Does Medicare Cover Adult Diapers?
Medicare does not cover adult diapers and other over-the-counter incontinence supplies. Medicare beneficiaries pay 100 percent of the costs for these supplies.
Medicare does cover treatments for the cause(s) of incontinence, such as a damaged bladder or enlarged prostates.
[keytakeaways]
- Medicare Part B covers services that treat the cause(s) of incontinence.
- Adult diapers protect a person’s hygiene when experiencing incontinence.
- Medicare does not cover adult diapers because they are considered medically unnecessary.
- Most Medicare Advantage plans do not cover adult diapers, but some cover limited over-the-counter supplies.
[/keytakeaways]
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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:[mfn referencenumber=1]nia.nih.gov, “Urinary Incontinence in Older Adults“, Accessed October 28, 2021[/mfn]
- 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.[mfn referencenumber=2]Medicare.gov, “Incontinence pads & adult diapers“, Accessed October 28, 2021[/mfn]
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.[mfn referencenumber=3]hopkinsmedicine.org, “Urinary Incontinence in Women“, Accessed October 28, 2021[/mfn]
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 per pair.[mfn referencenumber=5]idiaper.com, “How Much Should I Budget For Adult Diapers?“, Accessed November 8, 2021[/mfn]
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 necessary when prescribed by a doctor.[mfn referencenumber=2]Medicare.gov, “Incontinence pads & adult diapers“, Accessed October 28, 2021[/mfn]. 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 practice[mfn referencenumber=4]Medicare.gov, “What Part B covers“, Accessed October 28, 2021[/mfn]. 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 A and Part B, in addition to any expanded services offered. While most Medicare Advantage plans, like Original Medicare, do not specifically cover incontinence supplies, some plans do offer limited coverage for over-the-counter medical supplies. Check with your plan for details.[mfn referencenumber=6]Medicare.gov, “How do Medicare Advantage Plans work?“, Accessed October 29, 2021[/mfn]
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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.