Medicaid & Insurance Reimbursement
Medicare is the federal health insurance program for:
- People who are 65 or older
- Certain younger people with disabilities
- People with End-Stage Renal Disease (permanent kidney failure requiring dialysis or a transplant, sometimes called ESRD)
For many individuals covered under Medicare, the most important aspects are Parts A, B, and D
-
Medicare Part A (Hospital Insurance)
Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. -
Medicare Part B (Medical Insurance)
Part B covers certain doctors' services, outpatient care, medical supplies, and preventive services. -
Medicare Part D (prescription drug coverage)
Helps cover the cost of prescription drugs (including many recommended shots or vaccines).
MEDICARE ADVANTAGE AND OTHER MEDICARE PART C SUPPLEMENTAL PLANS
Part C includes Medicare Advantage plans. With a Medicare Advantage plan, you receive your Medicare coverage through a private insurance company. Medicare Advantage plans work differently from Supplement plans. They combine your Part A Hospital, Part B Medical and, sometimes, Part D Prescription Drug coverage into one easy-to-use plan. Medicare Advantage also gives you extra benefits and services that Original Medicare doesn’t cover.
( https://www.upmchealthplan.com/medicare/learn/basics/medicare-part-c.aspx )
Medicare doesn’t cover any incontinence supplies. But, there are some Part C plans available throughout the country that will offer benefits for products like adult diapers. Yet, these plans are only in specific service areas.
So, in some cases, no plans with this benefit exist in your location. If there are Medicare Advantage or other Part C plans in your area, you’ll want to review the summary of benefits to identify if coverage extends to adult diapers.
There are many Medicare Advantage and Part C plans that cover the QuickChange® Incontinence Wrap.
The code used for the QuickChange® Incontinence Wrap is usually T4545, but it may also be listed under A4335, A4520, A4535, A4539, or another special code. An insurance company may also provide the QuickChange® Incontinence Wrap under a special authorization procedure. You should contact your insurance provider for exact details concerning the special authorization procedures.
For those Part C plans that provide direct spend benefits, you may be avail yourself of those benefits by purchasing the QuickChange® Incontinence Wrap at www.Walmart.com.
TRADITIONAL MEDIGAP POLICIES
Medigap is Medicare Supplement Insurance that helps fill "gaps" in original Medicare and is sold by private companies. Many MediGap policies will not cover adult incontinence products including the QuickChange® Incontinence Wrap.
( https://www.medicare.gov/supplements-other-insurance/whats-medicare-supplement-insurance-medigap )
VETERANS ADMINISTRATION
As of July 2021, Veteran’s Administration (VA) Health Care covers QuickChange® Incontinence Wraps free of charge to all eligible veterans. Refills should be available through your VA pharmacy or the Consolidated Mail Order Pharmacy (CMOP). You will need a prescription or other statement from your provider.
The QuickChange Male Incontinence Wraps (item numbers UIM1010 & UIM1025) are now active on Medline's MedSurg FSS contract # 36F79721D0124.
Veterans or Providers can search for the QuickChange® Incontinence Wrap the same way they do other FSS contracted items, using the government website, National Acquisition Center (NAC) and General Services Administration (GSA) Advantage website. ( https://www.vendorportal.ecms.va.gov/NAC/MedSurg/List )
Please feel free to contact us at https://quickchange.com/pages/app-contact-form and we can provide you with our general guidance for the VA.
MEDICAID
Medicaid provides health coverage to millions of Americans, including eligible low-income adults, children, pregnant women, and people with disabilities. Medicaid is administered by states, according to federal requirements. The program is funded jointly by states and the federal government. ( https://www.medicaid.gov/medicaid/index.html )
Medicaid also offers benefits not normally covered by Medicare, including nursing home care and personal care services. ( https://en.wikipedia.org/wiki/Medicaid )
Medicaid is the largest source of funding for medical and health-related services for people with low income in the United States, providing free health insurance to 1 in 5 Americans. It covers more than 75 million low-income and disabled people.
Medicaid should not be confused with Medicare. Medicare is a program that provides “care” to the elderly. Medicaid is a program to “aid” the needy. A small portion of the population qualify for coverage under both Medicare and Medicaid.
Subject to federal standards, states administer Medicaid programs and have flexibility to determine covered populations, covered services, health care delivery models, and methods for paying physicians and hospitals.
Medicaid plays an especially critical role for certain populations covering: nearly half of all births in the typical state; 83% of poor children; 48% of children with special health care needs and 45% of nonelderly adults with disabilities (such as physical disabilities, developmental disabilities such as autism, traumatic brain injury, serious mental illness, and Alzheimer’s disease); and more than six in ten nursing home residents. States can opt to provide Medicaid for children with significant disabilities in higher-income families to fill gaps in private health insurance and limit out-of-pocket financial burden. Medicaid also assists nearly 1 in 5 Medicare beneficiaries with their Medicare premiums and cost-sharing and provides many of them with benefits not covered by Medicare, especially long-term care.
