Does Medicare Cover PureWick Catheter Systems?

What Medicare Covers for PureWick

Medicare Part B covers PureWick — a catheter system designed for women who experience urinary incontinence — but only under specific conditions. The system must be prescribed by a doctor, and you must meet medical necessity requirements that Medicare sets. Coverage is not automatic; your doctor's office typically handles the paperwork to confirm coverage before you receive the device.

PureWick is classified as durable medical equipment (DME), which means Medicare treats it the same way it treats wheelchairs, walkers, and oxygen equipment. You pay 20 percent of the approved amount after you meet your Part B deductible. The remaining 80 percent goes to the DME supplier. If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost may be lower depending on your plan's coverage rules.

Key Takeaways

Medicare Part B covers PureWick when a doctor prescribes it and documents that you have a medical need for it.
You pay 20 percent of the Medicare-approved amount after meeting your Part B deductible; Medicare pays 80 percent.
Your doctor must submit a prescription and medical justification to a Medicare-approved DME supplier before you receive the device.
Medigap plans typically cover your 20 percent coinsurance, and Medicare Advantage plans vary — check your plan documents or call the plan directly.
If Medicare denies coverage, you have the right to request a review and can ask your doctor to appeal on your behalf.

Medical Necessity Requirements

Medicare will not pay for PureWick unless your doctor documents that you have a medical reason for it. The most common documented reasons are severe urinary incontinence that cannot be managed with other methods, mobility limitations that make traditional catheterization difficult, or skin conditions that make standard catheters unsafe. Your doctor's notes must show why you specifically need this device rather than alternatives.

Medicare reviews the prescription and medical record before approving payment. If your doctor's documentation is vague or incomplete, the DME supplier will ask for more detail. This step usually takes a few days but can delay your order. Having your doctor include specific details — such as the number of incontinence episodes per day, what you have already tried, and why those methods did not work — speeds up the process.

How to Order Through Medicare

Start by asking your doctor for a prescription for PureWick. Your doctor does not need to write a paper prescription; they can send it electronically to a Medicare-approved DME supplier. You can choose which supplier to use, though your doctor may have a preferred vendor they work with regularly.

Once you have selected a supplier, call them and provide your Medicare number and the prescription details. The supplier will verify your coverage, confirm your deductible status, and calculate your out-of-pocket cost. They will then submit the prescription and medical justification to Medicare for review. During this review period — typically 5 to 10 business days — the supplier will contact you to confirm your shipping address and payment method. After Medicare approves the claim, the supplier ships the device directly to your home.

What You Pay Out of Pocket

Your cost depends on whether you have met your Part B deductible for the year. If you have not met it, you pay the full deductible amount first, then 20 percent of the Medicare-approved amount for the PureWick system. If you have already met your deductible, you pay only 20 percent of the approved amount.

The Medicare-approved amount for PureWick varies by supplier and region but typically ranges from $150 to $300 per month for the ongoing supplies. Your initial order may include a starter kit with additional equipment. Ask the DME supplier for a written estimate of your costs before they submit the claim to Medicare. If you have a Medigap plan, check whether it covers DME coinsurance — most Medigap plans do, which would reduce your 20 percent to zero. If you have a Medicare Advantage plan, your costs depend on your specific plan; call your plan's customer service line to confirm.

If Medicare Denies Your Claim

If Medicare denies coverage, the DME supplier will send you a notice explaining the reason. Common reasons for denial include incomplete medical documentation, a information that the device is not medically necessary, or a finding that you do not meet Medicare's specific criteria for this type of equipment.

You have the right to request a review. The DME supplier can help you file an appeal, or you can contact Medicare directly at 1-800-MEDICARE. Your doctor can also submit additional medical information to support the appeal. The appeal process typically takes 30 to 60 days. During this time, you can ask the supplier whether they will provide the device on a temporary basis while the appeal is pending, though they are not required to do so.

Medicare Advantage and Medigap Coverage

If you have a Medicare Advantage plan, coverage for PureWick may differ from Original Medicare. Some Advantage plans cover it the same way Part B does; others may require prior authorization or have different cost-sharing rules. Check your plan's formulary or call your plan's customer service number to confirm coverage before ordering.

Medigap plans do not change Medicare's coverage decisions, but they do change what you pay. Most Medigap plans cover the 20 percent coinsurance for DME, meaning you would pay nothing out of pocket after meeting your Part B deductible. Plans C, D, G, and M typically include this coverage. If you have an older Medigap plan, check your policy documents or call your Medigap insurer to confirm.

Frequently Asked Questions

Does my doctor have to use a specific DME supplier?

No. Your doctor can send the prescription to any Medicare-approved DME supplier. You can shop around and compare costs and customer service. Ask the supplier whether they are in-network with your Medicare Advantage plan if you have one, as this may affect your out-of-pocket cost.

What if I cannot afford the 20 percent coinsurance?

If cost is a barrier, talk to your doctor or the DME supplier about whether a different device might be covered at a lower cost. You can also ask whether the supplier offers payment plans. Some nonprofits and disease-specific organizations offer financial information for medical equipment; your doctor's office may know of resources in your area.

How often does Medicare cover replacement supplies?

Medicare covers ongoing supplies based on medical necessity and frequency of use. Your doctor and the DME supplier determine how often you need new supplies — typically monthly. If you need supplies more frequently than Medicare considers standard, your doctor must document the medical reason and request an exception.

Will my Medicare Advantage plan cover PureWick the same way Original Medicare does?

Not necessarily. Some Advantage plans have different rules for DME, including prior authorization requirements or different cost-sharing amounts. Contact your plan directly before ordering to confirm coverage and your out-of-pocket cost.

Can I use PureWick if I have both Medicare and Medicaid?

Yes, but the coordination between the two programs depends on your state's rules. Generally, Medicare is the primary payer, and Medicaid covers costs Medicare does not. Contact your state Medicaid office or your Medicaid managed care plan to understand how they coordinate on DME coverage.

This guide is for general information only and is not medical, financial, legal, or other professional advice. For decisions specific to your situation, consult a qualified professional. See our Editorial Policy.