Does Medicare Cover Bedside Commodes ?
Over the years that I have been the caregiver to my two elderly parents, I think that the most useful and versatile piece of equipment we have used, is the bedside commode. If you get a 3-in-1 commode, you can use it as a toilet frame, a raised toilet seat, a shower chair, a bedside commode and a chair for a sponge bath as well.
Original Medicare Part B does cover bedside commodes for use in the home, if they are prescribed as “medically necessary” by a Medicare enrolled-physician, and you buy from a Medicare-enrolled supplier.
Medicare covers 80% of the Medicare-approved price on items which are considered “medically necessary”, and will require a prescription from your doctor, or treating practitioner – I will be expanding upon this in a moment, as it is key to getting the highest possible coverage.
To qualify for bedside commode coverage you must be medically unable to use the toilet, or get to the toilet without assistance, and you must follow the proper prescribing purchasing process.
Here is text from Medicare itself –
Part B (Medical Insurance) covers commode chairs as durable medical equipment(DME) when ordered by a doctor for use in your home if you can’t use a regular toilet.“
If you wish to see the complete original text click Medicare.gov.
How much does a bedside commode cost ?
Bedside commodes cost between $ 37.99 and $3303.88.
The average price, by type, is –
Static bedside fixed arm commode – $220.00 (38 models $37.99 to $815.00)
Static drop arm bedside commode – $309.82 (33 models $72.98 to $1363.74)
Static shower chair bedside commode – $169.31 (3 models $119.95 to $199.00)
Transport bedside commode – $286.71 (11 models $192.00 to $449.00)
Shower Transport bedside commode – $917.05 (70 models $119.00 to $3303.88)
Transfer bench bedside commode – $404.99 (11 models $117.00 to $1845.00)
I have a very in depth article “How Much Does A Bedside Commode Cost ? A Guide With Over 160 Examples By Category” which lists all the types of bedside commodes, and then by type and weight capacity lists the prices of over 160 different bedside commdes, along with their product number and manufacturer.
Does Walmart sell bedside commodes ?
Walmart has a wide range of bedside commodes of all types – folding commodes, 3-in-1 commodes, drop arm commodes, bariatric commodes, transfer commodes, transport commodes and shower chair transport commodes.
Walmart has a very large range of bedside commodes on their website, with many of the best known brands –
Carex – a small range of 4 static folding, and assist lift bedside commodes ranging in price from $50.50 to $180.62
Drive Medical – a range of 18 static folding, 3-in-1, bariatric and drop arm bedside commodes ranging in price from $32.29 to $186.71
Healthline – a small range of 3 static folding, and assist lift bedside commodes ranging in price from $42.65 to $195.29
Lumex – a range of 11 static folding, drop arm and bariatric bedside commodes ranging in price from $71.13 to $180.62
McKesson – a range of 14 static folding, 3-in-1, bariatric and drop arm bedside commodes ranging in price from $34.99 to $203.67
Medline – a range of 12 static folding, 3-in-1, bariatric and drop arm bedside commodes ranging in price from $30.15 to $151.72
Nova Medical – a range of 6 static folding, 3-in-1, bariatric and drop arm bedside commodes ranging in price from $75.30 to $599.95
PCP – a range of 3 static folding and 3-in-1 bedside commodes ranging in price from $75.30 to $599.95
ProBasics – a range of 6 static folding, 3-in-1, bariatric and drop arm bedside commodes ranging in price from $32.99 to $222.10
Unfortunately, Walmart does not carry the brands “TFI Healthcare” or “Tuffcare”
There was a huge range of brands I have never heard of selling commodes.
I also have an article “Does Walmart Carry Bedside Commodes ?” again outlining the different types of bedside commode and where you can buy them other than Walmart, and which stores are specialized are best for which types.
What equipment does Medicare Pay for ?
Medicare Part B covers certain durable medical equipment for use in the home.
Durable medical equipment has to be able to withstand reapeated use for a sustained period of time in the home envrionemnt, and it has to be primarily medical in nature.
Medicare Part B doesn’t cover equipment which it sees as for comfort such as raised toilet seats or grab bars.
For each item of durable medical equipment there are strict guidelines for –
- the medical conditions, reasons and situations for which it can be used (it has to be medically necessary)
- the process for acquiring the equipment so that it will be covered by Mediacre Part B
Typical examples of the type of durable medical equipment that Medicare covers for use in the home are –
- transport chairs
- bedside commodes
- hospital beds
Medicare Part B will typically cover 80% of the Medicare-approved cost of durable medical equipment which is prescribed by a Medicare-enrolled physician as medically necessary, and which is bought, or rented, from a Medicare-approved equipment supplier.
