Does Medicare Cover Incontinence Supplies?
Find out whether Medicare will cover your incontinence supplies with our guide.
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A common question among seniors is whether Medicare covers incontinence supplies. Incontinence is a common problem affecting many young and older adults.
Having to rely on disposable diapers and pads regularly can end up costing a lot of money. For seniors on Medicare, it's essential to know whether or not their policy covers incontinence supplies.
This guide will look at what coverage is available and how to get the incontinence supplies you need.
What Is Medicare?
Medicare is a federal health program that provides coverage to individuals 65 years or older, those with specific disabilities, and those suffering from ESRD (End-Stage Renal Disease) or ALS (Lou Gehrig’s). Medicare is funded through a combination of payroll taxes and monthly premiums.
Medicare consists of four parts:
Medicare Part A covers hospitalizations and inpatient treatment for Medicare members. This includes long-term care and nursing home care.
Medicare Part B covers outpatient care or general medical services that enrollees receive outside the hospital.
Medicare Part C, also known as Medicare Advantage, are private health plans that eligible people can join. Medicare Advantage Plans are offered by private insurance companies and are subsidized by the federal government.
Medicare Part D relates to costs for prescription drugs and medication.
Here’s a recap of the different coverage options available to Medicare-eligible individuals:
| Plan Type | Coverage |
|---|---|
| Original Medicare | Part A and Part B expenses. |
| Medicare Advantage | Part A, Part B, and sometimes Part D costs. |
| Medicare Supplement Insurance | Helps with out-of-pocket costs not covered by Original Medicare. |
| Prescription Drug Plans | Part D costs. |
Does Medicare Cover Adult Diapers or Other Incontinence Supplies?
While Original Medicare covers a wide range of medical treatments and supplies, it does not cover adult diapers or other incontinence supplies.
This is because Medicare does not consider incontinence supplies as medically necessary, and they do not fall under what Medicare classifies as durable medical equipment (DME).
What Is Durable Medical Equipment?
DME is any type of medical equipment that can be reused multiple times or is designed for long-term use.
One of the benefits of using DME is that it can help to improve a patient’s quality of life by increasing their independence and mobility.
DME includes equipment like nebulizers, oxygen tanks, hospital beds, crutches and wheelchairs, and blood pressure monitors.
Medicare covers several types of DME under Part B but does not cover everything.
If you need incontinence supplies, you must pay them out-of-pocket or sign up for a Medicare Advantage Plan to get more DME benefits.
If you’d like to learn more about different Medicare Advantage Plans in your area and what they cover, contact PolicyScout at 1-888-912-2132 or email at help@policyscout.com.
Terms you should know:
Coinsurance is the share costs for medical care that Medicare members need to cover.
With Medicare Part B, Medicare members pay a fixed percentage of their covered medical costs (20%), and Medicare pays the remaining balance (80%).
For Medicare Part A, Medicare enrollees pay a set coinsurance amount for each day of inpatient treatment.
Deductibles are a set amount of money that enrollees need to cover before their Medicare insurance begins. For Part A, a deductible payment is required for each benefit period, and for Part B, the deductible is an annual fee.
Out-of-pocket costs are any expenses not covered by Medicare that members must fund. This includes coinsurance, deductibles, and uncovered costs.
Does Medicare Cover Adult Diapers?
Original Medicare won’t cover the cost of adult diapers, but if you have Medicare Advantage, you may be able to get it covered.
Some Medicare Advantage Plans offer their members coverage for over-the-counter (OTC) medical supplies like bandages, non-prescription medication, and disposable medical supplies.
Check your plan to see if your Medicare Advantage provider will also provide coverage for absorbent products such as adult diapers.
While Original Medicare won’t cover these costs, they will cover part of the expenses you’ll incur for tests, doctor consultations, and blood work under Part B.
Remember that you’ll still have some costs to pay for these services. Here’s a recap of the out-of-pocket costs you’ll need to pay with Original Medicare and Medicare Advantage for Part B.
| Type of Cost | Amount for 2022 |
|---|---|
| Part B Premiums | $170.10 per month on average. |
| Part B Deductible | $233 per year. |
| Part B Coinsurance | 20% of the total cost. |
| Medicare Advantage Premiums | The amount you pay will depend on your plan. Remember that you’ll still need to cover your Part B costs, too. |
Will Medigap or Medicare Advantage Plans Cover Disposable Incontinence Supplies?
While Original Medicare provides basic coverage for medical expenses, it does not cover all out-of-pocket costs, such as deductibles, co-payments, and coinsurance.
Medigap policies are designed to help cover these costs. There are ten Medigap policies, each labeled with a letter of the alphabet. Each plan provides an extra coverage level, so choosing the right policy for your needs is essential.
As such, you won’t be able to get coverage for incontinence supplies through a Medigap or Medicare Supplement Insurance Plan. These plans will only help you cover out-of-pocket costs related to Original Medicare.
Does Medicare Cover Incontinence Supplies in Nursing Homes?
If you are a nursing home resident, your incontinence supplies may be covered under Medicare Part A.
However, the CMS will look at each application on a case-by-case basis. It’s best to speak to your doctor, insurance agent, or the local CMS office to find out what you’re covered for.
Does Medicaid Help Pay for Incontinence Supplies?
Medicaid is a health insurance program available to low-income individuals, families, and people with specific disabilities.
The program covers many health care services, including doctor visits, prescription drugs, and hospital stays. In addition, Medicaid also provides long-term care services for people with chronic illnesses or disabilities.
Most state-run Medicaid programs will cover your incontinence supplies, and the process will entail:
Physician’s prescription with a qualifying diagnosis.
Prior authorization (PA) from the CMS.
Letter/certificate of medical necessity (LMN).
Remember that you’ll need to apply to become dual-eligible if you want to enroll in Medicare and Medicaid. If you’re on a Medicare Advantage Plan, you’ll need to change your plan type to a particular health plan known as a Special Needs Plan (SNP).
How to Save on Incontinence Supplies Original Medicare Won't Cover
If you’re a senior needing incontinence supplies, there are several ways to reduce your costs.
Here are some tips you can follow:
Reach out to your local SHIP program or county to find out if they offer community-based outreach programs to help. You can also contact your local Social Security Agency to find out what you can do to get assistance with finding and buying incontinence supplies.
If you’re unable to afford the cost of incontinence supplies, there are state and national organizations that offer support to people who need adult diapers. You can find a list of Diaper Banks throughout the U.S. by contacting the Simon Foundation for Continence.
Another step you can take is to get an RX card that provides you with money to purchase over-the-counter medications and supplies at affordable prices. Visit our RX hub today to learn more about our market-leading RX card.
Where Can I Learn More about Medicare Coverage?
While Original Medicare doesn’t cover incontinence supplies like adult diapers or pads, there are options to help pay for your incontinence supplies.
Check out our other articles if you’re interested in learning more about what Medicare will cover. Here are some of our top picks:
Does Medicare Cover Knee Replacements
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If you need assistance with finding a Medicare Advantage, Medigap, or Part D plan, we’re here to help. Reach out with your questions and speak to one of our experienced Medicare agents today on 1-888-912-2132 or help@policyscout.com.