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Does Medicare Pay for Adult Diapers in Assisted Living?
Date Updated: July 26, 2024
Written by:
Rachel Lustbader is a writer and editor with a background in healthcare and technology. Her work has been published on websites including HealthCare.com, BiteSizeBio.com, BetterHelp.com, Caring.com, and PayingforSeniorCare.com. She studied health science and public health at Boston University.
Both of Rachel’s grandmothers had very positive experiences in senior living communities, and Rachel saw firsthand the impact that kind, committed caregivers and community managers can have on seniors’ and their family members’ lives. With her work at Caring, Rachel hopes to help other families find communities, caregivers, and at-home products that benefit elderly loved ones and make life less stressful for family caregivers
Original Medicare (Parts A and B) doesn’t pay for adult diapers in assisted living or any other residential setting. Members must cover 100% of the cost of diapers and other incontinence supplies. However, Medicare Advantage plans may cover some over-the-counter health supplies, including adult diapers. In addition, Part D (prescription drug coverage) may include discounts for medical supplies, such as adult diapers. Review your plan documents carefully, or talk to an agent to find out if you have this type of coverage.
Does Medicaid pay for adult diapers in assisted living?
If you qualify for Medicaid, your plan may pay for medically necessary adult diapers. Medicaid is a federal and state program that provides health insurance for people who have a disability or earn limited income. While plans vary by state, most states offer coverage for incontinence supplies, such as adult diapers.
When are adult diapers medically necessary?
Adult diapers may be medically necessary if you have urinary incontinence, a condition that affects about 25% of Americans. It causes involuntary urine leakage, which can lead to infections, skin ulcers and other health complications. Many health conditions, such as diabetes, stroke, Parkinson’s disease or dementia, can lead to urinary incontinence.
It can also occur if you have weak or overactive bladder muscles, an enlarged prostate or a vaginal or urinary tract infection. Some medications cause urinary incontinence as well.