Disposable medical equipment and medical supplies are not normally covered by Medicare Part B.
Some examples of disposable supplies not covered are –
- fabric dressings
- faces masks
There are two exemptions to this –
- the Medicare Home Health benefit does cover some medical supplies
- if a disposable medical supply is being used in conjunction with an item of durable medical equipment which is being covered by Medicare for the individual
List of durable medical equipment covered by Medicare
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
Bed Side Rails
Bed Trapeze – covered if your loved one is confined to their bed and needs one to change position
Blood sugar monitors
Blood sugar (glucose) test strips
Canes (however, white canes for the blind aren’t covered)
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Cushion Lift Power Seat
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Infusion pumps and supplies (when necessary to administer certain drugs)
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mobile Geriatric Chair
Nebulizers and some nebulizer medications (if reasonable and necessary)
Oxygen equipment and accessories
Patient lifts (a medical device used to lift you from a bed or wheelchair)
Postural Drainage Boards
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Urinals (autoclavable hospital type)
Whirlpool Bath Equipment – if your loved one is homebound and the pool is medically needed. If your loved one isn’t homebound Medicare will cover the cost of treatments in a hospital.
Medicare-approved supplier near me ?
You can use this link to find a local DME supplier on Medicare.gov
List of durable medical equipment not covered by Medicare
Augmentative Communication Device
Bed Exit Alarms
Bed Sensor Pads
Beds – Lounge
Blood Glucose Analyzers
Braille Teaching Texts
Caregiver Paging Systems
Catheters – except those which are used for permanent medical conditions where the catheter is considered as a prosthetic
Chair Exit Alarms
Chair Sensor Pads
Contact Lenses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens
Disposable Bed Protectors
Door Exit Alarms
Electrical Wound Stimulation
Exit Alarm Mat
Eye Glasses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens.
Heat and Massage Foam Cushion Pad
Heating and Cooling Plants
Humidifiers – not room humidifiers
Injectors (hypodermic jet pressure powered devices for Insulin injection)
Motion Sensor Exit Systems with Pagers
Over bed Tables
Paraffin Bath Units (if not Portable)
Portable Room Heaters
Portable Whirlpool Pumps
Preset Portable Oxygen Units
Pull String Alarms
Raised Toilet Seats
Special TV Close Caption
Speech Teaching Machines
Surgical Face Masks
Telephone Alert Systems
Television Assistive Listening Devices
Walk in Bathtubs
How to get your DME covered by Medicare ?
For Medicare Part B to cover your durable medical equipment for use in the home it is required that you –
- are enrolled in Medicare Part B
- have a prescription signed by your Medicare-enrolled doctor saying that the equipment is a “medically necessary”
- have to purchase the DME from a Medicare-enrolled supplier
Care facilities – hospitals, or nursing homes, don’t qualify as a “home” for Medicare Part B, however they are covered under Medicare Part A (hospital treatment) for any DME they need when in a nursing facility for up to 100 days.
Note, that a long-term care facility, such as assisted living can qualify as a “home” for Medicare part B.
How Original Medicare part B defines living at home ?
- living in your own home
- living in the family home
- living in the community, such as assisted living
What do you do once you you have your prescription ?
Once you have a prescription Medicare part B will be responsible for paying 80% of the Medicare-approved price for your item.
You will be responsible for your co-payment equal to 20% of the Medicare-approved price of the equipment being purchased, if you have gone through a Medicare-enrolled “participating” supplier who accepts “assignment”. If not it may be more – read on !
You will also have to pay your annual deductible (if this hasn’t already been met).
Medicare will usually purchase less expensive items outright, but for larger purchases they will rent the item on a monthly basis.
If your parent’s equipment is rented from a Medicare-enrolled “participating” supplier who accepts assignment, your parent will be responsible for a monthly co-payment of 20% of the Medicare-approved rental price.
Mistakes not to make with Medicare
To be sure that you are paying the least amount possible, your Medicare enrolled “participating” supplier has to be one who accepts “assignment”.
This ensures that you pay the lowest possible price for the item – that being the Medicare-approved price.
The reason being ?
Medicare-enrolled suppliers are divided into two groups –
- Medicare Suppliers
- Medicare “Participating” Suppliers
Medicare “Participating” Suppliers have agreed to what is called “assignment” – they have accepted to only charge the Medicare-approved price for any DME, non-participating suppliers can charge you up to 15% more per item.
