Have you recently been prescribed urinary catheters? “Will my insurance cover my catheters?” is a common question for new catheter users or those who have recently changed insurances – and understandably so. Medical supply spending is rising in the U.S. and can rapidly become unaffordable to those who require daily management supplies such as catheters.

What Are Catheters?

Catheters are you to support and manage incontinence issues. Urinary catheters come in various shapes and sizes and are essentially soft and hollow tubes that drain urine from the bladder to a collection bag.

There are different styles of catheters, but the main categories are:

  • External: External catheters are more non-invasive versions of urinary catheters that both men and women can use. These catheters are also known as condom catheters or female external catheters.
  • Foley: Foley catheters, also called superpubic catheters, are generally placed by a healthcare professional directly into the urethra. A small water-filled balloon helps to keep the catheter positioned in place.
  • Intermittent: This category of a catheter is sometimes referred to as “in and out” and can include straight catheters, hydrophilic catheters, and closed system catheters. These catheters are lubricated and placed by the patient, or a caregiver, directly into the urethra so urine can drain into a connected drainage bag, toilet, or disposal receptacle.

Will My Insurance Cover Catheters?

Urinary catheter supply costs can add up quickly when paying out of pocket. Many healthcare insurances will cover some or all of the cost of catheters when they are medically necessary. Different insurances will vary in their coverage.

Medicaid And Catheter Coverage

Medicaid is federally funded but run by individual states; each state’s Medicaid program will vary in coverage, benefits, and eligibility. According to Medicaid.gov, as of April 2021, 82,301,711 people were receiving Medicaid benefits in the U.S.

Many Medicaid programs, known as Medi-Cal in California, will cover some, or all, of the cost of urinary catheter supplies. Depending on your state’s Medicaid stipulations, you may be able to obtain catheter supplies through your insurance coverage. Active Life Medical can help guide you through understanding the benefits and requirements of your Medicaid plan. If you don’t have Medicaid, you can check your eligibility and learn how to apply here.

Medicare And Catheter Coverage 

Certain portions of Medicare cover catheters; Medicare Part B covers the cost of prescribed catheters when medically necessary. Medicare can cover 80% of the price of the catheter, and 20% is out-of-pocket or through a secondary or supplemental insurance plan.

There are different types of Medicare coverage options. Some patients’ healthcare billing will go directly through Medicare, but private Medicare-managed care or replacement plans are available to manage your benefits and coverage. Each of these coverage options will handle catheter coverage differently. If you need assistance navigating your Medicare coverage options, the Product Specialists at Active Life Medical Products can help. You can also view Medicare-managed care plan options here. 

Private Insurances And Catheter Coverage 

Each private insurance plan handles catheter coverage in its way. Fortunately, many private health insurances will cover incontinence supplies when prescribed by a physician. When private insurances cover catheter supplies, deductibles, coinsurance, and out-of-pocket maximums will affect your cost. If you are unsure how your insurance will cover your catheter costs, the specialists at Active Life Medical can help you find out this information.

How Will My Insurance Cover The Catheters That I Need?

While there are different stipulations and requirements with every insurance company, there are several things that are generally universally needed:

  • Chart notes or medical records supporting the medical necessity of catheter usage
  • Doctor’s prescription detailing the type, kind, and quantity of catheters and supplies needed
  • Letter of medical necessity (LMN) or certificate of medical necessity (CMN) for supplies needed to be signed by a physician

For a claim to be processed for coverage with insurance companies, these documents mentioned above (and potentially others) will be required.

When you need catheters and want to bill them through your insurance, you must partner with a medical supply company such as Active Life Medical to help navigate the process. Because different healthcare plans will have additional stipulations, coverages, and requirements, having an expert that understands guidelines and scope can help ensure the process goes smoothly.

How Active Life Medical Products Can Help With Catheter Supplies

You need a trusted catheter product supplier when you require catheter supplies. Active Life Medical Products makes ordering the entire catheter supply process easy. Our Product Specialists can help you get your prescribed catheter covered through most insurances. Everything will be delivered directly and discreetly to your front door.

Call Active Life Medical Products at (800) 319-2336 to place your order.