Over two-thirds of Medicaid beneficiaries are enrolled in private managed care plans that contract with states to provide comprehensive services, and others receive their care in the fee-for-service system.
Medicaid generally covers incontinence products like adult diaper, briefs, and pads. Not all states have made a determination concerning coverage of the QuickChange® Incontinence Wrap. In states with several managed plans, some plans may routinely cover the QuickChange® Incontinence Wraps while others may not. In a small number of states, an individual waiver is needed using a special exception procedure.
If you are covered under Medicaid, you can see the coverage status of the QuickChange® Incontinence Wrap (QcW) in your state in the chart below.
Medicaid Coverage Status Chart
Please feel free to contact us at https://quickchange.com/pages/app-contact-form and we can provide you with our general guidance for your particular state.
CHILDREN’S HEALTH INSURANCE PROGRAM (CHIP)
CHIP is an insurance program that provides low-cost health coverage to children in families that earn too much money to qualify for Medicaid but not enough to buy private insurance. In some states, CHIP covers pregnant women. Each state offers CHIP coverage and works closely with its state Medicaid program.
CHIP generally covers incontinence products for children above the age of 3 or 4 years old with special needs. In many states, the QuickChange® Incontinence Wrap is available under CHIP. Since most state Medicaid programs administer CHIP side by side, the general Medicaid rules apply for coverage.
If you are covered under CHIP, you can see the coverage status of the QuickChange® Incontinence Wrap in your state.
Please feel free to contact us at https://quickchange.com/pages/app-contact-form and we can provide you with our general guidance for your particular state.
PRIVATE HEALTH INSURANCE
Private insurance plans typically do not cover incontinence supplies. Since we are an alternative to condom catheters, not just briefs, and fulfill special situations, UI Medical is currently working to seek coverage with insurance plans and will continue to update this page as new developments occur.
Although QuickChange® Incontinence Wraps are usually not covered under most private health plans, you may still wish to confirm coverage for T4545. Please keep in mind that the product may also be listed under A4335, A4520, A4535, A4539, or another special code. An insurance company may also provide the QuickChange® Incontinence Wrap under a special authorization procedure. You should contact your insurance provider for exact details concerning the special authorization procedures.
For those private health plans that provide direct spend benefits, you may be avail yourself of those benefits by purchasing the QuickChange® Incontinence Wrap at www.Walmart.com.
DIRECT SPEND BENEFITS
For those health plans that provide direct spend benefits, you may be avail yourself of those benefits by purchasing the QuickChange® Incontinence Wrap at www.Walmart.com or another qualified direct spend partner of your plan.
CONSUMER DRIVEN HEALTH PLAN (CDHP)
Consumer Drive Health Plans (CDHP) are preferred provider organization health insurance plans with lower premiums than traditional plans. CDHP’s are traditionally paired with approved medical savings accounts like Health Savings Accounts.
As in the case of private insurance, some PPO’s currently cover QuickChange® Incontinence Wrap. You may wish to confirm coverage for T4545. Please keep in mind that the product may also be listed under A4335, A4520, A4535, A4539, or another special code. An insurance company may also provide the QuickChange® Incontinence Wrap under a special authorization procedure. You should contact your insurance provider for exact details concerning the special authorization procedures.
Even if the PPO’s does not cover the QuickChange® Incontinence Wrap directly, you can use the paired Health Savings Account (HSA) for acquire the QuickChange® Incontinence Wrap. See the Health Savings Account section for more details.
HEALTH SAVINGS ACCOUNT (HSA’s)
HSA’s are a type of savings account that lets you set aside money on a pre-tax basis to pay for qualified medical expenses. The QuickChange® Incontinence Wrap qualifies as a qualified medical expense under the rules governing HSA’s. The rules require that you have a qualifying diagnosis ( https://www.irs.gov/pub/irs-pdf/p502.pdf ) . HSA account holders are encouraged to use www.Walmart.com for their qualifying purchase of the QuickChange® Incontinence Wrap as well as facilitate recordkeeping.
FLEXIBLE SPENDING ACCOUNT (FSA’s)
A Flexible Spending Account (also known as a flexible spending arrangement) is a special account sponsored by your employer that you put money into that you use to pay for certain out-of-pocket health care costs.
You use your FSA by submitting a claim to the FSA (through your employer) with proof of the medical expense and a statement that it has not been covered by your plan. You will then receive reimbursement for your costs. Ask your employer about how to use your specific FSA.
https://www.healthcare.gov/have-job-based-coverage/flexible-spending-accounts/
Many FSA plan administrators use Walmart’s Direct Spend program which offer the QuickChange® Incontinence Wrap.