If my supplier is not a Participating Supplier what happens ?
Medicare-enrolled suppliers who are not a “Participating” Supplier –
- accept payment from Medicare for DME at the Medicare-approved price
- but can they sell the DME to you at whatever price they choose
The result –
- Medicare pays the supplier their 80% of the Medicare-approved price for your item
- you end up paying your 20% co-pay of the Medicare-approved price for your item + the difference between the Medicare-approved price, and the supplier’s price
- and you will have to pay your annual Medicare deductible if it applies
Here is an example –
Medicare-approved bedside commode price – 200$
Medicare-enrolled Supplier bedside commode price -230$
- Medicare will pay 80% 0f the Medicare-approve price = 160$
- You will pay 20% co-pay of Medicare-approve price = 40$
- You will also pay the difference between the Medicare-approved price, and the Medicare-enrolled Supplier price – 230$ – 200$ = 30$
- So, you pay 40$ + 30$ = 70$
If your Medicare-enrolled supplier had been a “participating” supplier who accepts assignment, you would have paid 30$ less.
So, do use a Medicare-enrolled “Participating” Supplier, and always confirm that the supplier accepts “assignment”, as they will pay the least amount possible.
DME in skilled nursing facilities ?
If your parent is receiving treatment in a Skilled Nursing Facility, or hospital, they will be covered by Medicare Part A (Hospital Insurance). The facility is required by law to supply any DME needed for up to 100 days.
What about Medicare Advantage ?
For questions about the exact the process, and which supplier you can use, you will need to check with your Medicare Advantage Plan Provider as to how you should proceed.
Advantage Plan providers will require participants to use their network suppliers, and if they don’t use them they may find themselves footing the whole bill for your DME’s.
Medicare Advantage Plans are offered by private companies which Medicare has contracted to provide Medicare services, and they must by law, provide at least the same coverage as Original Medicare Parts A and B, and as such they will cover bedside commodes which are medically necessary.
Medicare Advantage Plans, just like with Original Medicare, usually have a co-pay, and the rates vary with the provider.
Free one-on-one help with understanding Medicare
SHIP – State Health Insurance Assistance Programs –
Free guidance about Medicare, Medicaid and Medigap is available from your SHIP program.
I have a short article explaining how to find your local SHIP – “Free Help Understanding Medicare And Medicaid ? Here’s Where You Get It”.
Does Medicaid cover bedside commodes ?
Medicaid receives it’s funding both on a federal and a state level, and functions differently form Medicare.
Each state, within the guidelines set out by the government, runs its Medicaid program in its own way.
Each state will have Medicaid State Plan, and more often than not Home Community-Based Services (HCBS), or waivers (also Medicaid).
Each program, or waiver, will have their own criteria for eligibility and it’s own specific goals, which has resulted in hundreds of programs, and waivers, for Medicaid across the US.
So what qualifies as durable medical equipment can vary from program to program, let alone from state to state, which means that there is a possibility of getting coverage for DME that isn’t possible with Medicare.
Medicaid and state programs for care in the home
Medicaid for home care, is called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”.
Theses programs and waivers all have as a goal to help the participants/beneficiaries to maintain their independence in their homes, cover the care and services required, and pay for “home medical equipment”.
You can find out more technical information about the waivers there are, at the official Medicaid site –
For HCBS programs and waivers the term “home” is used to mean that a beneficiary must be living in –
- their own home
- their family home
- a group home
- an assisted living facility
- a custodial care facility
Certain Medicaid waivers may allow for more DME coverage for the home than others
Consumer Direction/ Self Direction
Certain HCBS programs and waivers allow for what is called Consumer Direction/ Self Direction.
A participant in a program which allows for this will have a budget allotted to cover all their needs, and to help them maintain their independence in their home.
A financial planner will be appointed to the person, to help them manage the funds across all of their needs.
Durable medical equipment can be considered as part of their needs if it helps them to remain in their home.
Items which are not covered by Medicare such as bathtubs, grab bars or shower chairs, if considered medically necessary, and within the person’s allotted budget, may be purchased on some of these programs or waivers.
To find out more about Medicaid Self Direction click here.
Programs designed to transition people back to their own homes after staying in care institutions
Money follows the person is a Medicaid program which takes people from nursing facilities, and relocates them back to their homes – this, as I said previously, can also mean assisted living.
