Incontinence is an embarrassing but common condition for many people, with over half of seniors experiencing incontinence at some level of severity. It makes sense that it would be common because there are so many unique conditions that can cause incontinence that most people are likely to live with one at some point in their lives. After all, everyone will experience aging. It’s important to remember this commonness of urinary or fecal leakage, because even though it may be embarrassing, discussing any symptoms of incontinence or episodes of leakage with your doctor is a good idea. Incontinence can be a sign of a more serious condition or just a nuisance, but telling your doctor is the first step toward dealing with it.
Of course, treating incontinence isn’t something you can do just by talking to your doctor and learning a few mitigation strategies, though these can help. There are often treatment options like adult diapers, therapies, or surgeries that can help you to live with or treat incontinence. But these aren’t free. Can Medicare insurance cover incontinence treatment options or will you have to pay for these expenses out of pocket?
Original Medicare
There are many ways to deal with bladder control issues, from lifestyle changes to surgery. However, the differences in these strategies can drastically change your coverage options, especially under Original Medicare. First and foremost, let’s look into the day-to-day mitigation strategies, like incontinence pads or adult diapers. Are they covered by Original Medicare? Generally, these items aren’t covered by Original Medicare at all. This means you’ll owe 100 percent of the costs out of pocket. Even some devices like manual pump enema systems or pulsed irrigation and evacuation devices aren’t covered by Original Medicare. The reason for this is because they often fall under the category of common medical supplies or don’t qualify under the durable medical equipment (DME) requirement.
Original Medicare may cover certain devices if they’re medically necessary and qualify as DME.
That doesn’t mean Original Medicare won’t cover any treatments related to incontinence. It may cover certain devices like catheters, enema systems, or irrigation systems if they’re medically necessary and qualify as DME. Additionally, if you’ve had a colostomy, ileostomy, or urinary ostomy, Original Medicare may cover medically necessary ostomy supplies, based on your need according to your doctor. If you’ve read our “Dealing with Bladder Control Issues” article, you’ll know there are also surgical solutions to incontinence. The problem with Medicare insurance coverage for surgical solutions is it’s very difficult to definitively state whether or not they’ll be covered. Your best option is to talk to your doctor to find out if your case warrants a surgical option. If it is covered, it may be covered as an outpatient or inpatient surgery, depending on the surgery. To see what each cost would entail, read “Here’s What Medicare Insurance Costs in 2023” for inpatient (Part A) and outpatient (Part B) costs.
Medicare Advantage and Part D
Of course, there are other parts of the Medicare program that offer some coverage, as well. For example, Medicare Part C, or Medicare Advantage, must cover anything that Original Medicare covers, but may have additional coverage as well. Unfortunately, each plan is different, so it would be impossible to give you a definite answer for the specifics of what is covered. Speak with your provider or read the fine details of your plan to see exactly what’s covered for you.
If you’re already enrolled in a Medicare Advantage or Part D plan, check your formulary to see if you have coverage.
Similarly, there are treatments for incontinence that involve prescription drugs. If you choose to explore this option, a Medicare Advantage plan with drug coverage or a Medicare Part D plan may offer the coverage you’re seeking. Your coverage may change depending on your plan’s formulary. If you’re already enrolled in a Medicare Advantage or Part D plan, check your formulary to see if you have coverage. If there isn’t coverage or you aren’t enrolled in a plan and you want to explore your options, check out the Shop & Enroll plan finder tool to see what options are available near you!
Other Options
If there’s a need for incontinence solutions that aren’t covered by Medicare, such as many of the day-to-day supplies, but paying for them out-of-pocket would make things fiscally difficult, you do have other options. Unlike Medicare, Medicaid can cover incontinence supplies if they’re deemed medically necessary. Each state governs their own Medicaid plans, so you’ll need to explore your own state’s policies for specifics. Currently, most states do offer some form of coverage for qualifying beneficiaries. As long as you qualify for Medicaid, it can work with your Medicare coverage to help you deal with your leakage and incontinence concerns.
Unlike Medicare, Medicaid can cover incontinence supplies if they’re deemed medically necessary.
If you’re a veteran receiving coverage through a Veterans Health Administration (VHA) program, you may also receive some coverage for incontinence supplies under medical supplies and dressings. To receive coverage, you’ll need to qualify for a program and speak to your doctor about the medical need.
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Incontinence can be a regular source of grief and frustration, but it doesn’t have to be a drain on your bank account, too. By exploring your coverage options, you can receive assistance for many of the solutions that can either handle the day-to-day management of your condition or outright treat it through surgery or medication. Of course, by talking to your doctor, you may also discover the root cause of your incontinence, and Medicare insurance may be able to cover the treatment for that, as well. Talking to your doctor about your symptoms, even if they’re a little embarrassing, is the key to discovering your options so you can find solutions.
