Medicare Part B covers incontinence supplies, but only certain types and only with a doctor's order

Medicare Part B will pay for some incontinence supplies if your doctor writes an order saying you need them for a medical reason. The supplies covered are urological supplies — mainly catheters and catheter-related items — and ostomy supplies for people with a surgically created opening. Medicare does not cover adult incontinence pads, pull-ups, or underwear, even if you have a diagnosis that causes incontinence.

You pay 20 percent of the Medicare-approved amount after you meet your Part B deductible. The supplier must be enrolled with Medicare. If you use an unenrolled supplier, you may have to pay the full cost yourself.

The supplies must be medically necessary — meaning your doctor has documented that you have a condition requiring them and that they are the right treatment for your situation. straightforward having incontinence is not enough; Medicare looks at the specific medical reason.

Key Takeaways

  • Medicare Part B covers catheters and catheter supplies with a doctor's written order, but does not cover adult incontinence pads or pull-ups.
  • Your doctor must document that the supplies are medically necessary for your specific condition, not just that you have incontinence.
  • You pay 20 percent of the Medicare-approved cost after meeting your Part B deductible, and the supplier must be enrolled with Medicare.
  • Ostomy supplies (for colostomy, ileostomy, or urostomy) are covered under the same rules as catheter supplies.
  • If your doctor's order is denied, you can ask your supplier or doctor to request a coverage decision review from Medicare.

What types of incontinence supplies Medicare actually covers

Medicare covers intermittent catheters (also called straight catheters), indwelling catheters (Foley catheters that stay in place), and the supplies that go with them: catheter kits, lubricant, leg bags, drainage bags, and tubing. The number of catheters and related items covered per month depends on your medical need, as documented by your doctor.

Medicare also covers ostomy pouches and related supplies for people who have had bladder or bowel surgery. This includes pouches, adhesive barriers, skin barriers, and cleaning supplies specific to ostomy care.

What Medicare does not cover: adult incontinence pads, adult pull-ups, disposable underwear, bed pads, or any product designed to absorb urine or stool. These are considered personal hygiene items, not medical supplies, even though they are used to manage incontinence. Some Medicaid programs in certain states do cover these products, but Medicare Part B does not.

How to get your doctor's order and submit it to Medicare

Start by talking to your doctor about your incontinence and what supplies might help. Your doctor needs to examine you, understand your medical history, and decide whether catheters or ostomy supplies are the right treatment. If your doctor agrees, they will write an order that includes the type of supply, the quantity per month, and the medical reason you need it.

Once you have the order, find a Medicare-enrolled supplier. You can search for suppliers on the Medicare website by going to the Supplier Directory tool, or you can ask your doctor's office for a referral. When you contact the supplier, give them your Medicare number and your doctor's order. The supplier will submit the order to Medicare for coverage review.

Medicare will review the order to make sure it meets coverage rules. This review usually takes a few days to a week. If Medicare approves it, the supplier will send the supplies to you and bill Medicare for 80 percent of the approved cost. You will receive a bill for your 20 percent share after you have met your Part B deductible for the year.

What happens if Medicare denies your order

If Medicare denies the order, the supplier will send you a notice called an Explanation of Benefits (EOB) or a Notice of Non-Coverage. This notice will explain why Medicare said no. Common reasons include: the doctor did not provide enough medical documentation, the supplies do not meet Medicare's coverage rules, or the quantity requested seems too high for the diagnosis.

You have the right to ask for a coverage decision review. You or your doctor can contact Medicare directly to request this. You have 120 days from the date of the denial notice to ask. Your doctor can also provide additional medical information to support the need for the supplies.

If you disagree with the review decision, you can appeal further, but the process takes time. In the meantime, you can buy the supplies out of pocket from a non-Medicare supplier if you need them right away.

Medicare Advantage plans and incontinence supplies

If you have a Medicare Advantage plan (Part C), your coverage for incontinence supplies may be different from Original Medicare. Some Advantage plans cover the same supplies as Part B, while others may cover additional items or have different rules about quantity and cost-sharing.

Check your plan's formulary or call the plan directly to ask what incontinence supplies are covered. Your plan may require you to use a specific supplier or may have a prior authorization process. Because rules vary widely between plans, it is worth asking before you place an order.

Out-of-pocket costs and payment options

If Medicare covers your supplies, you will pay 20 percent of the Medicare-approved amount, but only after you have paid your Part B deductible (which is $240 in 2024, though this amount changes yearly). Once you meet the deductible, Medicare pays 80 percent and you pay 20 percent for the rest of the year.

If you cannot afford the 20 percent cost, some nonprofit organizations offer financial help for medical supplies. You can also ask your supplier whether they offer bulk discounts or payment plans. Some suppliers work with charities that help cover out-of-pocket costs for people with limited income.

If Medicare does not cover the supplies you need — such as incontinence pads — you will pay the full cost out of pocket. Prices vary widely depending on the brand and where you buy. Some people find that buying in bulk online is cheaper than buying at a pharmacy, though shipping costs can add up.

Frequently Asked Questions

Does Medicare cover incontinence pads or pull-ups?

No. Medicare Part B does not cover adult incontinence pads, pull-ups, or disposable underwear. These are classified as personal hygiene items, not medical supplies. If you need these products, you will pay for them out of pocket. Some state Medicaid programs do cover them, so check with your state's Medicaid office if you may have access to for both programs.

What if my doctor says I need catheters but Medicare denies them?

Ask your doctor to provide more detailed medical documentation explaining why catheters are necessary for your condition. Your doctor can submit this to Medicare as part of a coverage decision review. You have 120 days from the denial notice to request the review. If the second decision is still no, you can appeal further, though this takes additional time.

Can I buy incontinence supplies from any supplier, or does it have to be a Medicare supplier?

If you want Medicare to pay, the supplier must be enrolled with Medicare. If you use a non-enrolled supplier, Medicare will not pay and you will owe the full cost. You can find enrolled suppliers using Medicare's Supplier Directory on Medicare.gov, or ask your doctor for a referral.

Will my Medicare Advantage plan cover the same supplies as Original Medicare?

Not necessarily. Coverage rules vary between plans. Some Advantage plans cover the same supplies as Part B, while others may cover more or less. Call your plan's customer service number to ask what incontinence supplies are covered under your specific plan before you order.

How often can I get new supplies, and who decides the quantity?

Your doctor decides the quantity based on your medical need, and that amount is written in the order. Medicare will cover that quantity each month as long as the order remains valid. If your needs change, your doctor can update the order. The supplier cannot order more than what your doctor prescribed without a new order.