Does Medicare cover grabbers ?

by | Beginners Info, Health Care

As far as I can remember I think we have had several grabbers floating around the house for my elderly mom’s use. They are just so practical, and make so many tasks easier while also eliminating a lot of reaching forwards which can lead to nasty falls.

Does Medicare cover grabbers ? Medicare Part B does not cover grabbers for use in the home. Medicare does not consider grabbers to be “medically necessary”. Other programs such as Medicaid, non-Medicaid State Financial Assistance Programs and Assistive Technology Projects may pay for grabbers, if you are eligible.

Like so many useful items that our elderly parents use, the grabber doesn’t fit the bill (literally) with Medicare because their criteria for coverage is not that an article be useful, or that it keeps us comfortable, but that it is “medically necessary”.

There are two things that you have to take into account if an item is going to qualify for coverage by Medicare, apart from you needing to be enrolled in Medicare in the first place –

  • is your item in the category of equipment covered by Medicare – Durable Medical Equipment ?
  • is the item “medically necessary” in your case ? – only a Medicare-enrolled doctor can decide this by following the Medicare Part B guidelines

And don’t forget this is only for items which are to be used primarily in the home.

 

So what bathroom safety equipment does Medicare cover ?

You may be surprised to discover that Medicare will not cover grab bars, non-slip mats, bath lifts, shower chairs, transfer seats or raised seats for the toilet, as it views all of these items to be comfort items, and not to be “medically necessary”.

But luckily Medicare will cover walkers, crutches and commode chairs, and they can all be used in the bathroom as safety equipment to help protect our elderly parents and loved ones from the risk of falling.

What to do if your equipment isn’t covered by Medicare ?

If you only have Medicare and you don’t qualify for any other funding, you are going to have to improvise.

In our home we have a 3 in 1 bedside commode, and we have been able to use this as a raised toilet seat, a chair for sitting and having a sponge bath, a toilet safety rail and also as a bedside commode of course.

If your parent has a large enough shower you can use a bedside commode as a shower chair as well.

Rather than have grab bars my mom will sometimes put a walker where she is going to have to stand a while, or to help her get up if she feels she is going to be a bit stiff – I am referring to a walker without wheels (a zimmer frame). My mom also uses it to help her up a little step in the shower and back down again afterwards.

Before her hip replacement surgery I had bought a raised toilet seat for my Mom, but she found the 3-in-1 bedside commode placed over the toilet to be much more comfortable. Getting on and off using the arm rests also proved much easier than getting up from a raised toilet seat without them.

Don’t worry if you can’t get your equipment covered under Medicare, there are other sources of funding which can even get you quite large equipment, such as walk in bathtubs or showers with roll-in low thresholds,  for which you or your loved ones may qualify.

If you have to totally remodel your bathroom there are even grants, or programs, which will pay for this if it is for health reasons !

But before I start to talk about those, I want to continue and outline the Medicare purchase process, and the types of equipment you can get when it is “medically necessary”.

If you can’t wait and want to see the other sources of coverage and funding, click here

If you are not sure what type of bathroom safety equipment is available for you, or for a loved one, I have a long article with 54 safety tips that I have researched, and mostly tried and tested over the years for my mom and dad. It includes both practical tips, and a range of items you may wish to look at – I have not tried them all, but that doesn’t mean that they are not useful. You can find that here.

If you are struggling with, just starting to learn how to bathe a parent you, or  just want to make bathing easier for your parent, then you may be interested in this article here. 

Does Medicare cover bed rails ? 

Medicare will not cover bed rails for a standard bed, however Medicare does cover hospital beds which come with side rails.

If you or a loved on have a prescription stating that it is “medically necessary”, you can get a hospital bed with bed rails.

Medicare will pay for a basic hospital bed, which is not fully electric. If you wish to have a fully electronic bed you can though pay the difference to get one.

Medicare negotiates with suppliers to obtain a certain price for certain beds, so those models of beds are going to be the ones covered by Medicare.

For this reason it’s important to stick to the correct procedure if you want to be covered.

You may be able to get a hospital bed or bed rails with Medicaid and other sources of state funding which I will be outlining further ahead. 

For my mom I did quite a lot of research into bed rails and their alternatives, as I discovered they are not suitable for certain individuals . Even if you are eligible you may want to re-think bed rails as they have caused a significant number of deaths in at risk groups over the last 30 yrs. I wrote an article outlining some perfectly good and ultimately safer options.

You can read my article here

How often does Medicare pay for a walker ? 

