Medicare does not cover adult diapers and other over-the-counter incontinence supplies. Medicare beneficiaries pay 100 percent of the costs for these supplies. However, Medicare does cover treatments for the cause(s) of incontinence, such as a damaged bladder or enlarged prostates.
Key Takeaways
- Incontinence is a condition that causes the unintentional release of urine and/or feces.
- Medicare Part BMedicare Part B is medical coverage for people with Original Medicare benefits. It covers doctor visits, preventative care, tests, durable medical equipment, and supplies. Medicare Part B pays 80 percent of most medically necessary healthcare... covers services that treat the cause(s) of incontinence.
- Adult diapers are used to protect a person’s hygiene when experiencing incontinence.
- Medicare does not cover adult diapers because they are considered medically unnecessary.
- Most Medicare Advantage plansMedicare Advantage (MA), also known as Medicare Part C, are health plans from private insurance companies that are available to people eligible for Original Medicare (Medicare Part A and Medicare Part B).... do not cover adult diapers, but some do cover limited over-the-counter supplies.
What Is Incontinence?
Incontinence is when a person experiences an accidental discharge of urine and/or feces. Medicare Part B covers treatment plans for any of these conditions that can cause incontinence:1nia.nih.gov, “Urinary Incontinence in Older Adults“, Accessed October 28, 2021
- Weak bladder muscles.
- Overactive bladder muscles.
- Weak pelvic floor muscles.
- Damage to nerves that control the bladder from diseases such as multiple sclerosis, diabetes, or Parkinson’s disease.
- Blockage from an enlarged prostate in men.
- Diseases such as arthritis may make it difficult to get to the bathroom in time.
- Pelvic organ prolapse, which is when pelvic organs (such as the bladder, rectum, or uterus) shift out of their normal place into the vagina.
- Prostatitis—a painful inflammation of the prostate gland.
- Injury, or damage to nerves or muscles from surgery.
- An enlarged prostate gland, which can lead to Benign Prostate Hyperplasia (BPH), a condition where the prostate grows as men age.
So while Medicare does not provide coverage for adult diapers, Medicare will provide coverage for services that treat these causes for a beneficiary’s incontinence.2Medicare.gov, “Incontinence pads & adult diapers“, Accessed October 28, 2021
What Are Adult Diapers?
Adult diapers, also known as incontinence pads, are worn to maintain hygiene and minimize leakage if someone is experiencing incontinence. Specially designed absorbent underclothes, similar to regular underwear, can be worn underneath everyday clothes as an alternative.3hopkinsmedicine.org, “Urinary Incontinence in Women“, Accessed October 28, 2021
Disposable adult diaper costs can range from $52 to $210 per month. The costs of adult diapers depend on how many are used per day and the quality of the product. Reusable adult diapers can be used to save money over time, with an average cost of $38.09 per pair.5idiaper.com, “How Much Should I Budget For Adult Diapers?“, Accessed November 8, 2021
Why Doesn’t Medicare Cover Adult Diapers?
In general, Medicare does not cover over-the-counter medical supplies, including incontinence pads. Medicare does cover medical supplies that are medically necessaryServices or supplies that are needed for the diagnosis or treatment of your medical condition and meet accepted standards of medical practice.... when prescribed by a doctor.2Medicare.gov, “Incontinence pads & adult diapers“, Accessed October 28, 2021. Medically necessary services refer to services and supplies that are necessary for diagnosing or treating a beneficiary’s medical condition, as per the standards of medical practice4Medicare.gov, “What Part B covers“, Accessed October 28, 2021. Adult diapers are not strictly necessary for treating the cause of incontinence, so Medicare does not cover them.
Do Medicare Advantage Plans Cover Adult Diapers?
Medicare Advantage plans are required to cover the same services as Medicare Part AMedicare Part A is hospital coverage for Medicare beneficiaries. It covers inpatient care in hospitals and skilled nursing facilities. It also covers limited home healthcare services and hospice care.... and Part B, in addition to any expanded services offered. While most Medicare Advantage plans, like Original MedicareOriginal Medicare is private fee-for-service health insurance for people on Medicare. It has two parts. Part A is hospital coverage. Part B is medical coverage...., do not specifically cover incontinence supplies, some plans do offer limited coverage for over-the-counter medical supplies. Check with your plan for details.6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed October 29, 2021
Summary
If you were hoping Medicare would cover adult diapers, that is unfortunately not the case. Medicare does not cover adult diapers in any circumstance. You will have to pay the full costs for any adult diapers you buy. What Medicare will cover is treatments for the cause of your incontinence.
Citations
- 1nia.nih.gov, “Urinary Incontinence in Older Adults“, Accessed October 28, 2021
- 2Medicare.gov, “Incontinence pads & adult diapers“, Accessed October 28, 2021
- 3hopkinsmedicine.org, “Urinary Incontinence in Women“, Accessed October 28, 2021
- 5idiaper.com, “How Much Should I Budget For Adult Diapers?“, Accessed November 8, 2021
- 4Medicare.gov, “What Part B covers“, Accessed October 28, 2021
- 6Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed October 29, 2021