July 7th 2023
By Ari Parker
Medicare does not cover incontinence supplies, like adult diapers, but it does cover some incontinence treatments. Learn about Medicare incontinence coverage.
By Ari Parker
Urinary incontinence is more common as we age, especially among women. It’s unclear exactly how common incontinence is, and it’s believed that incontinence goes underreported because many older adults think it’s a normal, unmanageable part of aging. It’s also likely that the embarrassing nature of incontinence causes many older adults to keep the symptoms and issues to themselves.
While incontinence isn’t a serious medical condition, it’s unpleasant and can have an impact on quality of life, social engagement, and mental health. The good news is that it can often be prevented or controlled, and when it can’t, incontinence supplies can help older adults continue to go about their days normally.
Unfortunately, Medicare does not cover incontinence supplies like adult diapers. Medicare may cover some incontinence treatments. The causes of incontinence can help determine the right treatment plan and medical coverage.
Medicare doesn’t cover incontinence supplies and adult diapers, but it will cover treatments for medical conditions that cause incontinence.
Some Medicare Advantage plans offer over-the-counter (OTC) benefits that can cover incontinence supplies. Details vary with plans and insurance providers, so be sure to check your summary of benefits carefully.
Many things can cause incontinence. When incontinence lasts only for a short period, it’s often caused by:
Urinary tract infections (UTIs)
Vaginal infection or irritation
Certain medications
Constipation
When incontinence lasts for a longer period, there are many potential causes, including:
Inflammation or enlargement of the prostate gland
Weak bladder or pelvic floor muscles
Overactive bladder muscles
Damage caused by chronic conditions like diabetes, multiple sclerosis, and Parkinson’s disease
Cognitive issues that cause people to forget to go or be unaware they need to go to the bathroom
Mobility issues that make it challenging to get to the bathroom in time
Determining the cause of incontinence is important for developing the best treatment plan.
The first step to managing incontinence is consulting a doctor. Your doctor will help you determine the cause and best treatment plan.
Oftentimes, a combination of multiple treatments and supplies can help you manage incontinence and improve your quality of life.
Bladder Control Training
Bladder control training involves physical and mental exercises that make it easier to “hold it” and get to the bathroom in time. Three common exercises are:
Pelvic muscle exercises (Kegel exercises) strengthen your pelvic floor, which helps you avoid leaks and accidents.
Urgency suppression involves mentally distracting yourself, holding still, taking breaths, or squeezing your pelvic muscles to help you control your urges and make it to the bathroom on time.
Time voiding involves scheduling time to go to the bathroom. People often start by going to the bathroom every hour, then increasing the time between breaks to avoid accidents while they train their bodies.
Behavioral and lifestyle changes
Some dietary changes like quitting smoking and limiting caffeine and alcohol can help reduce incontinent episodes. Limiting liquids before bed can support nighttime incontinence. Clearing the path to your bathroom at home and being aware of where the nearest bathroom is when you’re out are other small changes you can make to ensure you get to the bathroom on time.
Medical Treatments
When bladder control training and lifestyle changes aren’t enough, medical treatments can sometimes alleviate the burden of incontinence. Medical treatments may include:
Medications
Medical devices like catheters that drain urine from your bladders and inserts that prevent or lessen leakage
Biofeedback sensors that increase awareness of natural signals your body sends when you need to go to the bathroom
Surgery for certain conditions like an enlarged prostate
Incontinence Supplies
Even with the best combination of treatments, you may still experience some incontinent episodes—or be afraid they could occur. In these instances, bladder control products like absorbent underwear, disposable underwear or diapers, and pads can help you feel confident to go about your day without a public episode.
The price of incontinence supplies can vary with the type of product, brand, cost of living for your location, and how often you need them. Adult diapers and disposable briefs can cost anywhere between $40 per month for economy brands to $360 per month for more premium brands. Bladder pads and bed pads tend to be less expensive. Skin care products like barrier creams and wipes can cost between $5 to $20 depending on the item.
Incontinence supplies can add up if you use all these products, but there are ways to save money through bulk orders, subscription orders, and local senior discounts. Some non-profits like Friends of Disabled Adults and Children (FODAC) and local senior care and community health centers may provide free incontinence supplies. Seniors with low incomes can check local resources for more information.
If you have Medicaid coverage or other health insurance that covers incontinence supplies, you can get them delivered through Home Care Delivered.
In general, Medicare doesn’t cover incontinence supplies like adult diapers, but it may cover incontinence treatments to help manage an underlying medical condition. Some Medicare Advantage plans provide over-the-counter (OTC) benefits that can help pay for incontinence supplies, but each plan varies. We’ll explain how each part of Medicare could cover incontinence-related treatments first and then get into Medicare Advantage OTC card benefits.
Medicare Part B is your medical health insurance and can cover certain treatments to help with incontinence issues. It doesn’t cover supplies like adult diapers, wipes, or bladder pads, but Medicare Part B does cover certain things to manage underlying conditions.
For example, a common symptom for people with End-Stage Renal disease is incontinence and other bladder issues. Medicare Part B can help with coverage for dialysis, but generally won’t cover incontinence supplies.
Medicare Part B also covers catheters as prosthetic devices (which are considered durable medical equipment) if deemed medically necessary. Before getting equipment for urinary catheters, speak with your doctor and check your specific insurance benefits to understand any costs to you.
Your Medicare Supplement insurance won’t cover incontinence supplies, but will help cover your out-of-pocket costs for incontinence treatment. Medicare Supplement plans cover the 20% of costs leftover from Original Medicare. For example, if you have Medicare Supplement Plan G, it’ll pay for the 20% of costs for a catheter that Original Medicare doesn’t pay once you reach your Part B deductible.
Medicare Part D coverage through a stand-alone prescription drug plan or a Medicare Advantage plan with prescription drug coverage can include drug treatments for incontinence. When discussing incontinence drug treatment with your doctor, check your prescription drug plan's list of covered drugs to ensure coverage.
Medicare Advantage plans provide the same level of coverage as Original Medicare. However, Medicare Advantage plans can also offer additional benefits beyond Original Medicare. One common benefit is an OTC allowance, which is a monthly or quarterly allowance for over-the-counter products. These products can include incontinence supplies.
This benefit varies widely between insurance plans, and isn’t always offered. The amount you receive for OTC benefits, which items you can buy, and how it works depend on your Medicare Advantage plan details.
If you ever need help using your OTC benefits, you can use Chapter’s free OTC app to keep track of your allowance and use all your benefits easily.
While Medicare doesn’t cover all incontinence supplies and treatments, it’s important for you to bring any issues with incontinence up with your doctor to discuss the best treatment plan. Your doctor can offer guidance on any medical issues that may be causing your incontinence—as well as bladder control training, lifestyle changes, and medications you can take to manage your incontinence.
If you ever have any questions about your Medicare coverage, we’re here to help! Our team of Medicare advisors is here to help you get the most value out of Medicare, whether that means explaining your options, helping you choose the right plan for your needs, or using your benefits. Call us at 855-900-2427 or schedule a time to chat.
