Does Medicare cover urinary catheters?

Steven Mott by Steven Mott | Licensed since 2012

This article was updated on: 09/12/2018

A urinary catheter is a tube that drains urine from the bladder, according to the U.S. National Library of Medicine. There are three types of urinary catheters for men and two types of urinary catheters for women. Both men and women may use an indwelling urinary catheter or an intermittent urinary catheter. And indwelling catheter is left in the bladder and may be used for a short or long period of time. An intermittent catheter is inserted into the bladder and then removed when the bladder is drained. Men may also use a condom catheter. With a condom urinary catheter, a condom-like sheath with a tube leading to a drainage bag fits over penis. Unlike an indwelling or intermittent urinary catheter, a condom catheter is not inserted through the urethra.

Why would I need a urinary catheter?

According to the U.S. National Library of Medicine, a doctor may recommend a urinary catheter for certain medical conditions such as:

  • Being unable to control when you urinate (urinary incontinence)
  • Being unable to empty your bladder when you need to (urinary retention)
  • Surgery on the prostate or genitals
  • Medical conditions such as multiple sclerosis, spinal cord injury, or dementia

Keep in mind that urinary catheters (especially long-term indwelling urinary catheters) may have many complications, such as urinary tract infections, bladder cancer, bladder stones and kidney damage. Intermittent catheterization is preferable to long-term catheterization, according the American Family Physician.

To prevent infection, you should drink plenty of fluids and clean the area where an indwelling urinary catheter exits your body every day, according to the U.S. National Library of Medicine.

Does Medicare cover a urinary catheter?

Medicare may cover a urinary catheter after a surgery if prescribed by your doctor and determined to be medically necessary. If you have an outpatient surgery, the urinary catheter may be covered by Medicare Part B (medical insurance). If you have an inpatient surgery, the urinary catheter may be covered by Medicare Part A (hospital insurance). Medicare may also cover a catheter if your urinary incontinence or urinary retention is determined to be permanent or lasting three or more months.

A Medicare Supplement plan may cover all or part of certain out-of-pocket costs for urinary catheters, such as your deductibles, copayments, and coinsurance amounts. Many people choose a Medicare Supplement plan, or Medigap plan, to help manage their health-care costs in Original Medicare (Medicare Part A and Part B).

As an alternative way to get your Original Medicare Part A and Part B coverage, you might consider Medicare Advantage (Part C). If you are covered under a Medicare Advantage plan, your out-of-pocket costs for urinary catheters and other medical services and supplies could also be lower. Keep in mind that Medicare Advantage plans and Medicare Supplement plans don’t work together; you can only use Medicare Supplement benefits to help pay for your costs that Original Medicare doesn’t cover.

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