Typically, Medicare Part B will replace equipment it covers, and which is worn out, once every five years from the date that it was received by the beneficiary.

So a walker with Medicare Part B coverage can typically be replaced every five years if it is worn out beyond repair, that is unless it has been lost, stolen or damaged beyond repair.

Equipment covered by Medicare which is lost, stolen or damaged beyond repair, may be replaced – Medicare will require that the beneficiary provide proof of the accident or damage.

The replacement item will be identical, or as near as is possible to the item that is being replaced.

Source: Medicare coverage of Durable Medical Equipment and Other Devices, CENTERS for MEDICARE & MEDICAID SERVICES.

You can read, or download, the original Medicare document here. 

The passage above is on Page 13 of the pdf.

How does Medicare decide, and then classify, which equipment it will cover ?

Medical equipment which Medicare gives coverage “for use in the home” to is classified under a category termed “Durable Medical Equipment” or DME’s.

Further along in this post I have compiled a long list of items which Medicare classifies as  Durable Medical Equipment and which are typically covered “for use in the home”. If you want to look at that now click  here.

For Medicare to qualify an item for home use as Durable Medical Equipment Medicare has to be satisfied that it fulfills their following criteria –

  • it’s got to be able to withstand repeated use over a sustained period of time – durable
  • it’s got to be used for a medical reason only – not for comfort
  • it’s got to be of use to someone who is actually sick, and of little use to a person who is well
  • it is going to be used primarily in the home
  • it’s expected to last a minimum term of 3 years

How do you, or your loved one, qualify for Medicare coverage for your DME’s ?

For someone to qualify for Medicare Part B coverage of DME’s “for use in the home”, they have to  –

  • have to be enrolled in Medicare Part B
  • have a signed prescription from their Medicare-enrolled doctor stating that the equipment is “medically necessary” 
  • purchase the equipment from a supplier who is a Medicare-enrolled supplier

To qualify as living at home, you can be –

  • living in your own home
  • living in the family home
  • living in the community, such as assisted living

If you, or your loved one, are staying in a skilled nursing facility this does not qualify as a home for Medicare Part B coverage. You will be covered under Medicare Part A – Hospital Care.

In  Skilled Nursing Facilities the coverage for DME’s is handled differently – they are provided for for up to 100 days by the nursing facility itself.

 

What happens once you have the signed prescription for your DME ?

After you have seen your Medicare-enrolled doctor and you have the order/prescription, the next step is to go see a Medicare-enrolled DME supplier, where you can choose your item.

The range of models for your particular item will most likely be pretty limited, and only the basic models.

There will be more forms to fill out with the supplier so that they get paid to get paid by Medicare.

With the prescription from a Medicare-enrolled doctor, Medicare part B will cover 80% of the Medicare-approved price for your item.

You, or your loved one, will usually pay the Medicare 20% co-payment of the Medicare-approved price of the item (unless you have supplemental insurance which covers co-pays), if you used a Medicare-enrolled “participating” supplier who accepts assignment.

Be warned if you didn’t use a Medicare-enrolled “participating” supplier who accepts assignment you can end up paying a lot more !!! More about that in a moment.

There will also be your Medicare deductible to pay, if it hasn’t already been met for the year in question.

Medicare will either purchase or rent DME’s

For smaller less expensive items Medicare will usually purchase them.

Typically though, Medicare rents the more expensive equipment from their DME Medicare-enrolled suppliers on a monthly basis.

If you chose a Medicare-enrolled “participating” supplier who accepts “assignment” there will only be a monthly co-payment of 20% of the Medicare-approved rental price, and again the deductible if it has not been met.

How to avoid over-paying the supplier ?

You, or your loved one, must choose a Medicare enrolled “participating” supplier  who accepts “assignment” so that you avoid paying any extra.

This way you know the DME is purchased, or rented, at the Medicare-approved price, and that you, or your loved one, will only pay the 20% co-payment and your deductible if it applies.

So, what happens if you don’t use a Medicare-enrolled “participating” supplier ?

Medicare has two types of enrolled suppliers –

  • Medicare Suppliers
  • Medicare “Participating” Suppliers

Medicare “Participating” Suppliers, have an arrangement with Medicare which says they will accept what is called “assignment”.

This is crucial because it means that they allowed to charge more than the Medicare-approved price for  DME’s.

A suppliers who is not “Participating” can charge any price for equipment that they like.

Medicare will pay only the Medicare-approved price, leaving you, or your loved one, to pay the difference between the Medicare-approved price and the supplier’s price, plus the co-payment and annual deductible (if it applies).

