Medicare will cover medically necessary safety items for your bathroom. However, your idea of what is medically required could differ from what Original Medicare considers. Unfortunately, it will not cover bathroom equipment regarded as convenience items.
Medicare covers these items as Durable Medical Equipment (DME) and is paid for by Medicare Part B. You’ll be responsible for 20% of the Medicare-approved amount once you meet your Medicare Part B deductible. DME must be necessary for a qualified medical condition for Medicare to pay. In addition, the DME supplier must be a Medicare-approved supplier.
Next, we’ll consider the most common bathroom safety devices. Medicare will cover some, and you can expect you’ll have to pay for others. We’ll discuss the details of what is and isn’t covered. Then we’ll discuss how you may be able to get some of the non-covered items paid for by a Medicare plan.
These medical devices are portable toilets easily transported and emptied after each use. Commode chairs are considered medically necessary, and Medicare Part B covers them as durable medical equipment. This item is partly covered when others aren’t because the design helps to prevent falls.
Medicare won’t cover raised toilet seats. These toilet seat risers are considered convenience items. Fortunately, these items are easy to find and inexpensive. These seats assist with using and getting up from the toilet more easily.
These items make bathroom visits more accessible and more convenient. While Medicare doesn’t consider these items medically necessary, they help reduce the risk of falling.
Like grab bars, many Medicare beneficiaries will require these to shower safely. But like Grab Bars, Medicare doesn’t consider these items medically necessary. Most shower chairs are affordable. They start at about $15 bucks. If you want a more deluxe model, you could pay $350 or more.
A transfer bench is also called a shower bench. This item fits in the bathroom and allows seniors to transition in and out of the shower easily. These can be necessary safety equipment. However, they are considered convenience devices. Thus Medicare will not cover them. Fortunately, you can purchase one of these for under $20. If you want a more complex model, it can cost $200 or more dollars.
Walk-in tubs and walk-in showers have become increasingly popular. These tubs typically have a seated area, making it easy for seniors to bathe and shower. Medicare doesn’t consider these as medically necessary either. These tubs are expensive, and you will likely have to pay a contractor to demo the current tub and re-install the new one. That adds to the cost of the process.
You can expect between $500 to $3500 for a walk-in tub and the cost to demy repair and install the tub. While you can attempt to submit a claim for reimbursement for a partial amount, you can expect Medicare to deny the claim.
Medicare won’t cover home modifications, including modifications made in your bathroom. Your doctor will likely recommend safety modifications as you age. Still, you’ll be required to pay out of pocket for the remodel.
Medicare Supplement health insurance helps cover the cost of items covered by Original Medicare. These Medigap plans will help cover coinsurance, deductibles, and copays related to Medicare Part A and B items. These Medicare plans will help cover equipment that lowers the risk of falling, such as canes, walkers, and wheelchairs.
Enrolling in a Medicare Advantage plan can give you benefits that Original Medicare doesn’t include. Medicare Advantage could allow purchasing of bathroom equipment for home use through the insurance plan’s over-the-counter (OTC) benefits. Sometimes, this type of equipment will be available through their OTC catalog.
Medicare does not cover raised toilet seats because they are considered convenience items. However, the good news is that these items are readily available and come at a budget-friendly price.
A grab bar is an item that can lessen the chance of a fall, but Medicare doesn’t cover these bars. They don’t consider grab bars medically necessary despite needing them to navigate the space safely.
Installation costs can vary from $75 to $250. Installation costs will vary depending on the difficulty of the installation area.
No! Medicare doesn’t consider shower chairs as a medically necessary item. You’ll have to pay out of pocket unless you have a Medicare Part C plan to pay for a shower chair as an OTC benefit.
Medicare will cover a walker to help lessen the chance of falling.
Medicare will cover commode chairs but, in most cases, not actual handicapped toilets.
Medicare health care doesn’t cover portable showers. These showers are considered convenience equipment.
Electric wheelchairs can be considered medically necessary for qualifying medical reasons. Your doctor will have to show that it’s a medically necessary item.
Medicare.gov lists the requirements that equipment must meet to be considered DME.
According to Medicare’s website, DME must meet the following criteria:
Medicaid is a state program. Thus, the coverage will vary depending on your state. Medicaid may cover some of these other items. The equipment, brands, and pricing rules will vary depending on your resident state and level of Medicaid.
Sometimes, you can find a program from a manufacturer of this type of equipment that will provide a discount when purchasing bathroom safety items. Check with the manufacturers that make the style of equipment you like.
You can also check for local charities. There is no shortage of charitable organizations that assist Medicare beneficiaries with paying for necessary items. Sometimes, these organizations will help with the remodeling needs of seniors with specific medical conditions.
Medicare will not pay for this item since a safety shower isn’t considered a medical necessity.
A shower transfer bench is unnecessary, so Medicare will not cover it.
While Medicare doesn’t cover all bathroom safety equipment items, several are. You can enroll in a Medicare Supplement health insurance plan to cover the rest.
Speaking with a licensed insurance agent can help determine which plan fits your needs best. Our experts can review all the programs in your area to see which plan fits the needs to cover the equipment that your doctor recommends.
For assistance finding a plan to help cover bathroom safety equipment, call us now, or fill out our online request form.
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Written By:
Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.
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