Home delivery of
bladder control and
incontinence supplies
at little to no cost
through Medicaid

ATTENTION MEDICAID RECIPIENTS

Did you know that you may be eligible to receive your incontinence supplies
at little to NO COST* to you through your Medicaid plan?

For nearly 30 years, ActivStyle has been the trusted leader in home delivery of quality bladder control and incontinence supplies. As America’s largest insurance reimbursed provider of incontinence supplies for home use, we assist tens of thousands of seniors, disabled adults, and special needs children nationwide with disposable medical supplies.

Your Medicaid program may cover products like adult diapers/briefs, protective underwear/pullups, bladder control pads, liners, male guards, underpads (chux), and more!

And, if you’re on Medicaid, you may be eligible to receive the supplies you need at little to No Cost to you.

Ready to make life easier?
Call us for a personal consultation to verify eligibility.

Call toll-free 1-888-273-7844

Monday – Friday 8:00 AM to 7:00 PM CST

Note: You must have an eligible Medicaid plan. Medicare and most commercial insurance plans DO NOT cover bladder control and incontinence supplies.

activstyle medicaid

"*" indicates required fields

Patient's Name*

First Last

Name of person submitting this form*

First Last

YOUR Relationship to Patient*

Contact Email

Contact Phone*

Patient's Address*

Street Address City State Zip

Patient's Date of Birth

Insurance Type (check all that apply)*

Medicaid

Medicare (does not cover incontinence supplies)

Other

Which supplies do you need? (select all that apply)*

Incontinence or Bladder Control Products (pullups, diapers, pads, wipes, gloves, underpads/chux, etc.)

Urological Supplies (catheters and associated supplies)

Ostomy Supplies

Other (please explain in comments below)

If eligible, a physician's prescription will be required for all supplies requested.

Comments

Acknowledgment*

I acknowledge that I am either a new patient or an authorized agent coordinating care of a new patient, and the new patient is aware that ActivStyle will be contacting them.

By submitting your information above, you consent to be contacted via telephone by ActivStyle. ActivStyle will use the information you provide to check your eligibility with your state’s Medicaid program. Your personal information will never be sold or shared.

Why do so many Medicaid recipients choose ActivStyle?

Affordable – Little to NO COST to eligible Medicaid recipients.*
FREE SAMPLE – Qualified Medicaid recipients, ask about a free sample for proper fit and performance.**
Quality Products – High quality name brands like Rely^® and Prevail^®.
Convenient – Delivered directly to your home. No more embarrassing trips to the store for incontinence supplies.
Discreet – Your order is shipped in discreet, brown boxes. And there is no delivery charge.
Expertise – Our compassionate, trained Product Experts help you select the best bladder control and incontinence products for your needs.
Easy – Let ActivStyle handle the details. We contact your doctor, process all the insurance paperwork, bill insurance on your behalf, and even remind you each month when it’s time to reorder.
Accredited – ActivStyle is nationally recognized by ACHC (Accreditation Commission for Health Care).
Get-It-Right Guarantee – We guarantee you will be satisfied with our product’s performance, quality, comfort, and fit or we will make it right.
Superior Customer Service – Of customers surveyed, 96% would recommend ActivStyle to a friend, family, or colleague and 95% were satisfied with ActivStyle’s customer service.

* No cost for qualified Medicaid recipients, with doctor’s approval (prescription).
** Free samples for qualified Medicaid recipients with first order. Product availability may vary by state. Offer not available to current ActivStyle clients.

Testimonials

“It’s just the greatest thing to have ActivStyle for my active life. I tried several different kinds of pullups before ActivStyle, but when I got the pullups from ActivStyle, they just fit. That’s a wonderful thing to have them fit like regular underpants. ActivStyle has really helped me because I’m an active person. Now I can get out and go and not worry about having embarrassing accidents in public.”
Diann

“I’ve been using ActivStyle about three years now. ActivStyle has given me freedom. I can go out and do things without any worries, about any leaks happening. And the pullups, I love the comfort, a slim design, I can wear anything with them without feeling uncomfortable or anything. When I go out, I feel really protected.”
Connie

Call us now for a discreet personal consultation to see if you are eligible!

Call 1-888-273-7844, Monday – Friday 8:00 AM to 7:00 PM CST.

ActivStyle offers a full range of incontinence products, including protective underwear (pullups), diapers/briefs, pads, liners, male guards, booster pads, underpads (chux), and male external catheters:

Protective Underwear (Pullups)
Moderate to Heavy Absorbency

Adult Diapers (Briefs)
Heavy Absorbency

Liners, Pads, and Guards
Light to Moderate Absorbency

Underpads (Chux)
Protection for Beds, Chairs, and other Furniture

Booster Pads
Increases Absorbency for Protective Underwear and Diapers

Male External Catheter
Condom Catheter

ACHC Accredited

ActivStyle is nationally recognized by the Accreditation Commission for Health Care, Inc. (ACHC). This designation demonstrates our commitment to continued compliance with ACHC’s high standards and the continued education of our employees regarding the policies and procedures that govern a medical supply company.

Home delivery of bladder control and incontinence supplies at little to no cost through Medicaid