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 –
“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.

Is a 3 in 1 commode covered by Medicare ?

Yes, a 3 in 1 commode is covered by Medicare Part B for use in the home if you meet the criteria for coverage for a bedside commode. 

Medicare requirements for a bedside commode ?

Medicare Part B will, typically, give 80% coverage to bedside commodes for use in the home, if –

• it is diagnosed as “medically necessary” for you, according to the Medicare guidelines for bedside commodes (see below)
• you have a signed prescription for the commode from a Medicare-enrolled physician
• you rent or purchase the commode from a Medicare-approved
• it is for use in the home

Medicare qualifying diagnosis for a bedside commode ?

The guidelines concerning a person who cannot use a regular toilet are such that a bedside commode will be covered if it is considered that you are medically unable to use the toilet, or get to the toilet without assistance.

This would be the case if –

• the beneficiary is confined to a single room (or bed bound), or
• the beneficiary is confined to one level of their home where there is no toilet facility, or
• the beneficiary is confined to their home and there are no toilet facilities in their home

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.

I have an article all about how to use a bedside commode as a raised toilet seat, the different types of commodes you can use, and other jobs that a bedside commode can be used for – “Can a bedside commode be used over a toilet ?”

How often will Medicare pay for a bedside commode ?

Typically, Medicare Part B will replace a bedside commode, once every five years from the date that it was received, unless it has been lost, stolen or damaged beyond repair.

Equipment covered by Medicare which has been lost, stolen or damaged beyond repair, may be replaced – Medicare will of course require proof of the initial coverage, and purchase.

Source: Medicare coverage of Durable Medical Equipment and Other Devices, CENTERS for MEDICARE & MEDICAID SERVICES. You can read the whole document here. 

The passage is on Page 13 of the PDF.

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)

A reliable standard 3 in 1 commode is usually in the range of  $40 to $100.

The more specialized models with more features, such as padding and drop arms, will cost a bit more.

Models for larger individuals will be more costly due to the reinforcement of the frame, and the increased size of the commodes.

If you qualify for coverage from Medicare Part B for a bedside commode, you will be allowed to choose from a range of more basic models, but may have the option to pay the difference, should you desire something a bit more comfortable, or sophisticated.

Medicare will pay 80% of the Medicare-approved price, and you will have to cover the remaining 20% of your co-insurance.

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 commodes, 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.
 

Does Medicare cover raised toilet seats ?

Medicare Part B, typically, does not cover raised toilets seat for coverage in the home as they are considered to be a comfort item, and not “medically necessary”.

Medicare Advantage Plans, on the other hand, may do so – since the fall enrollment of 2020 the plans have been allowed to add extra benefits for individuals with chronic conditions, and this can include bathroom equipment. 

Does Medicare cover shower chairs ?

Medicare Part B does not typically cover shower chairs for use in the home, as they are considered to be a comfort item, and most importantly not “medically necessary”.

As I noted with raised toilet seats though, Medicare Advantage plans, which are run by private companies, and contracted to offer the same services as Medicare, have been allowed to offer some new benefits, and some plans may offer bathroom equipment such as shower chairs.

Does Medicare cover bathroom equipment ?

The bathroom is likely the room considered to have the greatest number of risks for the elderly, and it has just about the largest range of safety equipment available to it.

Sadly, Medicare Part B is not going to help much.

Medicare Part B will not typically cover what it considers to be comfort items, and that includes all the following –

• grab bars
• raised toilet seats 
• bath lifts
• shower chairs
• bath chairs
• transfer seats
• toilet safety frames

Original Medicare Part B will though typically cover crutches, walkers and bedside commodes, if they are “medically necessary”, and these pieces of equipment can help in the bathroom to reduce the risk of falling, and to lend stability to those who have mobility and strength issues.

For those with Medicare Advantage plans, as of the fall of 2020, some plans may cover some bathroom safety equipment due to the changes in extra benefits covered.

To find out which Medicare Advantage plans will cover some bathroom safety equipment, you will have to consult with an insurance agent in your state.

I have a long article, with 50 plus safety tips, that I have learned over the 11 years that I have looked after my mom and dad. These are both practical tips, and some suggestions for bathroom safety equipment that you may find helpful. You can read the article here.

If you are looking for suggestions and advice on how to make bathing easier for your parent, especially if you are assisting them, then I have another article discussing ways I have found useful to make it a more comfortable and dignified experience for all parties – that one is here. 

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 repeated use for a sustained period of time in the home environment, 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 Medicare Part B

Typical examples of the type of durable medical equipment that Medicare covers for use in the home are –

• wheelchairs
• walkers
• crutches
• 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
• gloves
• face masks

There are two exemptions to this –

1. the Medicare Home Health benefit does cover some medical supplies
2. 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, typically covered by Medicare

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 home bound and the pool is medically needed. If your loved one isn’t home bound, 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 typically 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

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 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

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 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 from 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 its 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 an opportunity 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”.

These 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 programs and 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

Spend Down

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 ?

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.

To find your State Medicaid State Agency

If you just want to talk to, or to email someone, contact your state Medicaid Agency here.

Step 1 –

Click the link to Medicaid.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 for veterans.

You can find out about your local VA Medical Centers, Clinics and offices with this link here.

Below are some 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
• Veteran 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.

What other financial assistance can you 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 homeowner
• 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 in case 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.