If a participant needs certain medical equipment to make it possible to relocate back to their home, the program will purchase the equipment
And again, what is considered as durable medical equipment is less restricted than that covered by Medicare.
To see what is available and what the eligibility criteria are you will need to check with your state. The Medicaid programs are intended for those families with the lowest income, the elderly and the disabled.
Find the HCBS programs, waivers and 1915 waivers with their eligibility criteria in your state
If you wish to find the HCBS Waivers, 1915 Waivers, HCBS Programs and the Money Follows The Person Programs for seniors in your state, I have an article which lists all the HCBS waivers and programs which are available in each state – “Medicaid Home and Community Based Services Waivers and Programs For Seniors Listed By State”.
If your income is slightly too high for Medicaid eligibility
Medicaid runs a type of program called Spend Down which has been designed to help a person reduce their income, or income + asset level, so that they may become eligible for Medicaid.
I have an article where I explain who can qualify for Spend Down, the expenses they can deduct and how you know if you qualify which you can read here – “What is Spend Down ?”
How to purchase DME on Medicaid and state funded programs ?
– get the doctor, or therapist, to provide a medical justification letter, stating that the equipment desired is medically necessary.
– contact a DME supplier, who is Medicaid approved, and give them the medical justification letter from the doctor, or therapist.
– the DME supplier should fill out a Prior Approval Application.
– the document goes to the Medicaid state office where the purchase is either approved, or denied.
– if the purchase is unsuccessful, you will be notified as to the reasons why, and how to appeal the decision.
– if the purchase is approved you will receive the item.
To find your State Medicaid State Agency
If you just want to talk to, or to email someone, contact you state Medicaid Agency here.
Step 1 –
Click the link to Medicade.gov, look to the section I outlined in red.
Step 2 –
Select your state and click on the button they have marked “GO” – it will take you to your State Medicaid Agency with all their contact info.
How to get a bedside commode covered as a Veteran
The Department of Veterans’ Affairs has grants, programs, forms of financial assistance and pensions which will help to cover the cost of DME’s for veterans.
You can find out about your local VA Medical Centers, Clinics and offices with this link here.
Below are some of the forms of assistance available if you are a veteran –
- Grants for remodeling homes due to disabilities inflicted during military service
- Veterans Direct HCBS where the beneficiary allots different parts of their budget to their specific needs
- Veterans Pensions – there are veterans pensions which will allow for the purchase of equipment that veterans need for their homes, and the money is not lost to the pensioner
All above will pay for different types of durable medical equipment and bathroom safety equipment which are not covered by Medicare .
Other financial assistance you can get for DME in the home
Assistive Technology Programs
All states receive a grant to be used on “Assistive Technology Programs” – these are for programs which designed are to increase access to assistive devices in the home.
One of the primary groups who are meant to benefit from these programs are the elderly.
“Assistive Technology” and “DME” are basically interchangeable in this case as terms, all manner of equipment which can help in the home is covered.
You need to contact your State offices and find out how to apply.
To find out what programs your state runs click here.
Pick your state on the map or the drop down menu, and click on “Go to state”
– I chose Florida for this example
Click on the link “Program Title” – for my example I outlined it in red.
The AT Program state website will come up, and you can sign up, or use their contact info .
State Financial Assistance Programs
These are non-Medicaid programs developed to reduce the number of elderly persons entering Medicaid run nursing homes.
The programs are run on a state-by-state basis to help the elderly to remain living in their homes – not every state has one.
Modifications to the home, the purchase of necessary medical and safety equipment are all covered by the programs.
Eligibility will differ with each one, but they are for the elderly and the disabled.
USDA Rural Development Section 504 Home Repair Program
The elderly can get a grant for home remodeling and safety equipment if they live in a rural area.
The USDA Rural Development Section 504 Home Repair Program gives loans to homeowners on low incomes to –
“repair, improve or modernize their homes or grants to elderly very-low-income homeowners to remove health and safety hazards.”
– source USDA.GOV
The maximum grant is $7,500.00, which is also the lifetime limit.
To be eligible you must
- be the home owner
- be 62 yrs and over
- have a family income of less than 50% of the local average income
- be unable to repay a home repair loan.
Applications are accepted year round at local Rural Development offices here
Protection and Advocacy Programs
Legal services providing assistance to the elderly who are disputing denied claims.
I have added this incase you feel that you have been unfairly denied coverage.
You can ask at your local Area Agency on Aging about where to find a Program in your area.
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I’m Gareth and I’m the owner of Looking After Mom and Dad.com
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