If the supplier is a Medicare-enrolled “participating” supplier you will get the best price. Do always make sure that they accept “assignment”.

What coverage do you get with Medicare Advantage Plans ? 

With enrollment in a Medicare Advantage Plan you are covered for all the same medical services, supples and equipment that Medicare Parts A and B cover, and sometimes a few extra services.

You will need to contact your Advantage Plan provider to find out about their exact process for buying items with coverage, the doctors they work with their supply network.

Using doctors and suppliers outside of your plans network will usually lead to a loss of coverage for any items you buy.

 

Finding a Medicare-enrolled DME Supplier near you

To find a local Medicare supplier check this here at Medicare.gov

Durable Medical Equipment generally covered by Medicare if you qualify

If you don’t find the equipment you are looking for in my list of  Medicare covered DME’s below, you can use this link to Mediace.gov 

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.

Prosthetic and Orthotic Items

Orthopedic shoes only when they’re a necessary part of a leg brace
Arm, leg, back, and neck braces (orthotics), as long as you go to a supplier that’s enrolled in Medicare
Artificial limbs and eyes
Breast prostheses (including a surgical bra) after a mastectomy
Ostomy bags and certain related supplies
Urological supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.

DME’s usually 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

Get free assistance with understanding Medicare

If you are having trouble understanding Medicare you can get free help at SHIP – State Health Insurance Assistance Programs.

SHIP is a free state counseling service for people to talk to someone to help them understand Medicare, Medicare Advantage, Medigap and Medicaid benefits.

It is generally a phone service, but some may offer face-to-appointments as well.

To find local Medicare help click here

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

Step 1 –

After you have clicked on the link you will arrive here –

Step 2 –

Click on one of the two buttons to find your state – they both lead to the same menu to choose your state

Step 3 –

Pick your state from the list and click on it

Step 4 –

The screen will open a window with the contact info and a phone number for you to call, in your state, to speak with a counselor.

Will Medicaid cover grabbers and bathroom safety equipment ?

Medicaid is funded both on a federal level and at individual state level, and is very different from Medicare.

Each state, as long as it keeps within the basic Medicare guidelines, can have quite a lot of latitude in how to allocates the funding it has.

A state can have multiple programs where Medicaid agrees to waive certain requirements for eligibility, so that the state can provide care to those who need it, and who might otherwise be missed by the system because they were otherwise not eligible. 

These programs are known as waivers and will have specific eligibility requirements, and may have a limited number of places as well.

The waivers may vary greatly between states, and there are many different ones for working with people in their homes and in the community, trying to help them to maintain their independence.

Due to the hundreds of different waivers across the US, what is considered Durable Medical Equipment will very widely, and not only from state to state, but also across the different waivers within the one state.

 

Medicaid and state programs and waivers for care services in the home

 

Programs which have been designed to help individuals live independently in their homes, and in the community, by providing the care they require are called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”.

Such programs are primarily for low income families, disabled individuals and the elderly with specific medical needs.

For more indepth infromation than I can provide here on the HCBS programs or waivers, you can use the link below to medicaid.gov –

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

The programs/waivers, that I have been briefly outlining, will pay for “home medical equipment”, and will often cover 100% of the cost of that equipment in order to help the beneficiaries maintain they independence in their homes.

The term “home”, for the beneficiary, can  –

  • their own home
  • their family home
  • a group home
  • an assisted living facility
  • a custodial care facility

Certain programs and waivers may have a larger range of items they consider to be DME’s for home use

“Consumer Direction”or “Self Direction”

 If an HCBS program, or waiver, implements “Consumer Direction” or “Self Direction” as a way of managing the funding of the project, the program beneficiaries are each given a budget to cover their needs. Each participant is also appointed a financial advisor to help them manage their budget.

The advisor is going to help the beneficiary to use the money to cover what they need and to help them to maintain their independence in their home.

In these circumstances the items bought can extend to all manner of bathroom safety equipment and other devices not available as DME under Medicare coverage, as long as they are needed.

To find out more about Medicaid Self Direction click here

Helping the elderly return to their homes

 

Money follows the person – is a Medicaid based program designed to assist elderly adults in making the transition back from nursing facilities into their homes.

For this program assisted living can be considered as “their own  home”.

If certain medical equipment  is necessary for the participant to be able to make the move, it is purchased by the program.

As with a lot of the waivers, what may be considered a DME is often very different from that which is allowed with Medicare.

