Does Kaiser Cover Incontinence Supplies?

Absorbent pads and other incontinence supplies help individuals manage bladder and bowel incontinence by absorbing leakage and reducing odors. However, because these items are often disposable, they can be costly, particularly when used on a regular basis. Depending on which healthcare plan you have and what products you need, Kaiser may cover incontinence supplies. Kaiser supply depends on the provider network.

Here’s what you should know before you buy bladder and bowel protection items for yourself or a loved one. 

Does Kaiser Cover Incontinence Supplies?

Kaiser’s healthcare policies, including Medicare Advantage plans, typically include an OTC benefit, which may cover incontinence supplies. You can shop for plans available in your area by comparing plans in your ZIP code or by calling to get help from a licensed insurance agent.

This supplemental benefit provides coverage for certain over-the-counter medications and medical supplies up to a contractual limit, which differs by plan type. Items must be purchased through Kaiser’s OTC catalog, and available products may vary by year. Catalogs can be viewed online or mail-ordered upon request, and plan participants can place orders quarterly. Any unused portion of the benefit expires when the quarter ends.

However, healthcare plans, including those purchased through a single insurer such as Kaiser, vary widely when it comes to coverage terms, which can be affected by factors, such as plan type and service region. To learn more about your specific plan, contact Kaiser Permanente directly.

Does Kaiser Cover Intermittent or Closed-System Catheters?

Kaiser’s coverage of intermittent or closed-system catheters may depend on whether the participant has private insurance or a Medicare Advantage plan.

Coverage Under Medicare Advantage

Because Part C plans, such as Kaiser’s Medicare Advantage policies, legally must provide the same minimum benefits an Original Medicare beneficiary receives, these policies must cover the cost of intermittent or closed-system catheters for participants who have been diagnosed with a qualifying illness, such as permanent urinary incontinence or incomplete bladder emptying. To receive coverage, plan participants typically need to obtain a physician’s prescription and accompanying documentation of medical necessity. Documentation requirements may include:

• Diagnosis of an approved condition
• The patient’s prognosis
• Therapeutic interventions and outcomes
• The patient’s functional limitations
• The patient’s past experience with catheters
• Physicians’ notes
• Any other relevant information

Sterile coudé catheters may also be approved for individuals who are unable to use a straight catheter.

Coverage Under Private Plans

Depending on the policy and region, Kaiser’s private plans may also cover the cost of medically necessary catheters. Plan participants should contact Kaiser Permanente directly to learn more about the specific coverage terms of their policy.

Does Medicare Cover Incontinence Supplies for Seniors?

Medicare’s coverage of incontinence supplies may depend on a beneficiary’s medical condition and whether they have Original Medicare Parts A and B or a Medicare Advantage plan.

Coverage Under Original Medicare

Original Medicare doesn’t typically cover the cost of incontinence supplies for seniors. However, if an individual who has Medicare Part A is diagnosed with a terminal illness, medical supplies, such as catheters, may be covered under Medicare’s hospice benefit.

The terms of coverage under this benefit may vary, depending on the specific illness and the beneficiary’s individual care plan.

Coverage Under Medicare Advantage

Medicare Advantage plans, which are administered by private insurers, such as Kaiser Permanente, sometimes offer benefits not provided by Medicare Parts A and B.

These plan-specific benefits may include full or partial coverage for over-the-counter medical supplies, including adult diapers, bladder control pads or disposable under-pads.

If you have a Kaiser Medicare Advantage plan, you can find out what your plan covers by contacting a Kaiser representative or logging into your account online.

What Types of Incontinence Supplies Are Available?

There are various types of incontinence products available, and each is designed to fulfill a specific need. These items typically fall into the following categories:

• Bladder control pads: These pads are designed to absorb small amounts of urine. Because they’re thin and discreet, they're often ideal for active individuals who experience light leakage.
  
  
• Male guards: These absorbent pads are similar to regular bladder control pads, but are tapered to accommodate a man's body. They’re typically thin and discreet and are designed to handle light leakage.
  
  
• Bladder protection underwear: Sometimes referred to as pull-ons, bladder protection underwear replaces traditional undergarments. Designed to provide more absorbency and better overall protection than bladder control pads, they may be a good choice for men and women managing moderate leakage and for overnight use.
  
  
• Adult briefs: Designed to be worn under clothing, adult briefs offer more coverage area than other types of bladder control products and can accommodate both bladder and bowel incontinence. They’re ideal for individuals who experience heavy leakage.
  
  
• Booster pads: These pads are designed to supplement other bladder protection products, adding an extra absorbent layer. Because booster pads don’t typically have a waterproof side to contain liquids, they aren’t meant to be used alone.
  
  
• External catheters: External catheters, which are sometimes referred to as condom catheters, don’t absorb liquid. Instead, they channel urine through a tube, into a collection bag, which can be thrown away or emptied when full, depending on the specific product.
  
  
• Under-pads: These large, sheet-style pads can be positioned on a bed or other furniture, and have a waterproof barrier to keep surfaces clean and stain-free. Depending on the type of pad you purchase, you can throw the sheet away after use or wash it for reuse.

Can I Get Financial Assistance to Cover the Cost of Incontinence Supplies if My Plan Doesn’t Cover Them?

The following organizations may cover some or all of the cost of incontinence supplies for qualifying individuals:

• Medicaid: Low-income individuals who need help covering medical costs may qualify for Medicaid. Although Medicaid coverage varies by state, incontinence supplies may be covered if they’re deemed medically necessary by a plan-approved physician. Individuals may apply for Medicaid through the Health Insurance Marketplace or their state's Medicaid office.
  
  
• S. Department of Veterans Affairs: The U.S. Department of Veterans Affairs covers medical supplies, such as adult diapers, if they’re directly related to a veteran's diagnosed medical condition. Products typically need to be purchased from an approved pharmacy, medical supply company or institutional provider.
  
  
• Diaper banks: Individuals who can’t afford to purchase incontinence products may qualify for help through local diaper banks. These nonprofit organizations provide adult diapers and other essential incontinence supplies to low-income families. You can search for diaper banks in your area by visiting The Simon Foundation for Continence

Individuals who need help obtaining adult diapers and other incontinence supplies can contact their local social services office or aging services organization for further information on local organizations that can assist.