Does Medicare Cover Catheters?
Your Medicare insurance covers important medical devices and equipment if they’re medically necessary. One medical device that’s covered is a catheter, which some people need if they have chronic conditions.
Medicare covers catheters as durable medical equipment. For any durable medical equipment, you’ll pay 20% coinsurance after you meet your Part B deductible. Learn more about how Medicare covers catheters in this article.
Key takeaways:
Medicare covers three types of catheters: urinary catheters, IV catheters, and peritoneal dialysis catheters for at home use. These catheters must be medically necessary for you to qualify for coverage.
Common medical conditions that require catheters include incontinence, End-Stage Renal Disease (ESRD), and spinal injuries.
Once you meet your Part B deductible, you’ll pay 20% of the cost of a catheter. A Medicare Supplement plan can help reduce these out-of-pocket costs.
What are catheters?
Catheters are thin, flexible tubes that are used mainly for draining fluids from the body or injecting fluids into the body. There are several types of catheters, like:
Urinary catheters: used for draining urine from the bladder
Intravenous (IV) catheters: used for injecting fluids, medications, or nutrients into the bloodstream
Cardiac catheters: used for treatment or exams for the heart
Epidural catheters: used to deliver pain relief medications around the spinal cord
Peritoneal dialysis catheters: used administer dialysis fluid
Common medical needs for catheters at home
There are a few medical reasons you may need to use a catheter at home. Many people with certain chronic conditions or who are recovering from surgery need catheters to live more comfortably. Below, we’ve listed common conditions for urinary catheter use and IV catheter use.
You may need a urinary catheter at home if:
You have a neurological condition or prostate condition that prevents your bladder from emptying naturally
You have chronic incontinence from a spinal cord injury, multiple sclerosis, or a severe pelvic floor disorder (incontinence supplies is also covered by Medicare)
You undergo a surgery involving the urinary tract (like prostate surgery) or you have a spinal cord injury
You have a blockage that prevents urination
You may need an IV catheter at home if:
You have a chronic condition that requires you to have frequent IV infusions for medications, pain management, or nutrition
You have a chronic condition that causes dehydration, meaning you need hydration therapy
You need regular home infusion therapy
If you have ESRD (End-Stage Renal Disease) and you’d prefer at-home dialysis, you may use a catheter to remove waste and fluids from your body—this type of dialysis is called peritoneal dialysis. Medicare covers both at-home dialysis and dialysis at a treatment center. In some cases, you may also need an IV catheter for medication administration.
Does Medicare cover catheters?
Medicare covers urinary catheters, IV catheters, and peritoneal dialysis catheters for at-home use and during outpatient and inpatient visits. It can also help pay for catheter supplies and accessories, like infusion pumps, insertion trays, urine collection bottles, and lubricating gels.
The equipment needs to be medically necessary in order for you to receive coverage. In some cases, a catheter may be required to perform a procedure. For example, Medicare covers cardiac ablation, which is a medical procedure that can require a catheter to treat atrial fibrillation. The procedure and the equipment needed to perform the procedure are both covered by Medicare.
What are your out-of-pocket costs for catheters?
If you need to use a catheter at home, Original Medicare will pay for 80% of the cost of the equipment. You’ll pay 20% coinsurance for the catheter after you meet your Part B deductible. Make sure you review your Medicare Supplement options. This additional coverage can help cover costs that Original Medicare doesn’t pay for.
If you have a Medicare Advantage plan, your out-of-pocket costs will be different. While these plans must cover the same equipment and services as Original Medicare, they have different out-of-pocket costs *deductibles, copayments, and coinsurance) Look over your plan’s details carefully to see how it covers durable medical equipment.
Other devices and supplies that Medicare covers
Medicare covers a number of other medical devices and supplies. Some common devices include:
Canes, walkers, and wheelchairs
Hospital beds and other specialized mattresses
In many cases, medical equipment is imperative to assist the recovery process or to live comfortably. Medicare coverage can be complicated! A Chapter Medicare Advisor would be happy to assist you by answering your questions and comparing plan options. Simply call us at 855-900-2427 or schedule a time to chat to get started.