Understanding Three Types of Catheters Covered By Medicare and Other Insurances
Key Takeaways:
- Medicare covers urinary catheters for individuals with permanent urinary conditions such as incontinence or retention.
- There are three main types of urinary catheters covered by insurance: indwelling (foley), intermittent, and external catheters.
- Indwelling catheters are for extended use, intermittent for periodic drainage, and external catheters offer a non-invasive solution.
Introduction
Catheters play a vital role in managing urinary issues by assisting with the collection and drainage of urine from the body.
Medicare covers urinary catheters and devices used to collect urine for people dealing with lasting urinary issues, like permanent incontinence or retention. Permanent retention means the problem isn’t expected to be fixed within the next 3 months, either through medical procedures or surgery. As stated by the Centers for Medicare and Medicaid Services (CMS), “The beneficiary must have a permanent impairment of urination.”
Although you have to have a lasting problem to qualify, it doesn’t mean you won’t qualify if there’s a chance to get better down the road. If your medical records, including your doctor’s opinion, show that the issue will likely last for a long time, at least 3 months, then it’s considered a lasting problem.
This eligibility criteria is specific to Medicare and may slightly vary if you have a Medicaid or commercial plan.
Urinary catheters come in various types, each serving specific purposes in addressing different urinary conditions. In this blog post, we’ll define the three main types of catheters, indwelling, intermittent, and external, all of which are typically covered by insurance like Medicare.
Indwelling Catheters (Foley Catheters):
Indwelling catheters, also referred to as Foley catheters, stay in the bladder for an extended period, serving individuals with chronic urinary retention or specific medical conditions. Typically these catheters don’t need to be changed for three-four weeks or more, but this varies by individual circumstances.
These catheters consist of a flexible tube made of silicone or latex, with multiple drainage eyes near the tip to facilitate urine flow. Even though they’re good at helping with urine drainage, indwelling catheters can bring about some issues like urinary tract infections (UTIs), bladder spasms, and sometimes, they can cause problems like catheter-related injuries or blockages.
The actual insertion of an indwelling catheter is a procedure typically performed by a trained healthcare professional, such as a nurse or doctor. The catheter is carefully inserted into the bladder through the urethra and a small balloon is inflated to secure it in place.
Intermittent Catheters:
Used to empty the bladder at regular intervals, intermittent catheters are not used for a prolonged period like indwelling catheters, but rather are inserted for short durations as needed and then removed. Intermittent catheters are supposed to be used once and then thrown away. How frequently an intermittent catheter is used varies depending on the individual. You may do it multiple times throughout the day or just once a day. Your doctor or care team will provide the best recommendation on how often to self catheterize using intermittent catheters.
There are three primary variations within this category, straight tip and coude tip intermittent catheters.
- Straight Tip Catheters: Versatile and straightforward, suitable for both men and women. Commonly used for routine intermittent catheterization.
- Coude Tip Catheters: Featuring a curved tip, coude tip catheters are designed to navigate obstacles in the male urinary tract. Beneficial for men with an enlarged prostate or other anatomical challenges. Although possible, these catheters are rarely prescribed for women.
- Closed Kit Catheters: Closed Kit Catheters come pre-lubricated and often include additional components such as collection bags, gloves, and insertion supplies, providing a convenient, discreet, and portable sterile option for intermittent catheterization. These kits are designed to minimize the occurrence of urinary tract infections (UTI) for individuals at risk of infection or for those who have developed recurrent UTIs while using intermittent catheters with lubricant. There are several ways to qualify for these catheters including residing in a nursing facility, having a compromised immune system, or experiencing distinct recurrent UTIs while using intermittent catheters with lubricant within a twelve month timeframe.
External Catheters:
External catheters, also referred to as condom catheters for men, and sometimes known as female urinary pouches for women, offer a non-invasive alternative to traditional indwelling and intermittent catheters. These catheters are particularly suitable for individuals who experience urinary incontinence or have difficulty with conventional catheterization methods.
For men, external catheters resemble a condom in shape and design, hence the name “condom catheter.” They are typically made of soft, flexible materials such as silicone or latex, ensuring comfort during wear. The catheter is rolled onto the penis and secured with medical-grade adhesive or a specially designed adhesive band. This creates a seal to prevent leakage and allows urine to flow directly into a collection bag or other receptacle.
Female external catheters, while less commonly discussed, also provide a viable option for managing urinary incontinence in women. These catheters are typically designed to fit securely over the external genitalia and may feature a unique shape to accommodate the female anatomy comfortably. They function similarly to their male counterparts, providing a leak-free seal and directing urine away from the body.
One of the significant advantages of external catheters is their ease of use. These catheters eliminate the need for insertion into the urethra, reducing discomfort and lowering the risk of urinary tract infections (UTIs) associated with invasive catheterization methods.
Conclusion:
From indwelling catheters for continuous drainage to intermittent and external options offering periodic relief and non-invasive alternatives, each type serves a specific purpose. Catheter selection considers factors like gender and anatomy and an individual’s catheterization needs and abilities, aiming to enhance comfort and minimize complications. A healthcare professional can recommend the best type of catheter for a specific individual and to qualify through Medicare or other Health Insurance, documentation from a healthcare professional is required.
If you’d like to learn more about the steps to getting coverage for catheters and supplies through your health insurance check out our Urology and Incontinence page or give our urology and incontinence specialists a call today at 866.863.6332.