Does Humana Medicare Cover Incontinence Supplies?

When dealing with incontinence, managing the cost of supplies is a concern for many. If you’re on Humana Medicare, you might ask: Does Humana Medicare cover these costs, or more specifically, does Humana Medicare cover incontinence supplies?

This article untangles the complexities of coverage for incontinence supplies, offering you a clear understanding of what to expect from different Humana Medicare plans.

 

Key Takeaways

 

  • While Humana Medicare may have limited coverage for incontinence supplies, it covers a variety of incontinence treatments, such as certain devices and biofeedback-assisted pelvic muscle exercise training, if prescribed by a healthcare professional.

 

  • Alternatives to Medicare for incontinence supplies include Medicaid, local non-profits, community organizations, and the National Diaper Bank Network, which provide varying levels of support based on eligibility and medical necessity.

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Humana Medicare and Incontinence Supplies

As a prominent entity in the healthcare industry, Humana Medicare provides a range of plans that cater to various health needs, including incontinence supplies.

The extent of coverage for these supplies, however, is not guaranteed and largely hinges on the specifics of your Medicare plan. Consequently, gaining a comprehensive understanding of your plan is beneficial.

For instance, Medicare Advantage plans, like those offered by Humana, have the potential to cover a variety of over-the-counter incontinence supplies.

These could include men’s guards, protective pads, and other supplies aimed at managing incontinence. But how does this coverage stack up against Original Medicare? We’ll explore this next.

 

Humana Medicare and Incontinence Supplies

Original Medicare vs. Humana Medicare Advantage

When it comes to incontinence supplies, Original Medicare does not provide coverage. This means items like adult diapers, which can be essential for those dealing with incontinence, are not covered. However, Humana offers a solution in the form of Humana Medicare Advantage.

Humana Medicare Advantage is a robust plan that goes beyond the coverage of Original Medicare. It encompasses HMO, PPO, and PFFS plans, providing supplementary services that include potential coverage for incontinence supplies.

 

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This is a stark contrast to Original Medicare, which does not cover such items. Therefore, if you need coverage for incontinence supplies, Humana Medicare Advantage might be a suitable choice. But which factors affect this coverage?

 

Factors Affecting Coverage

Coverage for incontinence supplies is not automatic. Several factors come into play, including:

 

  • plan type,
  • prescriptions,
  • and medical necessity.

 

For instance, despite the broad coverage Humana Medicare offers, it does not extend to incontinence supplies due to a lack of medical necessity. This leaves the patient responsible for these costs.

Moreover, there can be limitations to the coverage provided by Humana Medicare. For example, although incontinence supplies are not included in the coverage of Original Medicare, Medicare Advantage plans might offer coverage for such supplies. Nonetheless, the particulars of the plan and involved prescriptions determine this.

Incontinence Treatments Covered by Humana Medicare

While Humana Medicare’s coverage for incontinence supplies may be limited, it does cover a variety of incontinence treatments.

This includes devices like Elitone, which offers external pelvic stimulation to help women alleviate symptoms of incontinence. Coverage is available if such devices are recommended by a healthcare professional.

Humana Medicare also covers biofeedback-assisted pelvic muscle exercise training, given that a beneficiary has previously tried pelvic floor muscles training without success. This treatment must be prescribed by a physician to qualify for coverage.

 

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Additionally, Humana Medicare provides reimbursement for up to 200 catheters per month, as these are considered essential supplies for incontinence treatment. But what role do prescriptions and recommendations play in influencing this coverage?

 

Prescriptions and Recommendations

A doctor’s prescription plays a crucial role in the coverage of incontinence treatments. For instance, Humana Medicare may cover incontinence supplies as part of its plan benefits if a physician prescribes them. The impact of a doctor’s prescription can be seen through specific Medicare Advantage plans.

Doctors often suggest a range of incontinence treatments, including:

 

  • Medications
  • Surgery
  • Pelvic floor physiotherapy
  • Anti-incontinence devices

 

The coverage for these treatments for patients with medical conditions and Humana Medicare Advantage plans is contingent upon the details of their specific Medicare Advantage plan.

 

Medicare Part B and D Coverage

Medicare Part B and D also play a role in managing incontinence. Although Medicare Part B does not typically cover incontinence treatments or supplies, Medicare Part D can help with the costs of prescription drugs for incontinence.

However, this requires the purchase of a separate Medicare Part D prescription drug plan.

It’s worth noting that Medicare Part D does not cover all prescription drugs associated with incontinence. The extent of coverage depends on the specific plan chosen.

