Medicare and adult diapers: Coverage, supplies, and costs

Original Medicare (parts A and B) does not generally cover adult diapers, other than in a long-term care facility. Other Medicare parts may help with coverage and costs.

This article discusses the causes, diagnosis, and treatments associated with adult urinary incontinence. It also looks at Medicare coverage, the cost of adult diapers, and possible financial help that may be available.

Urinary incontinence is the medical term for accidental leakage of urine from the bladder. The condition affects more than one-quarter of people in the United States, according to the American Urological Association.

Chronic contact with urine can cause skin damage, and wetness may cause swelling and skin breakdown. This, in turn, can lead to chronic wounds.

The bladder stores urine until it gets a signal from the brain to empty. Sphincter muscles control whether the bladder is closed or open. When the bladder is closed, the sphincter muscles are also closed around the tube, called the urethra, that allows urine to exit the body.

When a person is ready to urinate, a signal goes from the brain to the bladder, which contracts and allows the urine out through the urethra.

People may be able to control urine leakage with medication or physical therapy.

There are several reasons that the bladder may leak urine, including:

In addition, after a person has a stroke or if they have diabetes, dementia, or Parkinson's disease, they may feel a sudden urge to urinate but cannot get to the toilet in time to prevent leakage.

To diagnose the condition, a doctor will perform a physical exam, take a person's medical history, and perform urine and blood tests. Some people may also need to be admitted to the hospital.

A person's primary care doctor may also ask them to see a urologist. These are doctors who specialize in treating issues affecting the urinary tract.

There are several treatments that a doctor may prescribe, depending on the cause of the condition, its severity, and a person's lifestyle.

Treatments may include:

Medicare is a federal health insurance program with four parts. Each part covers different services, and some may help with the cost of adult diapers.

Part A provides hospital coverage, which includes inpatient care such as hospital stays.

Part B is medical insurance. It pays for tests, but it does not cover adult diapers because they do not qualify as durable medical equipment.

Part C, or Medicare Advantage, provides the same coverage as original Medicare (parts A and B), alongside certain other benefits. Although most Medicare Advantage plans do not cover adult diapers, some offer coverage for over-the-counter supplies, which does include adult diapers. A person can check with their plan provider for coverage details.

Part D is coverage for prescription drugs. It does not cover the cost of adult diapers. However, discount prescription drug cards may cover certain medical supplies, such as adult diapers.

Medicaid is a state and federally funded program that provides health coverage to people with low incomes and people with disabilities.

The federal government sets mandatory benefits that every state Medicaid program must cover. Each state sets the rules about optional benefits.

Adult diapers must be medically necessary for Medicaid to pay for them. If not, a person may have to pay 100% of the cost out of pocket.

In most states, Medicaid does cover adult diapers, though the amount varies. A person can contact their state Medicaid office to ask about assistance with paying for adult diapers.

The adult diaper market in the U.S. has a predicted market value of $4.5 billion by 2025, according to Statista.

A person with a moderate amount of urine leakage may use two to four disposable diapers each day, at a cost averaging $80–$160 per month.

However, if a person needs adult diapers for all their urinary needs, the cost can be up to $240 per month.

There are several programs that may help with costs.

The Medicaid waiver program can help community-based services provide help to people who might otherwise be in a long-term care facility. Each state may operate the program differently. People can contact their state's Medicaid office to check their eligibility.

Some communities also have diaper banks that provide diapers and other supplies to people with limited incomes. In many cases, adult diapers are free, though each group has specific policies about products, services, and distribution.

Also, some families may qualify for a National Family Caregiver Support Program grant, which helps families caring for older adults. The Department of Health and Human Resources in a person's state will set the eligibility requirements.

Discount prescription drug cards may also cover medical supplies.

People who shop for adult diapers online could also buy in bulk to help lower the cost.

Various health conditions can cause urinary incontinence. Medicare Part B will pay for tests to find out the cause of the incontinence, but it does not pay for adult diapers. Some Medicare Advantage plans may offer coverage, however.

Other resources to help pay for adult diapers include Medicaid, diaper banks, certain grants, and prescription drug cards.