Discussing incontinence care with your doctor may be a stressful endeavor for some, but it’s even more anxiety-inducing to be unsure which solutions are available and how much they cost. If you’re living with incontinence, you may wonder how health insurance can help you save money and which products it’s willing to cover. Rather than waiting on hold for a health insurance representative, it’s a wise idea to learn the basics surrounding incontinence products and insurance coverage. In this guide, we’ll explore typical health insurance plan coverage for incontinence care products, medications, and treatment methods, so you can make an informed decision before shopping.
Incontinence Care Products
Common products for incontinence care include absorbent pads, pullups, bed pads, and catheters, which all require you to purchase them on your own. Because you can't obtain these necessities through a doctor, it's important to understand exactly what your health insurance plan covers.
Incontinence Products Covered by Health Insurance
Your plan may or may not cover incontinence products. If you're unsure of the exact details, discuss your medical needs with both your health-care provider and insurance company to find out precisely which incontinence products are covered.
Traditional Medicare plans don't cover absorbent incontinence products such as pads, pullups, or bed pads. You'll foot 100% of the bill for incontinence supplies, but plans often cover urinary devices such as catheters. Some Medicare Advantage (Part C) plans offer additional plans for members, so there's a chance some incontinence supplies may be covered. Check with your plan to learn the specifics.
Because all 50 states have their own Medicaid requirements, check with your plan specifically to learn which products are covered. Medicaid plans in 45 states and Washington, D.C. cover absorbent incontinence products, including pads and pullups. Some plans also cover supplemental necessities such as wipes and gloves.
Under Employer-Sponsored Plans
Unfortunately, most health plans offered through employers do not cover incontinence supplies, including big names such as Blue Cross Blue Shield and UnitedHealthcare. They may, however, cover a monthly supply of catheters. Discuss the details with your insurer to learn the specifics.
Using FSA or HSA Dollars to Purchase Incontinence Products
If your health plan doesn't cover incontinence supplies, they're still eligible for reimbursement through your flexible savings account through your employer or an individual health savings account. As long as you save a sufficient amount each year, you can utilize these accounts to save money on incontinence supplies with or without insurance.
Who Is Eligible for Free Incontinence Pads?
If you’re on Medicaid, you may qualify for free incontinence supplies. This depends on which plan you’re enrolled in, as well as your current health status. Your health-care provider must have deemed incontinence products medically necessary, and you must have a current diagnosis for loss of bladder or bowel control. Seniors and low-income adults qualify.
Medication can help with some types of incontinence, specifically urge incontinence and overactive bladder. While they're not the right fit for every incontinence sufferer, these medications make a world of difference in relieving symptoms. Discuss them with your doctor to learn the benefits and drawbacks and to decide if they're a suitable fit for your needs and lifestyle. To obtain these medications, you'll require both a diagnosis and a prescription. Common doctors' recommendations include the following.
- Anticholinergics: Calming an overactive bladder, they may be helpful for urge incontinence.
- Urinary antispasmodics: Relaxing the bladder muscle and increasing the amount of urine your bladder can hold, they may also increase the amount of urination, helping empty the bladder completely and reducing the rate of urination overall. These are primarily used to treat urge incontinence.
- Alpha blockers: By relaxing muscle fibers and bladder neck muscles in the prostate for men, these make it easier to empty the bladder. They're used to treat both urge and overflow incontinence.
- Topical estrogen: These low-dose medications are available in cream, patch, and ring forms, and they help tone and rejuvenate tissues in the urethra and vaginal areas in women, providing better support to the bladder.
Can You Get Incontinence Products on Prescription?
Once you’re more informed about incontinence supplies, the next step is figuring out how to obtain them. While your doctor will provide you with valuable information on your condition and treatment, they won’t provide a prescription for incontinence supplies in the traditional sense. Instead, they’ll create documentation in your official medical record saying those supplies are medically necessary. This private info will be viewable by insurance providers, including Medicare and Medicaid, so you can obtain your supplies at an affordable cost — or no cost at all. Doctors can develop treatment plans to help reduce symptoms, help you work toward lasting relief, and ensure your insurance provider covers incontinence products in the future.
Incontinence Medication Covered by Health Insurance
Generic versions — lower cost versions of common medications — are covered by most health insurance plans, including Medicare and Medicaid. Brand name or specialty drugs, such as higher cost medications made by a single manufacturer, may be covered by your insurance. To find out what your plan covers and how much you owe, check out your health plan’s list of approved drugs.
In some cases, your doctor may decide that surgery is the best course of action for your medical needs. This is most common for people with stress incontinence, such as leaks when you sneeze or cough. Some of the common types of surgery to treat incontinence include:
- Sling procedures: A pelvic sling is inserted around your urethra and bladder neck to help keep the urethra closed, especially when you cough or sneeze.
- Bladder neck suspension: This gives greater support to your bladder neck and urethra through an abdominal incision near the bladder neck. Stitches are attached to ligaments near the pubic bone.
- Prolapse surgery: A doctor secures connective tissue with stitches to move your pelvic organs back into place. In women, surgery generally includes a combination of both prolapse surgery and a sling procedure to effectively relieve urinary incontinence symptoms.
- Artificial urinary sphincter: A small, fluid-filled ring is inserted around your bladder neck to keep the urinary sphincter shut until you're ready to urinate.
Incontinence Procedures Covered by Health Insurance
If a surgery is declared medically necessary by your doctor, it should be covered by health insurance. This is true for Medicare, Medicaid, and employer-sponsored health-care plans. Because what your surgeon and your insurance company consider medically necessary can differ, it varies how much of the procedure will be covered.
- If you opt for elective surgery, your insurance plan may not cover the costs. If delaying or avoiding the procedure is an option, this probably applies to you. Speak with your insurance plan for a precise rundown prior to scheduling.
- It’s important to coordinate your surgery with a hospital, surgeon, and medical team who take your insurance. On a PPO plan, your insurance will cover less of the cost for doctors and facilities they don’t have contracts with; on a HMO or EPO plan, you'll have to pay the full cost if the doctor or hospital isn't in your insurance network.
- Many health plans require you to pay coinsurance — a percentage of the total cost of the procedure — for surgeries before you hit your out-of-pocket max. If you stay in the hospital overnight, you’ll also owe a coinsurance fee.
Other Incontinence Treatments
In addition to surgery, there are a variety of less common incontinence treatment options available to control bladder leakage.
- Urethral inserts: A small disposable device you insert into the urethra before activities that can trigger stress incontinence such as running or working out
- Pessaries: A flexible silicone ring inserted into the vagina to support the bladder, which is worn all day to prevent leakage
- Bulking material injections: Synthetic material injected into the tissue that surrounds your urethra to keep the area closed and reduce leakage
- Botox injections: Can help calm an overactive bladder and is generally a last resort option for people who haven't responded to other treatments
- Nerve stimulators: Small devices implanted under the skin, where they deliver a series of painless electrical pulses to stimulate your sacral nerves
What Does Health Insurance Cover?
All these treatments are generally covered by health insurance, including Medicare and Medicaid, but may have a related coinsurance or co-pay cost. Speak with your health insurance plan to learn which benefits apply.
Whether you're shopping for bladder leak products or navigating medications and surgeries with your doctor, remember absorbent incontinence products, such as pads or disposable underwear, are rarely covered by insurance. While plans may cover medically necessary surgeries and medications, they also offer a wide range of incontinence treatment methods to choose from. Because costs depend on your individual health insurance plan, age, health status, and other factors, the first step to incontinence relief is understanding exactly what's covered. Speak with your insurance company for a detailed picture of the products and treatments that work best for you.
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