In the United States, incontinence pads and other types of incontinence supplies are sold without a doctor’s prescription, so you can buy them at the grocery store, big box store, local pharmacy, or online. As a result, doctors rarely prescribe incontinence underwear or disposable pads.
Doctors, on the other hand, can diagnose urinary or bowel incontinence and determine that the supplies are medically necessary. This classification may entitle older adults to financial assistance for incontinence supplies.
How to Get Incontinence Pads on Prescription
If you want reimbursement or help paying for the cost of incontinence protection as medical supplies, you must see a doctor who participates 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 on a regular basis may already have an incontinence diagnosis in their medical records. To find out more, contact the doctor’s office. Instead of a prescription, your doctor will write a medical justification statement explaining why you need incontinence supplies.
What Conditions Can Make Incontinence Supplies Medically Necessary?
Medical devices and supplies are generally covered by health insurance companies, Medicare, and Medicaid if they are “medically necessary.” This means that the person requires the device or product to manage or treat a diagnosed medical condition. There are no universal standards for what constitutes medical necessity. Each insurer makes that determination and establishes rules for evaluating claims to determine whether a requested supply will be approved.
The good news is that there are some general similarities between what constitutes a medical necessity for incontinence supplies. First, the person must be diagnosed with bowel or urinary incontinence. Following a diagnosis, one or more of the following must be true:
Other interventions, such as exercising to strengthen your pelvic floor muscles, have not reduced urine leaks and accidents.
The individual is unable to manage incontinence due to a disability, which could be physical, such as limited mobility, or cognitive, such as dementia.
The underlying disorder cannot be treated with medication or surgery. This could be because the disorder is caused by another medical condition, such as kidney problems caused by diabetes or nerve damage caused by MS. This category may also include incontinence caused by medications such as diuretics for high blood pressure.
The person has started taking medication, but it hasn’t had time to work.
The patient is awaiting surgery to correct the problem. For example, an insurer may approve incontinence products if you undergo bladder neck suspension to support the neck of your bladder and reduce stress incontinence symptoms.
Please keep in mind that this is a general list. The only way to know for sure how an insurance company defines medically necessary incontinence supplies is to contact them.
Will Medicaid, Medicare, and Other Health Insurance Cover Incontinence Supplies?
Coverage for urinary and bowel incontinence supplies varies by Medicaid, Medicare, and health insurance.
Medicaid is a government program that assists people in paying for medical care. In general, you must have demonstrated financial need or qualify for Medicaid waivers due to a specific condition or special circumstances. Some states, for example, will allow anyone with certain intellectual abilities to enroll in Medicaid regardless of income.
Although the federal government contributes to Medicaid funding, states set the rules for 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 in a given time frame, such as per month or year.
To learn more about the specifics of their Medicaid plans, recipients should contact their state’s Medicaid office. Visit the Medicaid.gov website to find the website address and phone number for the Medicaid offices in each state and U.S. territory.
Medicare is a health insurance program for people 65 and up, as well as people with certain disabilities. Original Medicare, also known as Medicare Parts A and B, and Medicare Advantage, also known as Medicare Part C, are the two major types. The type of Medicare that senior citizens enroll in determines whether they can receive financial assistance for incontinence supplies.
Medicare Parts A, B, and C are written on a clipboard.
Part B of Original Medicare covers medical devices and supplies. Unfortunately, Medicare Part B does not cover any type of incontinence supplies, even if a person requires them for medical reasons.
Medicare Advantage plans may cover incontinence supplies. These plans are provided by private insurance companies and frequently cover things that Original Medicare does not. As with Medicare, Medicare Advantage plans that help pay for incontinence supplies for men and women 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 limit the number of pull-up pants or discreet pads you can purchase.
Contact your provider to find out if your Medicare Advantage plan covers incontinence supplies.
Private Health Insurance
What private health insurance will cover varies widely, but most plans will not cover the cost of incontinence supplies. For more information, please contact your health insurance provider.
Are Incontinence Pads FSA/HSA Eligible?
Flexible Spending Accounts and Health Savings Accounts allow people to save money for out-of-pocket medical expenses. The IRS establishes the guidelines for what these plans can and cannot cover. As of 2022, a wide range of incontinence supplies are FSA and HSA-eligible. In most cases, bladder control pads, pull-up pants, incontinence underwear, and adult diapers can be reimbursed.
Pink piggy bank with the letters FSA printed on it
Depending on how your FSA or HSA works, you may be given a debit card that allows you to use funds from your account to purchase products. Other plans require you to pay for incontinence supplies out of pocket and then request reimbursement. After your purchase, you must save the receipt and submit paperwork or fill out an online form.
How Do I Get Incontinence Supplies?
In some cases, you may be able to deduct incontinence supplies as a medical expense on your tax return. The IRS allows you to deduct costs if your incontinence symptoms are caused by an underlying condition or disease. If you want to claim incontinence supplies on your tax return, make sure you follow the IRS rules.
Looking for Assistance
Seniors who require financial assistance to purchase incontinence supplies are not alone. Community-based services and nonprofit organizations may offer low-cost or free incontinence products. Diaper banks frequently distribute a wide range of incontinence supplies, and Area Agencies on Aging can connect you with other sources of assistance.
Signing up for incontinence supply subscriptions may also reduce costs and allow seniors to have supplies delivered monthly. Direct delivery can lower the overall cost of purchasing incontinence supplies by eliminating the need to use gasoline or public transportation.
READ ALSO: How to Prevent Becoming Incontinent
Above all, people who require incontinence supplies should not avoid changing pads or adult briefs on a regular basis in order to save money. This could result in skin irritation and infections, raising healthcare costs.
Do you or a loved one struggle with incontinence? Take our bladder protection quiz to receive a free sample pack to try.