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Medicare and Incontinence Supplies

For most adults, going to the bathroom is something that can be easily postponed. But for the millions of Senior Americans suffering from incontinence, delaying that trip to the bathroom can be difficult if not impossible.

One in five people over the age of 40 suffer from an overactive bladder and sometimes leak urine even before reaching the bathroom, this according to the National Association for Continence. This number rises significantly in the senior population.

At least 50 percent of residents in a nursing home suffer from incontinence. The cost of purchasing adult diapers can prove to be a heavy burden with incontinence supplies estimated to reach $900 to $4,000 per year.

Having coverage for incontinence supplies can be a very attractive option for those with Medicare. The next question is, “does Medicare cover incontinence supplies?”

The disappointing news is traditional Medicare does not cover incontinence supplies or adult diapers. This includes products such as adult briefs, underpads, adult diapers, bladder control pads, and guards. However, these supplies can be covered under a different medical insurance plan or at least be considered a tax-deductible expense depending on a person’s financial circumstances.


Medicare Alternatives

  1. Medicare Advantage Plans (HMO or PPO)

Medicare Advantage plans (HMO or PPO) also referred to as “Part C” are offered by Medicare-approved private companies. Some of these Medicare Advantage plans provide coverage for incontinence supplies. Coverage for these supplies can usually be availed by adding it to the list of covered items under the plan. These plans place a ceiling for incontinence supplies covered per month. Aside from placing limits on the number of incontinence supplies it covers, plans also stipulate the types of products covered.

  1. Medicaid

Medicaid generally does not cover incontinence supplies in all states. Although Medicaid is a state-run health benefits program, benefits and coverage still can vary by state. For those who qualify for Medicaid benefits program, check your state Medicaid office for guidance.

Medicaid provides limited coverage for incontinence supplies. Coverage varies from state to state, but it has the option to cover some incontinence supplies and other related accessories and equipment. For states that cover these, supplies include adult briefs, bladder control pads, guards, and bed underpads. Guidelines and amount of coverage can also vary from year to year, so be sure to review the policy accordingly.

To qualify for Medicaid coverage, the state requires proof that a physician has prescribed the use of incontinence supplies for a medical condition. This information should also include the number of supplies needed, typically on a monthly basis. The state’s Medicaid program oversees how the incontinence supplies are received. This can be done through a participating supplier who submits claims for reimbursement. Coverage for incontinence supplies can also be covered through a managed-care plan that includes these products in the services they offer.

  1. VA Benefits

Veterans are eligible for incontinence supplies as part of their “medical supplies” benefits. This is available through the Pharmacy Service, which provides these for home care of a diagnosed disability. Beneficiaries can also ask for an alternative brand if the standard-issue does not give the absorbency requirements needed. However, the request must be supported by a doctor’s prescription, which justifies this change.

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