Incontinence Supplies and Medicare Coverage is limited, but not impossible.
Despite the number of people who live with incontinence, traditional Medicare does not cover any incontinence supplies like adult diapers and pads. However, depending on your financial circumstances and the type of medical insurance you choose, the cost of incontinence essentials may be reimbursed or at least be a tax-deductible expense. Here are the options that may be available to you.
Medicare Advantage Plans
Although Medicare doesn’t cover incontinence supplies, in many states some of the Medicare Advantage plans offered by private insurance companies, like Blue Cross Blue Shield and United Healthcare, do. Usually you’ll need to purchase qualified items through an eligible provider, a company that has been approved to handle claims and will often process them for you. There are limits to how much product is covered on a monthly basis. These limits vary by plan, but are often between 200 and 300 briefs or diapers per month. The types of products that are covered also vary by plan. Some insurance companies divide incontinence products into different categories. According to one major health insurer, bed underpads are only covered if you also need diapers or briefs.
States require that your physician prescribe incontinence supplies for a medical condition. Your doctor will typically write out a prescription that specifies the quantity of supplies you need on a regular basis, typically monthly.
Your state Medicaid program will dictate how you receive your supplies, either through a participating supplier who submits claims to the state for reimbursement or through a managed-care plan that includes these products as part of their services.
Contact your state Medicaid office to find out if it offers coverage and what rules and limitations are. You can access a complete list of state offices here.
Health Savings Accounts
Another option is creating a flexible spending account or FSA. As with an HSA, disposable incontinence products are generally covered by medical FSAs if the incontinence is because of a doctor-diagnosed medical condition. An FSA must be set up by an employer, but you determine how much will be taken from each paycheck to fund the account—money that isn’t subject to federal, state, or social security taxes—based on what you project all uncovered healthcare expenses for the coming year will be. You withdraw funds throughout the year as needed to pay for qualified medical costs.
It’s important to work with your human resources manager or the HSA or FSA plan administrator to confirm that the plan available to you offers incontinence products as qualifying expenses.
Steps You Must Take
o get coverage with virtually any of the above options, your incontinence must stem from a diagnosed medical condition. Why? Because according to IRS rules, you can’t include the amount you pay for diapers or diaper services among your medical expenses unless they are needed to relieve the effects of a particular disease. It’s important to keep in mind that incontinence itself is not considered a disease or condition, but rather a symptomor “effect”—of a disease or condition. That’s why you must get a proper diagnosis from your healthcare provider. Incontinence suppliers who send you products and submit claims to Medicaid, for instance, must have the diagnosis code provided by your doctor to do so.
In addition to a set diagnosis, you’ll likely need your doctor to provide a written prescription for your incontinence supplies to show that they are needed to help you manage it. In some situations, it might also help to have a letter written by your doctor explaining your medical situation.
If you buy your supplies directly with funds from a HAS or FSA, keep all receipts as proof of the expenses.