Medicare Part B covers PureWick as a catheter alternative, but only under specific conditions

Medicare Part B will pay for PureWick — a non-invasive external catheter system — when a doctor prescribes it for urinary incontinence and you meet certain medical requirements. The system is classified as durable medical equipment (DME), which means Medicare treats it the same way it treats wheelchairs, walkers, and oxygen machines. You pay 20 percent of the approved amount after you meet your Part B deductible; Medicare covers the remaining 80 percent.

The catch is that PureWick is not automatic. Your doctor must document that you have a medical reason you cannot use a standard catheter — such as skin breakdown, repeated infections, or mobility issues that make self-catheterization unsafe. Medicare also requires that you try less expensive options first, or that your doctor explain why those options will not work for you.

The amount Medicare pays varies by supplier and region. You will need to rent or purchase the device through a Medicare-approved DME supplier, and that supplier handles the paperwork with Medicare on your behalf.

Key Takeaways

  • Your doctor must write a prescription stating the medical reason you need PureWick instead of a standard catheter.
  • Medicare Part B covers 80 percent of the approved amount after your deductible is met, and you pay 20 percent.
  • You must obtain PureWick from a Medicare-approved DME supplier, not directly from the manufacturer.
  • Medicare may require documentation that standard catheters are not medically appropriate for you before approving payment.
  • Rental and purchase options are both available, and costs vary depending on your supplier and region.

What Medicare considers a medical reason for PureWick

Medicare does not pay for PureWick straightforward because you prefer it or find it more comfortable. The prescription must state a medical condition that makes a standard indwelling catheter or intermittent catheterization unsafe or inappropriate.

Common reasons Medicare approves include skin conditions such as severe dermatitis or pressure ulcers that would worsen with a catheter, recurrent urinary tract infections linked to catheter use, or physical limitations that prevent you from managing a standard catheter on your own. If you have severe arthritis, paralysis, or cognitive decline that makes catheter care impossible, that counts. Latex allergy is another reason, though your doctor would need to document that you cannot use latex-free alternatives.

Your doctor's note should be specific. "Patient prefers PureWick" will not be approved. "Patient has stage 2 sacral pressure ulcer; standard catheter would impede healing" will be. If you are unsure whether your situation meets Medicare's standard, ask your doctor to explain the medical reason in writing before the DME supplier submits the claim.

How to get PureWick through Medicare

The process starts with your doctor. Schedule an appointment and bring up PureWick as an option for managing your incontinence. Your doctor will examine you, review your medical history, and decide whether it is medically necessary. If your doctor agrees, they will write a prescription that includes the medical reason and send it to a Medicare-approved DME supplier.

You then contact the DME supplier directly. You can find suppliers in your area by searching the Medicare DME supplier directory on Medicare.gov, or ask your doctor's office for a referral. The supplier will verify your Medicare coverage, confirm your deductible status, and explain your out-of-pocket costs. They handle submitting the prescription and medical documentation to Medicare for review.

Medicare typically responds within 5 to 10 business days. If approved, the supplier ships the equipment to your home and trains you on how to use it. If denied, the supplier will tell you why and may ask your doctor to provide additional medical information. You have the right to appeal a denial.

Rental versus purchase: which option Medicare covers

Medicare allows both rental and purchase of PureWick, and the choice depends on your situation and the supplier's inventory. Rental is typically the first option — you pay a monthly fee, and the supplier maintains and replaces the equipment. Purchase means you own the device outright after paying the full cost, though Medicare's 80/20 split still applies.

Rental makes sense if you are unsure whether PureWick will work for you long-term, or if your medical need may change. Purchase is better if you know you will need it for years and want to avoid ongoing rental fees. Some suppliers offer both; others specialize in one or the other. Ask the supplier which option they recommend based on your prescription and how long your doctor expects you to need the device.

Medicare's payment for rental is usually lower per month than the cost of purchasing, but over several years the total can add up. Your 20 percent coinsurance applies to whichever option you choose.

What you pay out of pocket

Your costs depend on three things: whether you have met your Part B deductible for the year, the Medicare-approved amount for PureWick in your region, and whether you choose rental or purchase.

If you have not met your Part B deductible (which is $240 in 2024, though this amount changes yearly), you pay the full cost of PureWick until the deductible is satisfied. After that, you pay 20 percent of the Medicare-approved amount, and Medicare pays 80 percent. The approved amount varies by supplier and location — it is not the same everywhere.

For example, if the approved amount is $150 per month for rental, you would pay $30 per month (20 percent) and Medicare would pay $120 (80 percent). If you purchase the device and the approved amount is $3,000, you would pay $600 and Medicare would pay $2,400. These are examples only; your actual costs will depend on your supplier and region.

Ask the DME supplier for a cost estimate in writing before you agree to anything. They should tell you the Medicare-approved amount, your deductible status, and your estimated out-of-pocket cost.

What happens if Medicare denies your claim

If Medicare denies coverage, the DME supplier will send you a notice called an Explanation of Benefits (EOB) that explains the reason. Common reasons for denial include: the prescription does not state a medical reason, your doctor did not document why standard catheters are not appropriate, or the supplier submitted incomplete information.

You have the right to appeal. Ask the supplier to contact your doctor and request additional documentation — for example, a detailed note about your skin condition or a list of catheter-related infections. Your doctor can then resubmit the prescription with more detail. This often resolves the denial.

If the appeal is also denied, you can file a formal appeal with Medicare. The DME supplier can guide you through this process, or you can contact your State Health Insurance information Program (SHIP) for free help. SHIP counselors understand Medicare appeals and can advocate on your behalf.

Supplemental insurance and PureWick coverage

If you have a Medigap (supplemental) policy, it may cover your 20 percent coinsurance for PureWick, depending on which plan you have. Medigap Plan C, D, F, and G typically cover Part B coinsurance, which means the plan would pay your 20 percent share. Plans A and B do not cover this coinsurance.

Check your Medigap policy documents or call your supplemental insurance company to confirm. If you have Medicare Advantage (Part C) instead of Original Medicare, your coverage for PureWick depends on your specific plan. Some Advantage plans cover DME; others do not, or they may require prior approval. Contact your Advantage plan directly to ask whether PureWick is covered and what your out-of-pocket cost would be.

Frequently Asked Questions

Does Medicare Part D (prescription drug coverage) pay for PureWick?

No. PureWick is classified as durable medical equipment, not a drug, so Part D does not cover it. Only Medicare Part B covers PureWick, and only when prescribed by a doctor for a medical reason.

Can I buy PureWick directly from the manufacturer and have Medicare reimburse me?

No. Medicare will only pay when you obtain PureWick from a Medicare-approved DME supplier. If you purchase it elsewhere, Medicare will not reimburse you. Always use a supplier in the Medicare directory to may support coverage.

What if my doctor says I need PureWick but Medicare denies it?

Ask your doctor to submit additional medical documentation explaining why standard catheters are not safe or appropriate for you. Many denials are overturned when the doctor provides more detail. You also have the right to appeal, and your State Health Insurance information Program can help you file an appeal for free.

Does Medicare cover the training or supplies that come with PureWick?

Medicare covers training on how to use the device as part of the DME benefit. Replacement supplies — such as collection bags or adhesive pads — may be covered as part of your rental or purchase, but this varies by supplier. Ask the supplier what is included in the cost and what you may need to buy separately.

If I rent PureWick, can I switch to purchasing it later?

Yes. You can rent for a period and then purchase if you decide you want to own the device. The supplier can help you transition. Your Medicare coverage and 20 percent coinsurance explore to purchase the same way they explore to rental.