Urinary catheters can help individuals maintain their independence, offer relief from certain medical conditions, or provide help following a medical procedure or surgery. These devices can be used both short and long term depending on what a specific person’s needs are. Urinary catheters and the urinary drainage bags they are used with can be highly beneficial, and Medicare benefits will often cover the cost of these materials.
What is a Urinary Catheter?
There are three main types of urinary catheters that can be used: indwelling, intermittent, and external. Indwelling catheters are inserted either through the urethra or a hole in the stomach and advanced forward until it is in the bladder. Then, once inside the bladder, a small balloon is filled with air so that it will not fall out. The tube is then anchored to the patient’s leg or stomach and connects to a urinary drainage bag.
An intermittent catheter works in a similar way to an indwelling catheter, but it is not kept in the body for prolonged periods of time. Instead, it is only inserted as needed. This allows individuals to go about their day without worrying about having a tube and urinary bag connected to them.
The third type of catheter is an external catheter. The most common of these is a condom catheter, and these are only able to be used by men. They have a sheath similar to a condom that fits over the penis and a tube at the tip that allows drainage into a bag. External catheters for women exist as well, but they are often not as effective and more difficult to use.
Why Does a Urinary Catheter Need to be Used?
Catheters may be indicated for a variety of reasons. If you have a medical condition that requires you to be bedridden, a catheter eliminates incontinence issues. Additionally, if you undergo genital or prostate cancer, you may require the use of a catheter to ensure that the area around the procedure site stays dry and the muscles do not have to strain, which may cause issues with tissue healing.
Also, a catheter may be needed if you have difficulties with incontinence or urinary retention. A catheter can help to fully empty the bladder if you have retention issues and help to control urine flow and prevent incontinence issues as well.
Urinary catheters are commonly used in the short term in hospitals and other medical facilities before or after procedures to assist with comfort and ease recovery. However, they can also be used on a long-term basis if a medical condition requires it.
Do Medicare Benefits Cover Urinary Drainage Bags?
Medicare offers coverage for all types of urinary catheters and drainage bags through both Original Medicare and Medicare Advantage plans. However, the supplies covered depend on your medical condition and the catheter you require. Additionally, your physician must deem it to be medically necessary to have the catheter, and you must have medical records to support your diagnosis and treatment.
If you utilize an indwelling catheter, Medicare will cover one catheter each month. These catheters come in a few varieties, including latex, silicone, two-way, and three-way. Since these catheters stay inserted long-term, only one each month is needed.
For external catheter use, 35 catheters are covered each month. Since condom catheters must be changed daily to help prevent infection, this number allows products to be used daily and provides a few extra catheters in case an issue arises.
Intermittent catheters are only used a single time, and 200 are covered each month. This allows you to use up to six catheters per day with extras on hand.
For all catheters, but especially for indwelling and external catheter use, Medicare will provide two urinary drainage bags that can be used. These bags can be easily emptied and rinsed out if needed, so two per month should provide more than enough.
Medicare recipients can receive the required catheters and drainage bags as mentioned above with only minor out-of-pocket costs. In addition to these, Medicare will also cover a number of supplies, including anchor devices, tape, irrigation trays, gauze, gloves, skin treatments, and more.