Medicare Coverage and Urology Supplies – A Comprehensive Guide

If you’re a Medicare recipient looking for a way to reduce the cost of urology supplies, then here’s something you definitely should know: Medicare covers urology supplies.

Urology supplies, such as catheters and drainage bags, can be expensive. In fact, a monthly supply of catheters alone can cost up to $200. But if you have Medicare (or are eligible for it), then this is a cost that may be avoided.

This guide will help you understand how to use Medicare to get urology supplies. From eligibility to placing orders, you’ll learn everything you need to know to get the supplies you need and possibly save money.

Have Medicare and Need Urological Supplies?

Medicare covers urology supplies

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Medicare Eligibility:

To be eligible to receive Medicare, you must meet one or more of the requirements established by the federal government.

There are three basic categories that qualify someone for coverage:

You are eligible for Medicare if you are at least 65

At least 65 years of age

You are eligible for Medicare if you are receiving SSDI

Receiving Social Security Disability Insurance (SSDI)

You are eligible for Medicare if you have ALS

Having Amyotrophic Lateral Sclerosis (ALS)

Types of Medicare

Medicare coverage is divided into two parts:

Medicare Part A

Part A

Part A of Medicare covers hospital expenses, such as hospital stays, skilled nursing care, hospice, and home-health services.

It may be possible to be eligible for part A without having to pay a monthly premium. You will not have to pay a monthly premium for Part A if you or your spouse paid Medicare payroll taxes while working.

If you and your spouse did not work or did not pay enough Medicare payroll taxes, you may not be eligible for premium-free Part A. You still may be able to purchase Part A, but you will have to pay a monthly premium.

Medicare Part B

Part B

Part B of Medicare is health insurance coverage. Like traditional health insurance, Medicare covers healthcare needs such as doctor’s visits, lab work, x-rays, and outpatient surgeries.

Part B also covers medical supplies and equipment that are medically necessary for treating an illness or condition. This could include urology supplies, such as catheters and drainage bags.

Part B is optional, and the cost varies for each person. Medicare and Medicare Advantage plans have a deductible and a 20% copayment for Medicare-covered services.

Medical Necessity Requirements

Medicare will only pay for services that are considered to be medically necessary. Services or supplies are considered medically necessary if they:

  • Are proper and needed for diagnosis, or treatment of your medical condition.
  • Are provided for the diagnosis, direct care, and treatment of your medical condition.
  • Meet the standards of good medical practice in the medical community of your local area.
  • Are not mainly for the convenience of you or your doctor.
Information

In order for an incontinence product to be covered by a Medicare plan, it must be considered “medically necessary”

Paperwork

In order for Medicare to cover urology supplies, you will need to submit at least two forms of paperwork. The type of paperwork needed may vary for different types of supplies. Generally, the paperwork will fall into these two categories:

Two forms are needed for Medicare coverage

1. Physician’s Order:

A Physician’s Order is the most common document required by Medicare plans for incontinence supply coverage. It’s basically a prescription that establishes what urology products are needed for treatment. All urology products require a Physician’s Order for coverage.

2. Medical Records:

Medical Records are documents that contain the recorded medical history of a patient. They include notes about all your visits, lab tests, surgeries and medications. They are provided by a physician, and generally contain a history of all the conditions and healthcare services a person has received.

Your physician will document in your medical record what medical condition requires the medical supplies.

Advanced Beneficiary Notice (ABN)

An Advance Beneficiary Notice of Noncoverage (ABN) is a document that alerts individuals to the possibility that their supplies may not be covered by Medicare.

If Medicare does not cover the supplies, or does not cover them for the person’s condition, or does not cover the quantity needed, the supplier will give the person an estimate of what the supplies cost. The person has the option to pay difference between what Medicare reimburses and the total cost.

Receiving an ABN does not mean you can’t get supplies; rather, it lets you know that if Medicare doesn’t provide coverage, then you will be responsible for paying the cost yourself.

Urology Supplies Covered by Medicare:

Medicare provides coverage for a wide range of urology products. Coverage may vary depending on need and your doctor’s orders, but here is a list of products that could potentially be received:

Urology supplies Medicare can cover
  • Intermittent Catheters
  • Indwelling Catheters
  • Condom/External Catheters
  • Drainage Bags
  • Irritation Trays & Supplies
  • Tape

Quantity Limits

A quantity limit is the maximum number of a urology product at Medicare will cover per billing cycle. Each product has its own quantity limit. Once this limit has been reached, the supplies will no longer be covered, and the individual will be responsible for any additional costs.

