Insurance Coverage for Incontinence Supplies

Pasted Graphic 1.jpg

Are incontinence supplies covered by Medicaid? What type of incontinence supplies will my insurance pay for? Does my insurance cover incontinence supplies? Does Medicare cover diapers or underpads?

It’s common to have questions like this. After all, you want to make sure you’re using your insurance benefits to the fullest.

The good news is that many plans, including California’s Medicaid program (MEDI-CAL), do cover incontinence supplies. Find out more with our handy insurance guide, covering Medicaid, Medicare, and private insurance plans, as well as alternate options for getting your supplies.

Medicaid Coverage for Incontinence Supplies

Medicaid is a state-run insurance option for low-income adults, children, senior citizens, and people living with disabilities. Each Medicaid program may have different requirements and benefits from state to state. Additionally, because Medicaid programs are funded in part by the federal government, it will follow certain federal guidelines including requirements regarding income limits.

Aloha Pharmacy is in-network with California’s Medicaid plans. Our specialists will discuss your Medicaid benefits with you in full, including any spend-downs, out-of-pocket costs, or pre-authorizations that may be required by your Medicaid plan before we can provide you with your incontinence supplies.

If you have Medicare with Medicaid, your incontinence supplies should have no out of pocket cost to you!*

Does CA Medicaid (Medi-CAL) pay for diapers?

Yes, CA Medicaid (Medi-CAL) will cover adult diapers or briefs and children’s diapers. However, allowable benefits and amounts may vary, depending on the managed care option in which you’re insured.

LA CARE, Molina, IEHP, and Cal-Optima are examples of Managed Care Organizations.

Does CA Medicaid (Medi-CAL) pay for incontinence supplies other than diapers?

While some managed care Medicaid plans will cover incontinence products other than adult diapers, other state managed care Medicaid plans may not. These managed care plans all have different guidelines, benefit levels, and authorization requirements. In other words, it’s difficult to give a definite answer without verifying your Medicaid plan.

Just contact our staff at the pharmacy a call, and we’ll get right to work on verifying your Medicaid coverage. This way, we can fully determine which of the incontinence supplies you need will be covered, as well as how many they will allow per monthly order.

Medicare Coverage for Incontinence Supplies

Medicare is a health insurance program provided through the United States federal government by the Centers for Medicare and Medicaid Services (CMS). They cover millions of people who qualify for coverage every year.

In order to qualify for Medicare, you must be an American citizen or a permanent legal resident who is 65 years or older or under 65 and living with a disability or receiving Social Security benefits.

Medicare has 4 parts of insurance coverage:

  • Hospital insurance coverage under Medicare Part A
  • Medical insurance coverage under Medicare Part B
  • Medicare Advantage plan options, known as Medicare Part C
  • Prescription drug coverage under Medicare Part D

Does Medicare pay for adult diapers and/or other incontinence supplies?

In short the answer is No. While Medicare covers intermittent catheters, ostomy supplies, and other related urological supplies, they typically do not cover incontinence supplies like diapers, mattress-protecting underpads, and bladder control pads or liners.

However, you still have options such as a Medicare Advantage plan through a private insurance company, which may cover incontinence products for you.

If you have CA Medicaid (Medi-CAL) with Medicare, it is very likely these products are covered.

Private Insurance Coverage for Incontinence Supplies

A private insurance plan is any health insurance coverage option that is not based on state or federal government assistance, such as Medicaid or Medicare.

Some popular private insurance companies you may have heard of or know may include Blue Cross Blue Shield, Aetna, Cigna, and United Healthcare, just to name a few.

Private insurance policies are there to help you when you need medical services and supplies, including prescription drugs, durable or disposable medical equipment (DME), and hospital stays.

Do private insurance plans pay for incontinence supplies?

Private insurance plans vary from company to company in terms of coverage, limits, and deductibles.

While many private insurance plans will pay for incontinence products, others may not. Some may cover them but have a specific limit as to how many are allowed per every 30 days.

For the most accurate quote on what your private insurance plan will cover, give us a call. We’ll verify your insurance and find out if your supplies will be covered. Then together, we’ll discuss your options, like how much your potential out-of-pocket cost might be after your insurance covers their portion, as well as how many products you can receive per order.