Does Medicare Cover Bedside Commodes ?

by | Beginners Info, Health Care

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.

Does Medicare cover bedside commodes ? Original Medicare will cover 80% of the Medicare-approved price for a bedside commode if it is 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 me expanding upon this in a moment, as it is key to getting the highest possible coverage.

With a bedside commode it will be covered if it is considered that you are medically unable to use the toilet, or get to the toilet without assistance, and if you follow the proper purchasing process.

Here is text from Medicare itself –
Commode chairs
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 does Medicare decide which pieces of equipment to cover ?

Original Medicare labels medical equipment for use in the home as “Durable Medical Equipment”, or DME.

Further on I have included a list of Durable Medical Equipment typically covered by Medicare, and another list of items you may have thought would be covered by Medicare, but are not . If you want to go straight to it just click here.

Many pieces of safety equipment that you may think would be considered medically necessary do not qualify, as they are considered by Medicare to be comfort items rather than medically necessary – items like grab bars, raised toilet seats, bathtub seats, bed exit alarms, transfer seats, are all not covered by Original Medicare Part B.

But don’t worry as there are other ways of getting the elderly these items paid for, which I will be outlining later.

For devices to be categorized as “Durable Medical Equipment” they have to meet the following Original Medicare criteria –

  • It must be durable (capable of withstanding repeated use over a sustained period of time)
  • It must be used for a medical reason, not just for comfort’s sake
  • The equipment is not usually useful to an person who is not sick
  • You must be using it in your home
  • It should have an expected lifetime of a minimum of 3 years

If the device is unable to fulfill these criteria you most likely will not be able to get it covered by Original Medicare.

Some of Durable Medical Equipment which Original Medicare lists in its own literature are walkers, wheelchairs, hospital beds and commode chairs.

You can use this link to find a local DME supplier on  Medicare.gov

How do you get Medicare covered DME ?

For any bits of equipment you purchase for your home to qualify as DME for Medicare coverage, 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.

What do you need to avoid doing wrong 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

or

  • 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.

Durable Medical Equipment typically covered by Medicare

To qualify you must have Original Medicare Parts A and B.

  • Part A (Hospital Insurance) covers DME for those who are living in skilled nursing facilities
  • Part B (Medical Insurance) covers DME for those living at “home” – I outlined the definition of “home” here.

Air-Fluidized Bed
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
Bead Bed
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)
Commode chairs
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Crutches
Cushion Lift Power Seat
Defibrillators
Diabetic Strips
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Heat Lamps
Hospital beds
Hydraulic Lift
Infusion pumps and supplies (when necessary to administer certain drugs)
IPPB Machines
Iron Lung
Lymphedema Pumps
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mattress
Medical Oxygen
Mobile Geriatric Chair
Motorized Wheelchairs
Muscle Stimulators
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)
Oxygen Tents
Patient Lifts
Percussors
Postural Drainage Boards
Quad-Canes
Respirators
Rolling Chairs
Safety Roller
Seat Lift
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Sitz Bath
Steam Packs
Suction pumps
Traction equipment
Ultraviolet Cabinet
Urinals (autoclavable hospital type)
Vaporizers
Ventilators
Walkers
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.

