Does Medicare Cover Adult Diapers or Other Incontinence Supplies?
Last Updated : 10/05/20186 min read
Incontinence is a common problem for older adults. According to the Centers for Disease Control and Prevention (CDC), of those age 65 and older and living independently, more than half of women and 25% of men are affected by urinary leakage. Fortunately, there is a wide variety of treatment options that can help, including absorbent pads or underwear that men and women may use for leakage protection.
Some of these options may be covered by Medicare; others are not. Read on to learn more about Medicare’s coverage of adult diapers and incontinence treatment.
What treatments are available for incontinence?
There are a variety of incontinence treatments available, depending on the type you have or its cause. According to the National Institutes of Health, bladder control training is usually recommended to strengthen your pelvic muscles and improve bladder control. Some common treatment options for urinary incontinence may include:
- Kegel exercises help strengthen the muscles that control the flow of urine. These involve contracting your pelvic floor muscles, which control your bladder, rectum, uterus, and small intestine.
- Lifestyle changes such as reducing the amount of caffeine, decreasing the amount of alcohol you consume, losing weight and quitting smoking. The extra weight can put pressure on your bladder and abdomen, aggravating urinary leakage or urges.
- Time voiding involves urinating on a regular, set schedule (for example, every hour or every other hour).
- Medication approved by the Federal Drug Administration (FDA) to treat incontinence may be an option if therapeutic exercises and lifestyle changes are not successful.
- Surgery may be an option if your incontinence is caused by an engorged prostate pushing down on your bladder. This is usually reserved for situations where therapeutic exercises and lifestyle modification have failed.
Does Medicare cover adult diapers?
If you have incontinence, adult diapers may be needed. Original Medicare, Part A and Part B, covers durable medical equipment (DME) or supplies, such as walkers, hospital beds, or blood sugar monitors.
Unfortunately, Medicare doesn’t cover incontinence supplies, including adult briefs, pads, or liners. These items don’t meet Medicare’s definition for durable medical equipment. Medicare defines durable medical equipment as an item that is durable or long-lasting (not disposable) and used in the home for a medical reason by someone who is typically ill or injured. Because most adult diapers are disposable and only used once, they don’t fit Medicare’s coverage criteria.
Does Medicare cover incontinence treatment?
Although Medicare doesn’t cover adult diapers, Medicare Part B does cover medical treatment for incontinence, including medical services, diagnostic tests, and doctor visits. If you have unexpected urinary leaks or experience sudden urges so strong that you fear you may not be able to get to the bathroom quickly enough, it’s a good idea to see your doctor. Your health-care provider may start by determining whether it is caused by a health condition such as diabetes, a urinary tract infection, or medications you may be taking. Your doctor can then discuss treatment plan options with you.
Medicare Part B covers your doctor visit as well as medically necessary follow-up treatments. You will be responsible for paying your Part B deductible and coinsurance (usually 20% of the Medicare-approved amount for the service).
If your doctor prescribes medications to manage your incontinence, Medicare Part D can help with prescription drug costs. You can get this coverage either through a stand-alone Medicare Part D Prescription Drug Plan (to go along aside with Original Medicare Part A and Part B) or a Medicare Advantage plan that includes Medicare Prescription drugs coverage. Both types of plans are available through private insurance companies approved by Medicare.
Before enrolling in a plan, it’s important to double check that it covers the medications you need. You can do this by checking the plan’s formulary, or list of covered prescription drugs, which may vary by plan. Remember, a plan’s formulary may change at any time. When required by law, you will receive notice from your plan of changes to the formulary. If your prescription drug is on the plan’s formulary, this means it may help with the cost of medication, although the amount of coverage will vary. You may be responsible for costs like copayments, coinsurance, and/or deductibles.
How else can I get help paying for adult diapers?
Although Medicare doesn’t cover adult diapers, you may have other options. If you are eligible for Medicaid, you may be able to get financial assistance to help cover the cost of adult diapers. Medicaid coverage varies by state, and each state has the freedom to expand its program beyond the minimum federal guidelines. To apply for Medicaid or for more information, contact your state Medicaid office.
Another option you might consider is a Medicare Advantage plan. Medicare Advantage plans are offered by private insurance companies that contract with Medicare to provide individuals with at least the same level of coverage as Original Medicare Part A and Part B. Some Medicare Advantage plans cover additional health services and medical supplies, which may include disposable adult briefs or pull-ups, bladder control pads guards, and bed under pads. Depending on the rules of the plan, you may have to get the incontinence supplies from a provider contracted with the Medicare Advantage plan. The type of incontinence products covered and whether they’re covered at all may vary, so it’s a good idea to check with the specific Medicare Advantage plan if this is a benefit you’re interested in.
Medicare Advantage plan may also offer you other benefits beyond Original Medicare, such as routine vision or dental, hearing, and wellness programs for older adults. As mentioned earlier, losing weight can help some patients with incontinence, so staying active through a fitness program may help you manage your condition.
Every person’s situation is different, and your health concerns will ultimately determine which plan may work for you. For help figuring this out, feel free to contact me.
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For more information on senior incontinence:
Centers for Disease Control and Prevention, “Prevalence of Incontinence Among Older Americans,” https://www.cdc.gov/nchs/data/series/sr_03/sr03_036.pdf
National Institutes of Health, National Institute on Aging, “Urinary Incontinence,” https://www.nia.nih.gov/health/publication/urinary-incontinence