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People with bowel and urinary incontinence may feel they have to structure their lives around the condition. Worries about accidents and leaks may make it seem like it's no longer possible to lead an active lifestyle, but the truth is that the right incontinence products can allow you to overcome the challenges.
Incontinence supplies can improve the quality of life and boost self-esteem in seniors. However, they do require an ongoing expense, and seniors on fixed incomes may worry about how they'll continue to afford adult diapers or absorbent pads. This often leads to questions about whether it's possible to get a doctor's prescription and submit the costs to insurance, Medicare, or Medicaid. In this post, we provide the answers.
In the U.S., incontinence pads and other types of incontinence supplies are sold over the counter, so you can purchase them at the grocery store, big box store, your local pharmacy, or online without a physician's prescription. As a result, doctors usually won't prescribe incontinence underwear or disposable pads.
However, doctors can provide a diagnosis of urinary or bowel incontinence and deem the supplies medically necessary. This designation may allow older adults to get help paying for incontinence supplies.
If you wish to get reimbursement or help paying for the cost of incontinence protection as medical supplies, you’ll need to visit a doctor participating in your health plan. The medical provider will need to examine you and may order tests to determine the underlying cause of your symptoms.
Those who see a healthcare provider regularly may already have an incontinence diagnosis in their medical records. You can call the doctor's office to learn more. Instead of writing a prescription, your medical provider will write a medical justification statement explaining why you require incontinence supplies.
Health insurance companies, Medicare, and Medicaid generally pay for medical devices and supplies if they are "medically necessary." This means the person needs the device or product to manage or treat a diagnosed medical condition. There are no standard criteria for what makes something medically necessary. Each insurer makes that determination and establishes rules for evaluating claims to determine if a requested supply will be approved.
The good news is that there are some general similarities between what constitutes a medical necessity regarding incontinence supplies. First, the person must have been diagnosed with bowel or urinary incontinence. After diagnosis, one or more of the following must be true:
Keep in mind that this is a general list. The only way to know for certain how an insurance company defines medically necessary incontinence supplies is to contact them.
Medicaid, Medicare, and health insurance each have different rules regarding coverage for urinary and bowel incontinence supplies.
Medicaid is a program that helps pay for medical care. Generally, you need to have demonstrated financial need or qualify for Medicaid waivers because you have a specific condition or special circumstances. For example, some states will allow anyone with certain intellectual abilities to enroll in Medicaid regardless of income.
Although the federal government helps fund Medicaid, states set the rules regarding coverage. In many states, Medicaid recipients can get help paying for incontinence supplies if they are medically necessary. However, the program may only cover some of the most popular incontinence products or may limit the number of absorbent products a person can be reimbursed for during a specific time frame, such as per month or year.
To learn about the specifics of their Medicaid plans, recipients should contact their state's Medicaid office. Visit the Medicaid.gov website to obtain the website address and phone number for the Medicaid offices of every state and U.S. territory.
Medicare is a health insurance program for people aged 65 or older and individuals with specific disabilities. There are two main types: Original Medicare, also known as Medicare Parts A and B, and Medicare Advantage, sometimes called Medicare Part C. Whether senior citizens can get help paying for incontinence supplies depends on what type of Medicare they enroll in.
Under Original Medicare, medical devices and supplies fall under Part B. Unfortunately, Medicare Part B doesn't cover any type of incontinence supplies, even if a person needs them for medical reasons.
Medicare Advantage plans may cover incontinence supplies. Private insurance companies offer these plans and often provide coverage for things that Original Medicare won't cover. As with Medicare, Medicare Advantage plans that help pay for the cost of incontinence supplies for women and men will only approve claims if there is a medical reason for their use. They may also establish a preferred brand or brands, only pay for specific types of protection, or place limits on the number of pull-up pants or discreet pads you can buy.
Contact your provider to determine whether your Medicare Advantage plan will pay for incontinence supplies.
What private health insurance will cover varies widely, but most plans won't provide assistance paying for incontinence supplies. You can contact your health insurance provider for more information.
Flexible Spending Accounts and Health Savings Accounts allow people to set aside money to cover out-of-pocket medical costs. The IRS establishes the rules for what these plans can cover. As of 2022, a wide range of products classified as incontinence supplies are FSA- and HSA-eligible. You can generally receive reimbursement for bladder control pads, pull-up pants, incontinence underwear, and adult diapers.
Depending on how your FSA or HSA works, you may receive a debit card that allows you to use funds from your account when buying products. Other plans require you to purchase incontinence supplies out of pocket and then request reimbursement. Either way, you'll need to save the receipt and submit paperwork or complete an online form after your purchase.
In some cases, you may be able to claim incontinence supplies as a medical expense on your income tax return. The IRS rules allow you to deduct costs if your incontinence symptoms are due to an underlying condition or disease. If you wish to claim incontinence supplies on your tax return, consult a tax professional to ensure you comply with IRS rules.
Seniors who need financial assistance to pay for incontinence supplies aren't alone. Community-based services and nonprofit organizations may provide low-cost or free incontinence products. Diaper banks often distribute a wide range of incontinence supplies, and Area Agencies on Aging can connect you with other sources of support.
Signing up for incontinence supply subscriptions may also reduce costs and allow seniors to have supplies delivered monthly. Direct delivery can reduce the total cost of buying incontinence supplies by eliminating the need to use gasoline or public transportation.
Above all, individuals who need incontinence supplies shouldn’t forego changing pads or adult briefs regularly to try to save money. Doing so could lead to skin irritation and infections that will only increase healthcare costs.
Do you or a loved one struggle with incontinence? Take our bladder protection quiz and get a free sample pack to try.
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