incontinence care doctor
Incontinence

Incontinence Care: What Does Health Insurance Cover?

The first time you meet with your doctor to discuss incontinence care, you may feel nervous or embarrassed. Just as stressful, you’re not sure what solutions are available and how much they might cost. You want to take care of yourself, but you don’t want to spend an arm and a leg doing it.

If you’re living with incontinence, you’ve probably wondered how your health insurance plan can help you save money on your incontinence care. But trying to understand health insurance may be one of the few things that’s even more unpleasant than dealing with unexpected bladder leaks.

Don’t jump down the Google rabbit hole or wait on hold for a health insurance customer service rep just yet. First, it’s a smart idea to learn some basics about the insurance benefits available for incontinence care. Let’s explore typical health insurance plan coverage for incontinence products, medications, surgeries, and other treatments.

doctor and patient with computer

Incontinence Care Products

Pads, diapers, pullups, bed pads, and catheters are all common products for incontinence care. Generally, these are items you purchase yourself rather than getting from a doctor. But will your health insurance cover part of the bill?

What Does Health Insurance Cover?

Your plan may or may not cover incontinence products. Unfortunately, most plans don’t cover the basics you purchase frequently.

Under Medicare

Traditional Medicare plans do not cover absorbent incontinence products such as pads, diapers, pullups, or bed pads. But they’ll often cover urinary devices such as catheters. If you have a Medicare Advantage plan, some incontinence care supplies may be covered—check with your insurance plan to find out which products are available.

Under Medicaid

Medicaid plans do cover some incontinence care products—pads, pullups, briefs, and underpads— in 45 states and Washington, D.C. If you have insurance through Medicaid, reach out to your state’s plan administrator to find out which items are covered and which companies are approved to take Medicaid—not everyone who sells these products is.

Under Employer-Sponsored Plans

Most health plans offered through employers from insurance companies like Blue Cross, United, Aetna, and Cigna do not cover incontinence care products like pads, diapers, pullups, or bed pads, but they may cover urinary devices such as catheters. It’s best to check with your insurer to see what options your plan covers.

Using FSA or HSA Dollars to Purchase Incontinence Products

Even if your health plan doesn’t cover incontinence products, you can still save some money by using pre-tax dollars—either from a Flexible Spending Account (FSA) through your employer, or a Health Savings Account (HSA)—to purchase your incontinence care supplies. Just make sure to contribute enough money to your account each year to cover your expenses!

Incontinence Medications

Medication can help with some types of incontinence, specifically urge incontinence and overactive bladder. Your doctor will need to write you a prescription. There are a few common kinds of medications your doctor might recommend:

  • Anticholinergics calm an overactive bladder and may be helpful for urge incontinence.
  • Urinary antispasmodics relax the bladder muscle and increase the amount of urine your bladder can control and empty.
  • Alpha blockers for men can relax bladder neck muscles and muscle fibers in the prostate and make it easier to empty the bladder.
  • Topical estrogen helps tone and rejuvenate tissues in the urethra and vaginal areas in women, providing better support to the bladder.

incontinence care prescription medication pills

What Does Health Insurance Cover?

Generic versions—lower cost versions of common medications—are covered by most health insurance plans, including Medicare and Medicaid. Brand name or specialty drugs—higher cost medications made by a single manufacturer—may or may not be covered by your insurance. To find out what your plan covers and how much you may owe, check out your health plan’s list of approved drugs.

Incontinence Surgery

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 (i.e. leaks when you sneeze or cough). Some of the common types of surgery to treat incontinence include:

  • Sling procedures in which 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, which involves placing stitches near your bladder neck and attaching them to ligaments near the pubic bone to provide more support to your bladder.
  • Prolapse surgery, which involves securing connective tissue with stitches to move your pelvic organs back into the right place.
  • Artificial urinary sphincter, which involves a small, fluid-filled ring that’s inserted around your bladder neck to keep the urinary sphincter shut until you’re ready to urinate.

What Does Health Insurance Cover?

As long as your doctor tells you a surgery is medically necessary, your health insurance should cover it. This is true for Medicare, Medicaid, and employer-sponsored health care plans. A few things to keep in mind:

  • If you choose to have a surgery that’s optional, your insurance plan may cover less or none of the costs. You should call your insurance plan to get a rundown of your benefits before scheduling this type of procedure.
  • 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 be on the hook for the full cost of the surgery if you go to a doctor or hospital that doesn’t take your insurance.
  • 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 (the dollar amount after which your insurance company pays for all of your covered health expenses). If you stay in the hospital overnight after your procedure, you’ll also owe a coinsurance amount for your stay.

Other Incontinence Treatments

In addition to surgery, there are a variety of less common incontinence treatment options available to control bladder leakage. Some alternatives include:

  • 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 stiff ring inserted into the vagina to support the bladder.
  • Bulking material injections of a synthetic material into the tissue surrounding the urethra to help keep the urethra closed and reduce urine leakage.
  • Botox injections into the bladder muscle, which may benefit people who have an overactive bladder.
  • Nerve stimulators, a small device implanted under the skin to deliver painless electrical pulses to sacral nerves involved in bladder control.

What Does Health Insurance Cover?

All of these treatment are generally covered by health insurance (including Medicare and Medicaid), but may have a related coinsurance or copay cost that you’ll owe if you haven’t met your plan’s out-of-pocket max. Talk to your health insurance company to understand what benefits apply to these options.

Wrapping Up

Whether you’re buying your own bladder leak products or working with a doctor to identify medication or surgery, check out these parting tips:

  • Absorbent incontinence products like pads or disposable underwear are rarely covered by insurance. But, you can keep your costs low by signing up for a subscription.
  • Ask your doctor for generic drugs, which are generally cheaper than brand name drugs with the same chemical makeup.
  • Medically necessary treatments—whether surgery or catheters—are generally covered by health insurance. The cost depends on your plan and how much you’ve spent on health care during the year.
  • When in doubt, review your plan’s Schedule of Benefits or call your insurance company to confirm what’s covered and what’s not.

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What has your insurance journey been? Share your tips for navigating insurance in the comments!