, or underpads must be paid for out-of-pocket.
Coverage under Medicare center on treatments, services, and tools deemed medically necessary to treat or manage specific medical conditions. Although many people’s daily lives depend on incontinence supplies, under Medicare’s rules they are classified as personal hygiene items rather than durable medical equipment or required treatment tool.
Since Medicare does not cover incontinence products, members usually have to look at alternative options:
- Out-of-pocket purchase: Most Medicare beneficiaries purchase incontinence supplies out-of-pocket. These products are widely available at pharmacies, medical supply stores, and online retailers.
- Medicaid for dual-eligible individuals: If a Medicare beneficiary also qualifies for Medicaid (known as being “dual-eligible”), Medicaid may cover the cost of incontinence supplies depending on your state’s Medicaid program and coverage criteria.
- Medicare Advantage plans: Some Medicare Advantage (Part C) plans, which are offered by private insurers, might offer additional benefits beyond what traditional Medicare covers. This could include coverage for incontinence supplies, but it varies by plan, so you would need to check with your specific plan provider.
- Local assistance programs: Some states or local community organizations provide assistance with incontinence supplies for seniors or those with disabilities. These programs vary widely, so it’s worth checking local resources.
Understanding these options can help Medicare beneficiaries find the support they need to manage incontinence effectively, even if it means looking beyond Medicare for coverage.
Choosing your incontinence supplier
Selecting a medical supply company that can bill Medicaid for the incontinence supplies you need involves several important steps to ensure that you receive the correct products and services. Here’s a guide to help you make an informed decision:
Check Medicaid enrollment:
- Verify provider enrollment: Ensure the medical supply company is enrolled as a Medicaid provider in your state. Not all suppliers can bill Medicaid directly, so it’s essential to confirm that the provider is authorized to do so.
- Contact Medicaid: You can contact your state’s Medicaid office or visit their website to get a list of approved incontinence supply providers. This ensures that any supplier you choose is recognized by Medicaid and can bill your plan directly.
Evaluate product selection and quality:
- Check available products: Make sure the supplier offers a range of incontinence products that meet your specific needs, such as adult diapers, pull-on underwear, pads, or underpads. The quality and comfort of these products are important, so look for brands that are known for reliability.
- Request samples: Many suppliers will offer complimentary samples of their products. This allows you to try different options before committing, ensuring the products meet your comfort and absorbency needs.
Consider customer service and support:
- Assess customer support: Choose a provider with strong customer service. This includes having knowledgeable representatives who can answer questions, assist with product selection, and help navigate the Medicaid billing process.
- Look for assistance with paperwork: Some suppliers offer services to handle all necessary paperwork with your insurance and healthcare provider, streamlining the process for you.
Review delivery options:
- Check delivery services: Confirm that the provider offers discreet and reliable delivery services to your home. Timely delivery is important to ensure you always have the supplies you need.
- Consider automatic reordering: Some companies provide automatic reordering services, ensuring you never run out of supplies. This can be especially helpful for managing long-term conditions.
Read reviews and get recommendations:
- Research reviews: Look for online reviews and testimonials from other Medicaid recipients. This can provide insights into the experiences of others and help you gauge the reliability of the provider.
- Ask for recommendations: You can also ask your doctor, case manager, or other healthcare professionals for recommendations on reputable suppliers they have worked with in the past.
Verify billing and coverage:
- Confirm medicaid billing: Before finalizing your choice, double-check that the provider will handle the Medicaid billing process on your behalf. This includes ensuring that they will only bill for the products you are eligible for under your Medicaid plan.
- Understand costs: Ask about any potential out-of-pocket costs that may not be covered by Medicaid, such as upgraded products or additional supplies beyond what Medicaid covers.
By following these steps, you can select a medical supply company that not only meets your incontinence care needs but also ensures a smooth process for billing Medicaid, providing you with peace of mind and reliable access to the products you require.
ActivStyle: Your Medical Supply Advocate
For nearly thirty years, ActivStyle—a Medicaid-reimbursed incontinence care supplier—is a supplier of first choice among doctors, case managers, caregivers, and patients. We take pride in offering high-quality, comfortable, and reliable incontinence products that are shipped discreetly to our clients.
ActivStyle provides a full line of superabsorbent incontinence products, from youth to bariatric sizes, including adult diapers/tab-style disposable briefs, pull-on underwear, booster pads, underpads, wipes, and more.
We provide full coordination of services from verifying your insurance coverage for the supplies requested, securing the necessary documentation from your doctor, billing your Medicaid plan on your behalf, and discreetly shipping your product to your door each month. Our Provider Services team is also uniquely trained to work with case managers and other providers who are working with individuals wanting access to incontinence supplies through a Medicaid waiver program.
Complementary samples
Interested in trying a complimentary sample of our Medicaid-covered products? This is a great way to explore the best incontinence products available. Whether you’re new to incontinence or looking to try different options, sampling our products is an excellent way to discover what works best for your needs. Product samples are available to Medicaid-eligible individuals, with their first order.
Getting started with ActivStyle
To get started with ActivStyle, complete our sign-up form or call toll-free 1-888-280-8632, Monday-Friday, 8AM- 7PM CT. One of our trained experts will work with you to determine if your Medicaid plan covers necessary incontinence supplies. While on the phone, our friendly representative will collect your Medicaid plan number and doctor information. Once we determine your eligibility, our team will contact the doctor for the required prescription, verify insurance coverage, and bill insurance for the supplies. It is helpful if you have seen your doctor within the past 6-12 months, have discussed incontinence with them, and let them know you are working with ActivStyle. Once eligibility is determined and we have the prescription from your doctor, you may enjoy convenient, monthly shipments of medically necessary incontinence supplies direct to your home at little to no out-of-pocket to you.
