Medicare's coverage of PureWick depends on your specific situation and which part of Medicare you have

PureWick is a catheter-free urinary collection system designed for people with incontinence who cannot use traditional catheters. Medicare Part B covers PureWick as durable medical equipment (DME) — but only under specific conditions. You must have a doctor's order, meet medical necessity requirements, and use a Medicare-approved DME supplier. Coverage is not automatic, and your out-of-pocket costs depend on whether you have met your Part B deductible and what your supplemental insurance covers.

The key difference from other incontinence products is that PureWick requires a prescription and must be ordered through a DME supplier, not purchased over the counter. This makes the coverage process more involved than buying adult incontinence pads at a pharmacy.

Key Takeaways

  • Medicare Part B covers PureWick as durable medical equipment when prescribed by a doctor and ordered through a Medicare-approved DME supplier.
  • Your doctor must document that PureWick is medically necessary for your condition and that you cannot use other incontinence management options.
  • You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible, unless you have a Medigap or Medicare Advantage plan that covers DME differently.
  • The DME supplier must be enrolled with Medicare; ordering from a non-approved supplier means Medicare will not pay and you will owe the full cost.
  • Your doctor's order is valid for one year, and you can request refills through your DME supplier without needing a new prescription each time.

How to get a prescription from your doctor

Start by talking to your primary care doctor or the specialist treating your incontinence — a urologist, urogynecologist, or continence nurse. Explain that you have tried other incontinence management methods and that PureWick would help you. Your doctor needs to document in your medical record why PureWick is medically necessary for you specifically, not just that you have incontinence.

Medicare requires the doctor to state that you have tried or cannot use other options first. This might mean you have tried absorbent pads and they are not working, or that you have a skin condition that makes traditional catheters unsafe. Once your doctor agrees, they will write a prescription that includes the quantity you need per month and the duration of the order (usually one year).

Ask your doctor's office which DME supplier they typically work with, or ask them to send the prescription directly to a supplier you choose. Some doctors' offices have a preferred supplier relationship and can speed up the process.

Finding and working with a Medicare-approved DME supplier

Not every medical supply company is approved to bill Medicare for DME. You need to use a supplier that is enrolled with Medicare and has the proper credentials. You can search for approved suppliers on the Medicare DME Supplier Locator at dmepos.cms.gov, or call 1-800-MEDICARE and ask for a list of approved suppliers in your area.

Once you have chosen a supplier, give them your doctor's prescription. They will verify your Medicare coverage, confirm your deductible status, and tell you what you will owe out of pocket. The supplier handles the billing to Medicare and sends you the PureWick supplies. Most suppliers deliver to your home.

Keep the supplier's contact information. When you need a refill, you can call them directly — you do not need a new prescription from your doctor each time, as long as the original order is still valid (within one year of the prescription date).

What you will pay out of pocket

Under Medicare Part B, you pay 20 percent of the Medicare-approved amount for PureWick after you have met your annual deductible ($240 in 2024, though this amount changes each year). The exact amount you owe depends on what Medicare determines is the approved price for the product in your area.

If you have a Medigap (supplemental insurance) plan, it may cover some or all of your 20 percent coinsurance, depending on which plan you have. Plans C, D, G, and M cover the Part B coinsurance. If you have a Medicare Advantage plan, your out-of-pocket costs follow your plan's rules, which may be different — some plans charge a copay for DME instead of coinsurance. Check your plan documents or call your plan to find out.

If you have not met your Part B deductible yet, you will pay the full Medicare-approved amount until you reach $240 (or the current year's deductible). After that, you pay 20 percent.

What happens if your doctor's order expires

A prescription for PureWick is valid for one year from the date your doctor writes it. If you need to continue using PureWick after that year, your doctor must write a new prescription. Contact your doctor's office 30 days before your current order expires and ask them to renew it. Your doctor may want to see you again to confirm that PureWick is still medically necessary, or they may renew it based on your medical record.

Once you have a new prescription, give it to your DME supplier. There is no gap in coverage as long as you request the renewal before the old order runs out.

When Medicare may deny coverage

Medicare will not pay for PureWick if your doctor did not write a prescription, if the prescription came from a non-physician (such as a nurse or physician assistant without prescribing authority in your state), or if you ordered it from a supplier that is not Medicare-approved. You will owe the full cost in these situations.

Medicare may also deny coverage if the medical record does not show that you have tried other incontinence management options first or that you have a medical reason you cannot use them. If this happens, your supplier will send you a notice explaining the denial. You have the right to appeal within 120 days by submitting additional medical information from your doctor.

If your Medicare Advantage plan denies coverage, the appeal process is different and faster — contact your plan directly to understand your options.

Questions to ask your doctor

Before your appointment, write down these questions so you do not forget to ask them:

  • Do you think PureWick would help my incontinence?
  • What other options should I try first, or why is PureWick better for my situation?
  • Will you write a prescription for PureWick, and can you send it to a specific DME supplier?
  • How often should I use PureWick, and how many units per month do I need?
  • How long will the prescription be valid, and when should I contact you for a refill?
  • If Medicare denies coverage, will you help me appeal or provide additional documentation?

Frequently Asked Questions

Can I buy PureWick without a prescription and have Medicare pay for it?

No. Medicare only covers PureWick when it is prescribed by a doctor and ordered through a Medicare-approved DME supplier. If you buy it over the counter or online without a prescription, Medicare will not reimburse you, and you will owe the full cost.

Does Medicare Advantage cover PureWick the same way as Original Medicare?

Medicare Advantage plans must cover PureWick if it is medically necessary, but the amount you pay out of pocket may be different. Some plans charge a copay for DME, others charge coinsurance. Check your plan's formulary or call your plan to find out what you will owe before you order.

What if my doctor says PureWick is not medically necessary?

If your doctor does not believe PureWick is right for you, ask them what other options they recommend. You can also ask for a referral to a specialist, such as a urologist or continence nurse, who may have a different opinion. If you disagree with your doctor's decision, you have the right to seek a second opinion.

How long does it take to receive PureWick after I order it?

Most DME suppliers deliver within 5 to 10 business days of receiving your prescription. Some offer faster delivery for an additional fee. Ask your supplier about their typical delivery time when you place your order.

Can I switch DME suppliers if I am not happy with mine?

Yes. You can change suppliers at any time. Give your new supplier a copy of your current prescription, and they will take over billing and delivery. You do not need your doctor's permission to switch suppliers.