Urinary incontinence is a condition in which there’s involuntary loss of urine. These “leaks” or “accidents” can happen to anyone at any time, but they’re most common among seniors and women who have delivered babies vaginally.
A 2024 study found that 11.2% of Medicare members had a claims-based diagnosis of incontinence in 2018.
Despite how common this condition is, managing it can be difficult and expensive, especially for seniors on a fixed income.
Ahead, we explain the government programs that are available to defray the cost of urinary continence supplies.
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What Is Urinary Incontinence?
Some 13 million people in the United States are affected by urinary incontinence, according to the National Institutes of Health. That includes up to 45% of women, who are at increased risk because of pregnancy, childbirth, diabetes and hormonal changes with menopause, and up to 34% of older men. In residents of long-term nursing facilities, prevalence rates rise to more than 75%.
Urinary incontinence can take several forms:
— Urgency incontinence. Also called overactive bladder, this form occurs when you have a sudden, strong urge to urinate and can’t hold it long enough get to a toilet.
— Stress incontinence. This is when urine leaks out when you laugh, cough, sneeze or exercise.
— Overflow incontinence. This is when your bladder doesn’t empty completely, so excess urine builds up and leaks out.
— Functional incontinence. This is when another physical issue, such as an injury or disability, slows you down and makes it difficult to reach the toilet in time.
Besides being embarrassing and posing hygiene issues, incontinence can also lead to health complications, especially when it’s not carefully managed. Complications can include:
— Increased risk of urinary tract infections
— Dermatitis or skin rashes from prolonged wetness
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Does Medicare Cover Incontinence Supplies?
In a word, no. That’s because original Medicare (parts A and B) does not cover the cost of disposable incontinence supplies such as:
— Adult diapers
— Pads and inserts
— Protective underwear
Although these supplies are important for basic hygiene and preserving dignity, “Medicare classifies them as being for ‘personal comfort’ and not ‘medically necessary,'” explains Neal K. Shah, North Carolina-based chairman and co-founder of Counterforce Health and CEO of CareYaya Health Technologies.
More than 50% of Medicare beneficiaries in need of incontinence supplies cannot afford them, Shah adds, which means that many seniors are forced to choose between buying adult diapers and buying groceries.
While Medicare does not cover disposable items such as diapers, it does cover some durable medical equipment (DME) that might be used by individuals with incontinence.
DME includes items a health care provider deems medically necessary to assist patients who are recovering from an illness or to help manage a disease or disability, explains Dr. Bernard Steinbacher, senior medical director of Lyric, a health care technology firm based in King of Prussia, Pennsylvania. Some of the more common types of DME are walkers, wheelchairs, diabetic supplies, prosthetics and orthotics.
There aren’t many examples of DME that could be used for incontinence, given that most of the products used to support people with incontinence are specifically designed to be disposable. However, if your health care provider prescribes a certain piece of equipment as medically necessary for treating incontinence, then theoretically, Medicare should cover it.
That means that if you’ve been diagnosed with permanent urinary incontinence and are prescribed urinary catheters and external urinary collection devices, they would likely be covered by original Medicare, as these urological items are considered medically necessary.
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Do Medicare Advantage Plans Cover Incontinence Supplies?
While original Medicare, which is managed by the federal government, does not cover these supplies, some Medicare Advantage plans, which are offered by private insurers, do. Although they’re not administered by the government, Medicare Advantage plans still must meet standards set by the Centers for Medicare & Medicaid Services.
“Medicare Advantage plans sometimes provide additional coverage for incontinence supplies as a supplemental benefit, but the coverage is highly variable both by plan and by region,” Shah explains.
If you have a Medicare Advantage plan, you should carefully review your options and each plan’s specific benefits during open enrollment to understand whether incontinence supplies will be covered.
Does Medicaid Cover Incontinence Supplies?
For low-income individuals who qualify for Medicaid, incontinence supplies are usually covered. Medicaid, a joint federal and state program that provides health insurance to low-income individuals, covers a variety of supplies:
— Diapers
— Pads
— Underpads
Some older adults qualify for both Medicare and Medicaid simultaneously. For dual-eligible beneficiaries who meet income requirements, Medicaid might cover incontinence supplies, Shah says, but policies differ state to state.
How Can I Get Free Incontinence Supplies?
Depending on where you live, you may have access to certain programs that will cover the cost of incontinence supplies. For example, New York’s Medicaid Incontinence Supply Program provides eligible residents with no-cost supplies.
There are several other groups that may be able to help, and the best way to connect with them is to contact your Area Agency on Aging, your local senior center and any charitable foundations near you that support seniors.
How Can I Find Low-Cost Incontinence Supplies?
When paying out of pocket for incontinence supplies, consider buying in bulk.
“Numerous vendors provide subscription services that sell directly to consumers, and these services offer bulk discounts of 30% to 50% off retail prices,” Shah explains.
Incontinence supplies are also usually eligible for reimbursement with a health savings account or a flexible savings account. Medicare Medical Savings Account plans are a type of Medicare Advantage plan that includes a savings account you can use for health care expenses. Because you manage the money in the MSA plan, you can use it for incontinence supplies when you need them.
Other Incontinence Management Strategies
In some cases, incontinence can be treated with surgery, medications or physical therapy. Short of those measures, there are changes you can make to better manage the condition:
— Make some lifestyle changes. Losing weight, quitting smoking, drinking more water, following a high-fiber diet and limiting caffeine and alcohol consumption can all help reduce incidents of incontinence.
— Engage in bladder training. This type of therapy teaches your bladder to hold fluids longer. The training can take several forms, including waiting longer and longer to urinate, waiting a few minutes after urinating and trying again and setting a schedule for urination.
— Strengthen the pelvic floor. Kegel exercises and other types of movement or physical therapy can also help strengthen the muscles in the pelvic floor to reduce and prevent urine leakage.
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Does Medicare Cover Incontinence Supplies? originally appeared on usnews.com