Therefore, a detailed review of your plan to comprehend the extent of coverage for incontinence treatments and supplies is advised.

Medicaid and Dual Eligible Special Needs Plans

Exploring other avenues for coverage, Medicaid and Dual Eligible Special Needs Plans (D-SNPs) can also play a role in covering incontinence supplies.

Medicaid coverage for such supplies varies depending on the state and specific Medicaid plan. Coverage may be available if it’s determined to be medically necessary, and individuals who are dual eligible may receive full coverage.

D-SNPs, on the other hand, are tailored to cater to the requirements of individuals who qualify for both Medicare and Medicaid, regardless of their national origin, age, disability, or other factors.

 

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These plans aim to synchronize and integrate benefits from both programs for eligible recipients. But how is coverage managed on a state level, and how can you merge benefits from Medicare and Medicaid?

 

State-Specific Coverage

Medicaid coverage for incontinence supplies is state-specific.

 

  • In California, for example, Medicaid offers coverage for incontinence supplies to individuals enrolled in a Medicaid plan in the state, although there may be age-related limitations on coverage.
  • In Texas, Medicaid provides coverage for these supplies when prescribed by a physician for the treatment of urinary or fecal incontinence.

 

In New York, Medicaid covers a variety of incontinence supplies, such as:

 

  • disposable and reusable diapers
  • liners
  • underpads
  • briefs
  • bladder control pads
  • protective underwear

 

These supplies are provided they are medically necessary. Similarly, Florida Medicaid provides coverage for these supplies when they are prescribed and considered medically necessary by a healthcare provider.

 

Combining Medicare and Medicaid Benefits

Combining Medicare and Medicaid benefits can provide full coverage for incontinence supplies. This dual eligibility allows individuals to utilize the advantages of both programs to reduce healthcare expenses and ensure access to essential incontinence products.

However, challenges can arise from this combination, such as inadequate coordination between the two programs, which could lead to increased expenses and adverse outcomes for individuals eligible for both.

Furthermore, those with limited dual eligibility may not have access to complete Medicaid benefits, affecting their support for Medicare premiums.

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Alternative Options for Incontinence Supplies

If Medicare coverage is not sufficient or not available, you might wonder, “Does medicare cover incontinence supplies?” In such cases, there are alternative avenues for obtaining incontinence supplies. For example, you can consider the following options:

 

  • Local non-profits and community organizations may have programs in place to supply free or low-cost incontinence supplies to those who require them.
  • Some manufacturers and retailers offer assistance programs or discounts for individuals in need.
  • Online marketplaces and websites may offer discounted prices or bulk purchasing options.

 

These initiatives can provide valuable support to individuals in need, regardless of their race color national origin or sexual orientation gender identity, such as free language interpreter services.

 

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Certain local non-profit organizations, like adult diaper banks and organizations supported by state-level programs like Medicaid, provide incontinence supplies.

You might also find assistance through initiatives like the National Diaper Bank Network, which offers complimentary diapers to families, or by contacting local charities and organizations for support. But how do these alternative options manifest in detail?

 

Local Non-Profit and Community Organizations

Local non-profit organizations can be a lifeline for those in need of incontinence supplies. These organizations, which include:

 

  • local senior health centers
  • diaper banks
  • local chapters of the Salvation Army
  • agencies that provide assistance to families in need

 

We offer a variety of incontinence products covered, such as diapers, adult briefs, bladder control pads, cover adult diapers, and other products for urinary incontinence, catering to the needs of individuals regardless of their sex, sexual orientation, gender, expression, transgender status, marital situation, or any other personal factors.

To access these free or low-cost supplies, individuals can:

 

  • Reach out to diaper banks in their vicinity and demonstrate their need based on low income or Medicaid eligibility
  • Explore support from established non-profit organizations like the Salvation Army or local food banks
  • Research state-level resources and programs for potential Medicaid coverage.

 

National Diaper Bank Network

The National Diaper Bank Network is another valuable resource for those in need of incontinence supplies.

This nonprofit organization collaborates with over 225 community-based diaper banks across the United States to supply diapers to families facing financial constraints and to promote awareness about diaper need.

Individuals can access services from the National Diaper Bank Network by visiting their website to connect with community-based diaper banks listed in their directory. These banks collect, store, and distribute free diapers.

The Network provides incontinence pads and liners and does not have specific income restrictions for eligibility, although it primarily supports low-income families.