Even remodeling parts of the home, if it is necessary before the participant can make the transition, is paid for by this program. 

If you don’t quite qualify for Medicaid

Some states have a program called Spend Down.

Spend Down is a program, unfortunately not available in all states, which allows your in different ways to reduce you income so that you qualify for Medicaid Benefits.

The system is designed so that if you’re are not eligible for Medicaid benefits because you have too high a level of income, or assets, there are a number of ways that are allowed for you to reduce those, so that you can become eligible.

One of the ways is to subtract your medical bills from your income, and if you fall below the Medicaid income limit you will be eligible for Medicaid benefits.

I have grossly simplified Spend Down here, but you can read a very in-depth article on the US NEWS website here.

How do you get DME’s with Medicaid waivers and HBSC programs ?

Step 1

– the doctor, or therapist, has to provide a medical justification letter, which states that the equipment is medically necessary

Step 2

– you or your loved one have to find a DME supplier who is Medicaid-approved, and to give to them the medical justification letter

Step 3

– the DME supplier then fills out a Prior Approval Application for Medicaid

Step 4

– the document is then sent to the Medicaid State Office for approval or denial

Step 5

– if you or your loved one are unsuccessful you will be notified as to the reasons why, and given advice on how to appeal the decision

Step 6

– if approved you or your loved one will receive the DME

How to find the HCBS programs, waivers and 1915 waivers in your state

Click on the link below will it take you to CMS.gov (CENTER FOR MEDICARE AND MEDICAID SERVICES) to look at the different “HCBS programs”, “waivers” and “1915 waivers” offered by your state and Medicaid.

Once you select your state on the map, it will show you a section with your state waivers and programs, and also their criteria for eligibility- click here.

Step 1 – Find your state on the map.

Step 2 – Click on you state – I gave N.Dakota as an example

Step 3 – You will come to your state and it’s list of available resources, and here you can choose

 

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

Below is an example of the type of page you will get if you click on the HCBS programs and waivers link.

You will be able to find out what programs and waivers there are in your state, and what the eligibility criteria are.

How to find your State Medicaid State Agency

If the documents on the link above are too technical I wouldn’t waste your time. I would contact your state Medicaid Agency, and you can do that here.

Step 1 – Once you have clicked the link to Medicade.gov, look at the section I have outlined in the image below

Step 2 – select your state, and click on the button they have marked “GO” – it will take you to your State medicaid Agency.

I there any other state financial assistance for DME’s

Assistive Technology Projects

Every state receives a national grant  to be used in “Assistive Technology Projects”. The projects are there to increase access to assistive devices in the home for those who are in need of them – the elderly being one of the primary focus groups.

The terms “Assistive Technology” and “DME” are synonymous for these purposes.

You, or your loved one, would need to contact the State offices to find out if they are eligible and how to apply.

Find out what projects your state runs here

Step 1/

Select your state on the map or from the drop down menu and click on the button “Go to state”

– I chose Florida for this example

Step 2/

Look for the link “Program Title” – for my example I outlined it in red – and click on that.

Step 3/ 

The state AT Project website will come up, and you can sign up or use ther contact info to get in touch and find out what they offer to help the elderly, and if you or a loved one are eligible.

State Financial Assistance Programs

These are non-Medicaid programs, which have been set up to lower the number of elderly persons entering Medicaid run nursing homes.

The programs are designed for the elderly to remain living in their homes – not all states have them.

Home modifications and purchases necessary equipment, which includes bathroom safety equipment and walk in tubs and showers are all paid for by the programs.

Eligibility for the programs varies, but they are typically focused on the elderly and the disabled.

    Protection and Advocacy Programs

    Each state has legal services providing assistance to the elderly in disputing their denied claims.

    Summary 

    You cannot get grabbers, and many other aids covered by Original Medicare Part B for “use in the home” if Medicare doesn’t consider they are “medically necessary”.

    On the occasion that Medicare Part B will cover your DME, don’t forget before purchasing to ask the supplier if they are a Participating Supplier who accepts “assignment”.

    Even if Medicare won’t cover your grabber or some other type of equipment for the home, check that you don’t qualify for Medicaid or one of the other non-Medicaid state funded programs.

    If you are spending a lot on Medical supplies, take a look at “Spend-Down”, or one of it’s other names, and see if you can qualify for Medicaid.

    Medicaid state programs in many cases accepts a broader range of equipment as DME and will often pay 100% of the cost.

    Good luck !

    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

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    Does Medicare cover grabbers ?
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