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Does Medicare Cover Intermittent Catheters?

By Complete Care Specialist January 22, 2020

When you need medical supplies and insurance comes into play, things can seem a little overwhelming. Each person’s plan is different and there is no straight answer to whether or not certain coverage is available. When you choose us as your medical supply company, we will communicate with your doctor and insurance companies to ensure you get the supplies you need.

Although we do most of the work for you, it is still important for you to understand your coverage. In this post we will be covering Medicaid, Medicare, private insurances and how Complete Care Medical can help you get your medical supplies through each one.

First, what does my insurance need to cover my intermittent catheters?

First and foremost, in order to get your single-use catheters covered by your insurance you need to have proper documentation and a prescription for intermittent catheters from your doctor. This is because your insurance wants to see that these supplies are a medical necessity. Having the proper documentation at this step will help you get the products you want.

Don’t worry here, we can help you get covered depending on the product that you are wanting or that your doctor has recommended. If you have been going to your doctor for regular checkups, all you have to do is send a copy of the prescription, and from there we can provide the necessary documentation to the insurance company on your behalf.

Tip: We can communicate with your doctor to help make sure that your documentation is up to date and has the proper requirements for the specific product you want. For example, you may need a coude tip catheter because you are unable to successfully pass a straight tip catheter. Having this documented will show the insurance why you need the different product. We will work with your doctor’s office to ensure the documentation is written properly to get your supplies covered.

Does Medicaid pay for intermittent catheters?

Medicaid coverage can get a little tricky because coverage varies from state to state. Depending on the state you reside in, you may be covered for 120-200 catheters per month, and there may be restrictions on which products will be covered. We will work with you and check your specific plan to make sure your covered. Give us a call at (800) 503-7604.

Will Medicare cover the cost of catheters?

If you have Medicare (Part B), they will cover up to 200 intermittent catheters per month along with sterile lubrication packs each month. The exact amount will be based on the prescription your doctor writes and medical necessity. For example, let’s say you need two catheters per day, you will be covered for 60 catheters each month. Once you reach your annual deductible, Medicare will cover 80% of the cost for supplies. If you have additional insurance, such as private secondary insurance, they will typically pick up that extra 20% leaving you with no cost.

We will verify your plans coverage and be sure the documentation matches the prescription written by your doctor.  From there, we will be able to determine how much you are qualified for and help you from there.

What if I have private insurance? What do they cover?

Private insurance coverage varies depending on your plan. Most insurances follow Medicare guidelines and will cover up to 200/month.  However, keep in mind that a secondary insurance can sometimes pick up the remaining 20% that your primary insurance doesn’t cover.

Before we submit your order, we will verify your plan to see exactly what is covered. Complete Care Medical is in-network with many of the private insurance plans and networks available and we are constantly working on getting contracted with new plans. Call us today to verify your coverage or to get help understanding your plan. Call us at (800) 503-7604

The importance of reading fine print

It’s vital to read the fine print of your insurance benefits. Even if someone else you know who has the same insurance has their catheters covered, it doesn’t mean every person with the same insurance will. Each plan is different. The best thing to have your plans coverage explained to you and to be sure it will cover the medical supplies and prescriptions you may need.

When speaking with your plan’s administrator, be sure your coverage includes DME (Durable Medical Equipment). This is the category in which your catheters and incontinence supplies will covered.  Also, find out the maximum out-of-pocket expenses and be sure the coverage includes all of your needs.

Tip: Your insurance company will have a case worker or a coordinator that you can talk with. They are very helpful and are there for you. 

The Claims Process is On Us

That’s right - You don’t have to worry about filing a claim to your insurance company for your catheters. We do that for you, for free, as a courtesy. We’re here to help you get the supplies you need and take care of the potential hurdles along the way.

We will help you every step of the way to ensure that you get what you’re qualified for. If you have any questions at all throughout the process, we are here to help and to make sure you get the supplies you need. Contact us at (800) 503-7604

Choosing Complete Care Medical is choosing a medical supplier on your side. You will have a personal, Patient Care Representative and a full team that cares and will fight to get your supplies covered. We are committed to getting you the supplies you need as quickly as possible and provide free and discreet shipping! Don’t settle for average, get a company in your corner Today!

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