Product-by-Product Coverage

Select a product below to learn more about the Medicare coverage options available.

Select a Product

(Skip to Getting Supplies)

*All material is presented solely as educational information.

Intermittent Catheters

 

Covered:

  • Yes

Maximum Number Covered per Month

  • 200 (Medical Necessity will determine your coverage).

Requirements:

  • Supplies must be medically necessary and prescribed by your doctor.
  • Medical records are required for coverage

HCD can provide this product through Medicare!

Coude Catheters

 

Covered:

  • Yes

Maximum Number Covered per Month

  • 200 (Medical Necessity will determine your coverage).

Requirements:

  • Supplies must be medically necessary and prescribed by your doctor.
  • Medical records are required for coverage

HCD can provide this product through Medicare!

Indwelling Catheters

 

Covered:

  • Yes

Maximum Number Covered per Month

  • 1 (Medical Necessity will determine your coverage).

Requirements:

  • Supplies must be medically necessary and prescribed by your doctor.
  • Medical records are required for coverage

HCD can provide this product through Medicare!

Disposable Male/External Catheters

 

Covered:

  • Yes

Maximum Number Covered per Month

  • 35 (Medical Necessity will determine your coverage).

Requirements:

  • Supplies must be medically necessary and prescribed by your doctor.
  • Medical records are required for coverage

HCD can provide this product through Medicare!

Bedside Drainage Bags

 

Covered:

  • Yes

Maximum Number Covered per Month

  • 2 (Medical Necessity will determine your coverage).

Requirements:

  • Supplies must be medically necessary and prescribed by your doctor.
  • Medical records are required for coverage

HCD can provide this product through Medicare!

Leg Drainage Bags

 

Covered:

  • Yes

Maximum Number Covered per Month

  • 2 (Medical Necessity will determine your coverage).

Requirements:

  • Supplies must be medically necessary and prescribed by your doctor.
  • Medical records are required for coverage

HCD can provide this product through Medicare!

Irrigation Trays

 

Covered:

  • Yes

Maximum Number Covered per Month

  • 1 (Medical Necessity will determine your coverage).

Requirements:

  • Supplies must be medically necessary and prescribed by your doctor.
  • Medical records are required for coverage

HCD can provide this product through Medicare!

Irrigation Syringe

 

Covered:

  • Yes

Maximum Number Covered per Month

  • 1 (Medical Necessity will determine your coverage).

Requirements:

  • Supplies must be medically necessary and prescribed by your doctor.
  • Medical records are required for coverage
  • Sterile water/saline is only covered for intermittent irrigation of indwelling catheters.

HCD can provide this product through Medicare!

Sterile Water/Saline

 

Covered:

  • Yes

Maximum Number Covered per Month

  • 500 ml (Medical Necessity will determine your coverage).

Requirements:

  • Supplies must be medically necessary and prescribed by your doctor.
  • Medical records are required for coverage
  • Irrigation syringes are only covered for intermittent irrigation of indwelling catheters.

HCD can provide this product through Medicare!

Medical Tape

 

Covered:

  • Yes

Maximum Number Covered per Month

  • 1 roll (Medical Necessity will determine your coverage).

Requirements:

  • Supplies must be medically necessary and prescribed by your doctor.
  • Medical records are required for coverage
  • Coverage includes both waterproof and non-waterproof styles.

HCD can provide this product through Medicare!

Gauze

 

Covered:

  • No

Maximum Number Covered per Month

  • Not Covered

Medicare does not cover this product.

Skin Barriers/Sealants/Ointments

 

Covered:

  • No

Maximum Number Covered per Month

  • Not Covered

Medicare does not cover this product.

Gloves

 

Covered:

  • No

Maximum Number Covered per Month

  • Not Covered

Medicare does not cover this product.

Getting Supplies with Medicare:

The first step to getting supplies through Medicare is to visit your doctor and get a diagnosis. A doctor’s confirmation that the supplies are medically necessaryis required for coverage. If you don’t see a doctor, you cannot get the paperwork necessary to get your supplies through Medicare.

Contact Us

Once you’ve seen your doctor, it’s time to call us. We’ll collect the Medicare paperwork for you, set up monthly deliveries of supplies, and bill Medicare on your behalf. Enrollment takes just 5 minutes!

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Disclaimer:
Unless otherwise noted, the recommendations in this document were obtained from the sources indicated. Be advised that information contained herein is intended to serve as a useful reference for informational purposes only. HCD cannot be held responsible for the continued accuracy of or for any errors or omissions in the information. All trademarks and registered trademarks are the property of their respective owners.

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