Will My Insurance Cover Catheters?

July 12,2022 |
Woman looking at medical bills.

Urinary catheters are a type of medical device that are used to assist individuals with urination. They can be used for both short-term and long-term conditions and can drastically improve an individual’s quality of life. Catheters are inserted into the urethra, up to the opening of the bladder. Indwelling, or Foley Catheters, are left in place for a few weeks or months while an individual recovers while intermittent catheters are inserted at home whenever you need to empty your bladder. Intermittent catheters cannot be reused and therefore, require a new catheter each time you need to use the bathroom. If you’re in a situation where you need to use catheters for an extended period of time, the cost may be something you’re worried about. Disposable medical supplies can add up without any help from your insurance provider. To help you gain a stronger understanding of what to expect, we’ll go over everything you need to know about insurance coverage for catheter supplies.


When to Use a Catheter

The main reason that an individual will need to start using a catheter is if they’re unable to empty their bladder on their own. This could be due to injury or an underlying urologic condition that needs treatment. The most common of these include urinary incontinence, urinary retention, suffering from a spinal cord injury, advancement of multiple sclerosis, spina bifida, enlarged prostate, or other conditions that make it hard for individuals to voluntarily void.

Different types of catheters are often used under different circumstances. This means that someone who needs a Foley catheter usually will not benefit from using intermittent catheterization and vice versa. Your doctor will discuss your options and provide you with instructions regarding how to perform self-catheterization before you’re discharged.

Always wash your hands before performing intermittent catheterization and if you have any questions or concerns, don’t hesitate to reach out to your doctor. This is especially important if you notice any signs of irritation or infection around the urethra.


How Much Do Catheters Cost?

The individual sale price of a catheter depends on several factors. For example, if you opt for a standard intermittent catheter, the single unit price can be anywhere from $1.00 to $1.50. However, if you decide to use a hydrophilic catheter or other closed-system option, the price can increase and range from $2.00 per catheter all the way up to $5.00 per catheter. Those who choose to purchase standard catheters will also need to buy lubrication separately to reduce discomfort or complications during insertion.

If you’re going to need to use intermittent self-catheterization for the foreseeable future, this price can be daunting. Let’s say you use the bathroom three to four times per day and opt for standard catheters. This amounts to about $6.00 per day, $42.00 per week, and over $2,000.00 per year. The price can add up and quickly become a financial burden.

On the other hand, if you have insurance coverage you may not have to pay a dime out of pocket. This all depends on your specific coverage details, the type of insurance you have, and the conditions of your policy. However, many insurance plans cover the entire cost of sterile, single-use catheters without charging you any deductibles or co-pays. To better understand your coverage details, you’ll need to talk to a representative of your insurance company directly.


Are Catheters Covered by Insurance?

Most catheters are covered by insurance, but again, it’s important to clarify this information directly with your provider. However, plans across Medicare, Medicaid, and nearly all private insurance carriers see catheters as a necessary medical device and therefore, provide full coverage. If you find that you’re not fully covered, you may need to pay a deductible before receiving a discount or receiving incontinence supplies without co-pays.

Does Medicare Pay for Catheters?

Medicare Part B pays for catheters based on individual needs. Currently, this includes up to 200 single use, intermittent catheters each month. Medicare also covers sterile packets of lubrication for individuals who need it. However, in order to benefit from this coverage, you’ll need a written prescription from your doctor that states your individual catheter needs and usage requirements. You will only receive insurance-covered catheters based on your doctor’s prescription. You may also be required to supply supporting documentation regarding your condition, especially if you need specific types of catheters (i.e., coudé vs. straight tip). Medicare coverage and regulations regarding catheter use vary by state, so it’s important to talk to your doctor and call a representative to learn more about coverage details regarding incontinence supplies. Medicare may also cover external catheters and drain bags depending on your needs.

Does Medicaid Pay for Catheters?

Medicaid coverage varies by state, which means you’ll need to check with a state-wide representative to receive accurate, up to date information regarding catheter coverage. However, in most instances, you can receive your catheters at little to zero out of pocket costs after Medicaid covers their portion.

Some states do require individuals covered by Medicaid to complete a spend-down requirement prior to paying for medical supplies. Other states only cover a certain number of supplies per month. Additionally, certain Medicaid plans will provide you with options on the type of catheters available, while others only cover uncoated straight tip catheters. Since Medicaid can be a little more confusing than Medicare, it’s always recommended to check your coverage options prior to making an order.

Will My Private Insurance Pay for Catheters?

Private insurance companies are vastly different from one policy to another. This makes it difficult to definitively say whether or not they’ll pay for your catheters or other medical supplies. It depends on the company, the plan you have, the deductible, co-pays, out-of-pocket limits, and more. However, unlike Medicare and Medicaid coverage, most private insurance companies cover advanced catheter products such as closed system kits, coudé catheters, hydrophilic catheters, and travel-friendly options. This can make it easier to navigate daily life when you need to use intermittent self-catheterization.


When to See Your Doctor

If you notice any bothersome signs of a urologic condition, it’s important to see your doctor or urologist as soon as possible. This is the only way to ensure that you’re addressing the correct condition, which is essential for alleviating symptoms. Your doctor will also be able to provide you with a prescription, which will increase your chances of having your catheter supplies covered by your insurance plan. After ordering your incontinence supplies, you can either file a claim or work with a reputable medical supply company like Byram Healthcare to ensure the process goes as smoothly as possible.

When you do need to use intermittent catheterization, remember that it’s never safe to reuse catheters. Although there are some options online that claim they’re safe to be reused, the FDA recommends that all intermittent catheters are only used once before being properly disposed of. When they’re reused, the risk of infection increases drastically, which can lead to further complications and chronic health problems. Luckily, thanks to the wide range of insurance covered options, you don’t need to sacrifice your health and wellness for affordability.

Intermittent catheterization can help reduce symptoms and disturbances of many urologic conditions. They help you heal and function your best without putting excess strain on your bladder. If your doctor prescribes the use of an indwelling catheter, coverage tends to be the same or similar to intermittent options. However, you may need to stay in the hospital or receive further medical supervision in these cases. It’s best to call a representative of your insurance company to determine everything that will be covered and what needs to be paid out of pocket. If you have any questions about catheterization or other urologic conditions, don’t hesitate to speak to your urologist.

Regardless of why you need to use intermittent catheterization, getting the proper supplies in a timely, discretionary manner will make your life easier. Byram Healthcare has a range of intermittent catheters to help you manage your conditions and live a happier, healthier life. Using our easy ordering process, we can also help you file your claim and maximize your insurance coverage on each order.

Byram Healthcare is a member of the National Association for Continence’s Trusted Partners Program, whose mission is to provide quality continence care through education, collaboration and advocacy. We continue to build partnerships in the clinical community to ensure we focus on what’s best for the patient.