Navigating Humana Medicare Plans

To maximize your coverage for incontinence supplies, it’s vital to comprehend your Humana Medicare plan. This involves comparing Humana Medicare Advantage HMO and PPO plans, which differ in their network, cost, and coverage.

HMO plans require the selection of a primary care physician (PCP) and referrals for specialist visits within the network, while PPO plans allow access to any doctor or specialist, both in and out of the network, without requiring a referral.

In terms of cost, HMO plans generally feature lower monthly premiums and out-of-pocket expenses compared to PPO plans, which typically have higher premiums but offer more flexibility in selecting healthcare providers.

Furthermore, both HMO and PPO plans include all the benefits provided by Original Medicare, but PPO plans may also encompass additional benefits and services not covered by Original Medicare.

But what are the nitty-gritty comparisons of these plans, and how can you reduce expenses with preferred pharmacies?

 

Comparing Humana Medicare Advantage HMO and PPO Plans

When comparing Medicare Advantage HMO PPO plans, it’s important to consider their advantages and disadvantages. HMO plans generally offer reduced premiums and out-of-pocket expenses, require the selection of a PCP, and mandate referrals for specialist consultations.

 

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On the other hand, PPO plans entail higher costs but provide greater flexibility and the option to consult any physician without referrals.

While the specifics of incontinence supplies coverage may differ by plan, Humana Medicare Advantage HMO plans may offer coverage for incontinence supplies or provide an over-the-counter (OTC) allowance for such health products. PPO plans may offer similar provisions, although the specifics can differ by plan.

 

Lower Cost Preferred Pharmacies

Preferred pharmacies can be a cost-effective way to obtain incontinence supplies. Humana’s preferred pharmacy network, for instance, allows Medicare members to acquire prescriptions at a reduced cost compared to standard in-network pharmacies. These preferred pharmacies include:

 

  • CenterWell Pharmacy
  • Albertsons Companies pharmacies
  • Kroger Health and its family of pharmacies
  • Costco
  • Publix
  • HEB

 

These pharmacies can offer cost savings on incontinence supplies and other healthcare products.

Potential savings can be significant, with Humana Medicare beneficiaries obtaining prescriptions at a lower cost at preferred pharmacies compared to standard in-network cost-share pharmacies.

The exact savings may vary depending on the plan, so it’s advised to scrutinize your plan details or contact Humana directly for more information.

Summary

In conclusion, while incontinence can pose challenges, understanding your coverage options can help manage these challenges effectively. Humana Medicare may cover incontinence supplies depending on the plan type and specific coverage details. Original Medicare does not cover incontinence supplies, but Humana Medicare Advantage plans may offer coverage.

Remember that coverage depends on factors such as plan type, prescriptions, and medical necessity. While Humana Medicare may cover specific incontinence treatments, alternative options, such as local non-profits or the National Diaper Bank Network, can be a lifeline. Combining Medicare and Medicaid benefits or understanding your Humana Medicare plan specifics can also help maximize your coverage.

Frequently Asked Questions

 

 

Does Medicare pay for incontinence supplies?

No, Medicare does not cover incontinence supplies or adult diapers, but some Medicare Advantage plans may provide coverage for these products in specific service areas. It’s best to check with your plan for details.

 

How to get free incontinence pads?

You can get free incontinence pads from local senior health centers, Medicaid, free diaper coupons, and loyalty programs. These resources often provide a bulk supply of free pads for those in need.

 

What is the Humana OTC allowance for 2023?

The Humana OTC allowance for 2023 is $50 every month, available for Humana Healthy Options Allowance Members diagnosed with a chronic health condition to use toward the purchase of food, over-the-counter products, and home supplies from a national network of retailers.

 

What incontinence treatments are covered by Humana Medicare?

Humana Medicare covers a variety of incontinence treatments, including devices like Elitone and biofeedback-assisted pelvic muscle exercise training, if recommended or prescribed by a healthcare professional.

 

What are some alternative options for obtaining incontinence supplies?

You can consider reaching out to local non-profits or community organizations, and explore the National Diaper Bank Network for alternative options to obtain incontinence supplies. These options can provide assistance in accessing the necessary supplies.

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Speak with a licensed insurance agent

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Russell Noga
( Medicare Expert )

Russell Noga is the CEO of ZRN Health & Financial Services, and head content editor of several Medicare insurance online publications. He has over 15 years of experience as a licensed Medicare insurance broker helping Medicare beneficiaries learn about Medicare, Medicare Advantage Plans, Medigap insurance, and Medicare Part D prescription drug plans.