Does Medicare Cover Catheters and Related Supplies?

Medicare, a federal health insurance program, helps millions of eligible Americans manage healthcare expenses. Understanding the extent of Medicare coverage for various medical supplies, such as catheters, is a common inquiry for beneficiaries.

Medicare Coverage Basics

Catheters and related supplies are primarily covered under Medicare Part B, which addresses outpatient care, certain medical supplies, and preventive services. Part B categorizes these items as Durable Medical Equipment (DME). For coverage to apply, the use of catheters must be determined as medically necessary.

In specific scenarios, catheters may also be covered under Medicare Part A when a beneficiary is an inpatient in a hospital or during a stay in a skilled nursing facility (SNF), where the supplies are part of the overall care. Medicare Advantage Plans (Part C) are offered by private companies approved by Medicare. These plans must cover at least everything that Original Medicare (Parts A and B) covers, though they may have different rules, costs, or provider networks.

Types of Catheters Covered

Medicare covers several common types of catheters when medical necessity is established. Intermittent catheters, also known as “in-and-out” catheters, are used for temporary drainage and are self-inserted multiple times a day. Indwelling catheters, such as Foley catheters, remain in the bladder for an extended period, continuously draining urine into a collection bag. External catheters, including condom catheters, are non-invasive devices worn over the penis for urine collection.

Coverage extends to the catheters and necessary related supplies. These ancillary items can include drainage bags, insertion kits, and lubricating jelly, which support the safe and effective use of the catheter.

Requirements for Coverage

Obtaining Medicare coverage for catheters requires adherence to specific conditions and comprehensive documentation. A written prescription from a physician is an absolute necessity, detailing the type of catheter, the required supplies, and the frequency of use. This prescription serves as the initial step in establishing eligibility for coverage.

The physician must also provide thorough documentation explaining the medical necessity for the catheters. This documentation outlines the specific medical condition, such as urinary retention or chronic incontinence, that necessitates the use of the equipment. Catheters fall under Medicare’s Durable Medical Equipment (DME) classification, meaning they must meet the program’s criteria for DME, which typically involves items that are durable, used for a medical purpose, and not generally useful to a person in the absence of an illness or injury. Beneficiaries must obtain their catheters from a supplier enrolled in Medicare, and that supplier must accept assignment. This ensures that the supplier agrees to Medicare’s approved amount as full payment, limiting the beneficiary’s out-of-pocket costs to the deductible and coinsurance. Medicare also establishes frequency limits for certain catheter types, such as intermittent catheters, often allowing for specific quantities per month based on the documented medical need.

Costs and Supplier Information

Beneficiaries are responsible for certain financial obligations when Medicare covers catheters. Before Medicare begins to pay, the annual Part B deductible must be met. For 2025, this deductible is $240. After the deductible is satisfied, Medicare typically pays 80% of the Medicare-approved amount for Durable Medical Equipment, leaving the beneficiary responsible for the remaining 20% coinsurance.

It is important to choose a supplier who “accepts assignment,” meaning they agree to accept the Medicare-approved amount as full payment for the covered service or item. When a supplier accepts assignment, they bill Medicare directly, and the beneficiary is only responsible for the deductible and coinsurance. Beneficiaries can find Medicare-approved DME suppliers by using the “Supplier Directory” tool on Medicare’s official website or by asking their doctor for recommendations. Medicare Advantage plans may have different cost-sharing structures, including varying copayments, deductibles, or network restrictions, so beneficiaries enrolled in these plans should consult their specific plan documents for details on their financial responsibilities.