DME typically not covered by Medicare

Adult Diapers
Air Cleaners
Air Conditioners
Alcohol Swabs
Augmentative Communication Device
Bathroom Aids
Bathtub Lifts
Bathtub Seats
Bed Bath
Bed Boards
Bed Exit Alarms
Bed Sensor Pads
Bed Lifter
Beds – Lounge
Bed Wedges
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
Communicator
Contact Lenses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens
Dehumidifiers
Dentures
Diathermy Machines
Disposable Bed Protectors
Disposable Sheets
Door Exit Alarms
Easygrip Scissors
Elastic Stockings
Electrical Wound Stimulation
Electrostatic Machines
Elevators
Emesis Basins 
Esophageal Dilators
Exercise Machines
Exit Alarm Mat
Eye Glasses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens.
Fall Alarms
Fans
Fabric Supports
Fomentation Device
Grab Bars
Grabbers
Gauze
Hearing Aids
Heat and Massage Foam Cushion Pad
Heating and Cooling Plants
Home Modifications
Humidifiers – not room humidifiers
Incontinence Pads
Injectors (hypodermic jet pressure powered devices for Insulin injection)
Irrigating Kits
Insulin Pens
Massage Equipment
Motion Sensors
Motion Sensor Exit Systems with Pagers
Needles
Oscillating Beds
Over bed Tables
Paraffin Bath Units (if not Portable)
Parallel Bars
Portable Room Heaters
Portable Whirlpool Pumps
Preset Portable Oxygen Units
Pressure Leotards
Pressure Stockings
Pulse Tachometer
Pull String Alarms
Raised Toilet Seats
Ramps
Reading Machines
Reflectance Colorimeters
Sauna Baths
Special TV Close Caption
Speech Teaching Machines
Stair Lifts
Standing Table
Support Hose
Surgical Face Masks
Surgical Leggings
Syringes
Telephone Alert Systems
Television Assistive Listening Devices
Telephone Arms
Toilet Seats
Treadmill Exercisers
Walk in Bathtubs
Wheelchair Lifts
Whirlpool Pumps
White Canes
Wigs

Free one-on-one help with understanding Medicare

State Health Insurance Assistance Programs – SHIP – give free counseling about Medicare for people who need guidance.

SHIP counselors also give advice and help with Medicare Advantage, Medigap and Medicaid benefits.

It’s usually a phone service, but occasionally some of the programs may offer face-to-appointments as well.

If you want to find your local Medicare SHIP click here.

How to contact a SHIP counselor in your state, step by step

Step 1 –

You will come to this page –

Step 2 –

Click on a button to find your state – both buttons lead to the same menu

Step 3 –

From the list select and click on your state

Step 4 –

You’ll get a new window with the contact info and phone number for you to call in your state

If Medicare won’t cover you, will Medicaid cover a bedside commode ?

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 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 –

https://www.medicaid.gov/medicaid/hcbs/authorities/index.html

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.

To find your Medicaid State office

Here is a link to CMS.gov When you select your state you will see a the list of the state waivers and programs, along with their eligibility criteria click here.

If your income is slightly too high for Medicaid eligibility

In some states there’s a program called Spend-Down.

The Spend-Down program helps a person to reduce their income level so that they are eligible for Medicaid, HCBS’s and waivers.

One method to do this, is to allow a person to subtract their medical bills from their income, and if this causes their income level to fall below the  limit for Medicaid eligibility, the person will qualify and can apply to the different HCBS’s and waivers.

You can read all about it in an article on the US NEWS website here.

How to purchase a DME on these Medicaid and state funded programs ?

Step 1

– get the doctor, or therapist, to provide a medical justification letter, stating that the equipment desired is medically necessary.

Step 2

– contact a DME supplier, who is Medicaid approved, and give them the medical justification letter from the doctor, or therapist.

Step 3

– the DME supplier should fill out a Prior Approval Application.

Step 4

– the document goes to the Medicaid state office where the purchase is either approved, or denied.

Step 5

– if the purchase is unsuccessful, you will be notified as to the reasons why, and how to appeal the decision.

Step 6

– if the purchase is approved you will receive the item.

Find the HCBS programs, waivers and 1915 waivers with their eligibility criteria in your state

To find what is on offer in your state click here.

Step 1 –

Pick your state from the map.

Step 2

Click on you state 

Step 3 –

Choose –

  • your state Medicaid Agency marked with a (1), or
  • your state Home and Community Based Services, Waivers and 1915 Waivers marked with a (2)

You will then see a page like this example below, with the programs and waivers in your state, and their eligibility criteria.

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

Step 1/

Pick your state on the map or the drop down menu, and click on “Go to state”

– I chose Florida for this example

Step 2/

Click on the link “Program Title” – for my example I outlined it in red.

Step 3/

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.

    I’m Gareth and I’m the owner of Looking After Mom and Dad.com

    I have been a caregiver for over 10 yrs and share all my tips here.

    Gareth Williams

    Recent Content

    Summary
    Article Name
    Does Medicare cover bedside commodes ?
    Description
    Yes, Medicare will cover 80% of the Medicare approved price for a bedside commode, as long as it is proven medically necessary, you buy from the right supplier, and that you follow the whole process correctly.
    Author
    Publisher Name
    Lookingaftermomandad.com