We had written an article last year on whether Medicare covers disposable diapers. The response has been surprising and we have received hundreds of calls since the article was first posted. In response to this overwhelming interest we are updating our previous article and will hopefully help answer the question, "Will Medicare Pay for Adult Diapers".
Original Medicare (Part A), does not cover incontinence supplies such as adult diapers for any condition while living independently or in assisted living. Even though diapers are classified under the broad category of Durable Medical Equipment (DME), Medicare makes an exception for adult diapers and other disposable incontinence products and carves these items out as non covered medical equipment. It's believed that incontinence supplies are not covered due to the length of use as once they have been used they are thrown away. Please, do note that if an individual is hospitalized or admitted to a skilled nursing facility, Medicare Part A will cover diapers while under this care.
Medicare Part B - does not cover adult diapers, however, will cover other incontinence products like external urinary collection devices and disposable catheters for intermittent, self catheterization when coverage criteria are met and the individual or caretaker can perform the procedure.
Medicare Part C - can cover adult diapers, however, this depends on the plan. Part C (Medicare Advantage) plans allow you to choose to receive all of your healthcare services through a provider organization. These plans may help lower your costs of receiving medical services, or you may get extra benefits for an additional monthly fee. You must have both Parts A and B to enroll in Part C. Coverage for adult diapers and other disposable incontinence products are provided to members under select Medicare Advantage PPO plans. Since Original Medicare does not cover adult diapers, the scope of the benefit, reimbursement methodology, maximum allowable payment amounts and member cost-sharing are determined by the member’s group. If an individual has a Medicare Part C Plan they should speak to the plan administrator to see if the plan covers adult diapers or other disposable incontinence supplies.
In summary, Medicare does not cover adult diapers or other disposable incontinence supplies, unless the you have a Medicare Part C plan that allows for this type of coverage. If you have an Advantage Plan then speak with your administrator to see if adult diapers are covered or if the coverage could be added on for an additional cost.
We hope this helps answer the question as to whether adult diapers and incontinence supplies are covered by Medicare.
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We have receiving a number of calls regarding qualified Indiana Medicaid Incontinence Providers. Currently eMedical is not eligible to provide Incontinence Supplies through Indiana's Medicaid Program. For those that are looking for qualified providers there are two, both of which are outside the State of Indiana (Go figure... We will leave that for another discussion). I have attached a link at the bottom of this article, which will take you to a .pdf document from Family Voices, Indiana. The document provides the contact information for the two qualified incontinence providers and some other great content, such as answers to the following questions:
1.) Does Medicaid cover the cost of Incontinence Supplies?
2.) At what age will Medicaid begin covering Incontinence Supplies?
3.) Once I qualify for supplies what must I do to receive the Incontinence Supplies?
4.) How often will orders be processed?
5.) If I am unhappy with the Incontinence Supplies I receive, what should I do?
For those that qualify for Medicaid assistance, good luck and we hope this information is helpful. If for any reason you are not able to open the .pdf, please contact us at (800) 818-1686 or email us at firstname.lastname@example.org and we will be happy to email you the information.
Don't forget to use our interactive Incontinence Needs Assessment to ensure that you are using the correct Diaper, Brief, Pull-up Underwear or Pad for your specific level or degree of incontinence.
Your Incontinence Partner
Does Medicare Pay for Adult Diapers? This is a question that we get on a routine basis. And the short answer is NO; Medicare’s coverage of incontinence does not extend to absorbent products like adult diapers.
Medicare does cover other incontinence products like catheters and other external urinary collection devices for patients who have permanent urinary incontinence or permanent urinary retention. They define permanent urinary retention as retention that is not expected to be medically or surgically corrected in that patient within three months.
In many states Medicaid will pay for youth and adult diapers and pads. This will depend on the state in which you reside and whether you qualify for coverage. I will warn you that obtaining the protective pads, diapers and pull-up underwear that you need or like can be difficult as Medicaid typically limits the brands that are offered. I have heard many stories about how the products that are covered are of inferior quality. Depending on the state you live in you may only have a few places to acquire pads, diapers or pull-up underwear. For example, in Indiana there are only a few companies that the state has contracted with to provide youth and adult diapers, which is limiting for the customer and has resulted in a mini-monopoly. There are may draw backs to working with Medicaid to obtain your protective diapers, but hopefully the drawbacks are out weighted by having your diapers, pads and pull-up underwear paid for. Just do not be surprised if you receive poor customer service and inferior products.
For those that have a Health Savings Account, Flexible Spending Account or Health Reimbursement Account you can have the cost of your incontinence products reimbursed (see an earlier blog post on HSA’s, FSA’s and HRA’s for additional information.)
Your Incontinence Partner