Does Anthem Cover Incontinence Supplies?

Anthem and the Anthem family of brands (which includes the Blue Cross and Blue Shield group of affiliated companies) offers Medicare Advantage (Medicare Part C) plans and policies with varying levels of benefits, not every plan covers the same services and supplies.

Some Medicare Advantage plans like the ones offered by Anthem may help plan members pay for incontinence supplies, or they may provide an allowance that can be used by plan members to purchase qualified over-the-counter healthcare items, which might include incontinence supplies.

Anthem Medicare Advantage plan members who want to find out if their policy includes any coverage for incontinence supplies or over the counter (OTC) items should contact Anthem directly. A benefits administrator can help you understand the coverage options that may be available to help you pay for incontinence supplies.

What Products Are Classified as Incontinence Supplies?

Incontinence products are items designed to help individuals experiencing bladder or bowel leakage. Depending on the individual product, these items can absorb or contain urine or fecal material and often reduce odors.

There are several categories of incontinence products:

• Bladder control pads: Thin and discreet, bladder control pads are designed to be worn with standard undergarments to absorb light leakage.
  
  
• Male guards: Similar to standard bladder control pads, male guards can handle light leakage but are shaped for a man’s needs.
  
  
• Disposable underwear: Disposable underwear, or pull-ons, can replace traditional undergarments for individuals experiencing moderate leakage. They provide more substantial protection than bladder control pads, including a wider absorbent area, and they’re ideal for overnight wear.
  
  
• Incontinence briefs: Sometimes referred to as adult diapers, incontinence briefs take the place of traditional undergarments and can be worn under clothing. They offer more coverage area than bladder control pads or disposable underwear and can handle both bladder and bowel incontinence. These absorbent items are designed to accommodate heavy leakage.
  
  
• Booster pads: These inserts add an extra absorbent layer to an existing bladder control product, such as an adult diaper. Because they aren’t meant to be worn alone, they don’t typically have a waterproof side.
  
  
• Condom catheters: These external catheters, which are sometimes referred to as penile sheath catheters, fit over the penis and channel urine into a wearable collection bag. Depending on the model, the bag may be emptied or discarded when full.
  
  
• Under-pads: These large, absorbent sheets are designed to protect furniture and bedding from leaks. Although most under-pads are designed for single use, washable products are available.

What’s the Difference Between Incontinence and Urological Supplies?

Although incontinence and urological supplies may seem similar, they fall into two distinct categories. While incontinence supplies absorb urine leakage, urological supplies actively help remove urine from the body. Urological supplies may include:

• Internal catheters
• Drainage bags
• Insertion trays

Does Anthem Cover Urological Supplies?

Because urological supplies, including catheters and drainage bags, are generally considered medically necessary, they’re typically covered by Original Medicare (Medicare Parts A and B) and are therefore covered by Medicare Advantage plans, such as those offered by Anthem. However, coverage amounts and guidelines may vary by plan type and region.

When considered medically necessary, urological supplies are also typically covered by Anthem Medicare Advantage plans.

Anthem Medicare Advantage Coverage

Anthem Medicare Advantage policies are governed by federal Medicare guidelines and must provide benefits that are the same or greater than those offered under Original Medicare. This includes intermittent, closed-system or sterile coudé catheters if a beneficiary has received a qualifying diagnosis, such as incomplete bladder emptying or permanent urinary incontinence. 

Plan participants may need to meet any applicable deductible before coverage begins, and benefits may be contingent upon having a valid prescription and documentation of medical necessity, which may include:

• A qualifying diagnosis
• The patient's prognosis
• Prescribed treatments and their outcomes
• Any history of urinary catheter use
• Doctors’ notes and other applicable information

Because some Medicare Advantage policies may offer additional benefits, and coverage can vary by region, individuals should call Anthem directly to find out more about their plan specifics.

Does Original Medicare Cover Incontinence Supplies for Seniors?

Medicare Part B, which provides coverage for general medical care and outpatient services, doesn’t typically cover the cost of incontinence supplies. However, coverage for some products may be covered under Part A, Medicare’s hospitalization component, if a beneficiary becomes terminally ill.

Coverage terms may vary depending on the individual’s diagnosis and the formal care plan proposed.

Where Can I Get Financial Help for Incontinence Supplies?

If your insurance doesn’t cover the full cost of the incontinence products you need, paying for these items can be expensive. However, if you qualify, the following organizations may help cover the cost of incontinence supplies or provide essential products directly to individuals:

• Medicaid: Individuals who meet their state’s income requirements may qualify for coverage for essential medical services and supplies through Medicaid. Depending on where you live, Medicaid may cover the cost of incontinence supplies if they’re considered medically necessary. The program may also pay for supplemental items, such as gloves and wipes.
  
  
• S. Department of Veterans Affairs: If you’re a veteran, you may be able to get adult diapers or other incontinence supplies through the U.S. Department of Veterans Affairs if a doctor confirms medical need. If you qualify for this benefit, products must be purchased through a program-approved supplier.
  
  
• Adult diaper banks: In some areas, local organizations sponsor adult diaper banks, which provide incontinence supplies to low-income individuals. These nonprofits may require interested individuals to provide proof of financial hardship, including food stamps or a letter of assistance from their state of residence. To find a diaper bank near you, visit the Directory of U.S. Diaper Banks.

If you need help paying for incontinence supplies for yourself or a loved one, your local social services office or aging services agency may be able to direct you to appropriate resources and facilitate the application process.

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