How Does Medicare Cover an Overactive Bladder?

Tamera Jackson by Tamera Jackson | Licensed since 2007
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This article was updated on: 09/12/2018

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An overactive bladder may causes you to urinate eight or more times a day or two or more times at night, according to the U.S. National Library of Medicine. An overactive bladder may also give you the strong, sudden need to urinate immediately. An overactive bladder may be accompanied by incontinence, or an involuntary loss of urine. Read more about Medicare coverage of incontinence supplies. An overactive bladder may cause you to feel embarrassed, isolate yourself, or limit your social life, according to the Mayo Clinic. Nighttime urination also may disrupt your sleep. As you age, you’re at increased risk of developing an overactive bladder, according to the Mayo Clinic.

What treatment is available for an overactive bladder?

According to the Mayo Clinic, an overactive bladder occurs because the muscles of the bladder contract involuntarily, even when bladder is not filled with urine.  The first overactive bladder treatment may be behavioral strategies. These include:

  • Fluid schedules
  • Timed urination
  • Bladder-holding techniques using the pelvic floor

Medication may be the next step for overactive bladder treatment. According to the Food and Drug Administration (FDA) there are several overactive bladder treatment options that help the bladder muscle relax and stop it from contracting at the wrong times.

  • Myrbetriq (mirabegron) is a medication that relaxes the bladder muscle during filing, helping its ability to store urine
  • Oxytrol for Women (oxybutynin) is a patch available over-the-counter without a prescription. Oxybutynin works by relaxing the overactive bladder muscles.
  • Oxytrol for men is a patch available by prescription only.
  • Botox may be injected directly into the bladder muscle, causing the overactive bladder to relax and increasing its ability to store urine.

Does Medicare cover an overactive bladder?

Medicare Part A and Part B only cover limited prescription drugs and usually do not cover the prescription drugs you take at home, such as drugs for an overactive bladder. You may need Medicare Part D prescription drug coverage to get help paying for medications for an overactive bladder. You can get Part D coverage through:

  • A stand-alone Medicare Part D Prescription Drug Plan
  • A Medicare Advantage plan with prescription drug coverage

A stand-alone Part D Prescription Drug Plan works alongside Original Medicare, Part A and Part B. A Medicare Advantage plan is an alternative way to you get your Medicare Part A and Part B benefits. Medicare Advantage must cover everything Original Medical covers, with the exception of hospice care, which is still covered by Part A. Most Medicare Advantage plans also cover prescription drugs. Some Medicare Advantage plans may also include a supplement benefit for over-the-counter items such as incontinence supplies for an overactive bladder.

Also keep in mind that not all plans cover the same set of prescription drugs. Every private insurance company contracted with Medicare to provide prescription drug coverage maintains its own formulary, or list of covered medications. If you take Myrbetriq, Oxytrol, or Botox for an overactive bladder, you may want to check the formularies of the plans you’re considering to make sure it’s covered. Note that plans may change their formularies from time to time, but you will receive notice from your plan when necessary.

Medicare may also help you treat underlying health issues that could contribute to an overactive bladder. According to the Mayo Clinic, maintaining a healthy weight, quitting smoking, and getting daily physical exercise may help reduce the risk of an overactive bladder.

  • Medicare generally covers behavioral counseling to help you lose weight.
  • Medicare generally covers smoking & tobacco use cessation.
  • A Medicare Advantage plan may cover a wellness program to help you stay active.

Do you have more questions about Medicare coverage of an overactive bladder?

For information via email, or to schedule a phone consultation, please use one of the links below. You can view a list of plans in your area you may qualify for by clicking the “Compare Plans” button on this page.

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