Does Medicare Cover Raised Toilet Seats ?

by | Beginners Info, Health Care

Raised toilet seats will, for a lot of elderly people, become a pretty standard and wonderfully helpful, piece of equipment, if mobility, stiffness and balance start to become an issue in their lives. And in particular, if like my mom, your parent has a hip, or knee replacement, you will find out just how much of a relief it will be to them, both in terms of pain and in worry/stress relief.

Medicare Part B does not give cover to raised toilet seats, but it will cover a portable bedside commode, if you qualify, and which can be used as a raised toilet seat. If you have Medicare Advantage Plus, Medicaid, if you qualify for a state waiver or HCBS program, are a veteran, or qualify for a non-Medicaid state financial assistance program you may be eligible for any type of raised toilet seat.

Why does Medicare only cover certain bathroom safety equipment ? And which is that ?

Original Medicare Part B will not cover any items which it considers to be just for comfort, as it does not consider them to be “medically necessary”.

To this end, Medicare will not cover raised toilet seats, bathtub lifts, grab bars, non-slip mats, toilet rails, transfer seats or shower chairs.

You are in luck in though, as Original Medicare Part B will cover walkers, commode chairs and crutches, as long as you can prove it is “medically necessary”. And a  portable bedside commode can work very well as a raised toilet seat in your bathroom.

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 here – Medicare.gov.

Walkers are also advised to be used with raised toilet seats, to help with stability when sitting down, or getting up from the toilet, so as long as you can prove they are “medically necessary” you may be able to get these items.

I have an article all about how to use a bedside commodes 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 ?”

If you want to know more about other pieces of safety equipment that you may need for your loved one in the bathroom, I have a long article with many bathroom safety tips and devices, that I have researched for my mom and dad. The article is a mix of over 50 safety tips and items that you may wish to look at. You can find it here.

Or, if you are learning how to help your parent with washing themselves, you may be interested in this article here, where I talk not only about bathing, but about how you, and your elderly parent, can get comfortable with the situation of helping, and of being helped. There’s a lot to learn.

How does Medicare choose which pieces of equipment to cover ?

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

Further on, I have made a list of Durable Medical Equipment covered by Medicare. If you would like to go straight to it just click here.

For an item to be qualify as “Durable Medical Equipment” it has to meet some basic Medicare criteria:

  • Durable (it has to be 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 individual 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 equipment does not fulfill these criteria you most likely will not be able to get it covered by Medicare.

The examples of Durable Medical Equipment which Medicare gives 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 does my parent get their Medicare covered DME ?

For any item your loved one purchases to qualify as DME for Medicare coverage, your loved one will need –

  •  to be enrolled in Medicare Part B
  •  a prescription signed by their Medicare-enrolled doctor stating that the equipment is a medical necessity
  • to buy the DME through a Medicare-enrolled supplier

What does Original Medicare part B consider to be at home ?

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

A hospital, or nursing home, cannot qualify as a “home” for Medicare Part B, however they will be covered under Medicare Part A for any DME they need when in a nursing facility.

A long-term care facility, such as assisted living can qualify as a “home” for Medicare part B.

What pitfalls are there to avoid with Medicare ?

So that you ensure that your parent is paying the least amount possible, their DME supplier must be Medicare-enrolled “Participating” supplier who accepts “assignment”.

This ensures that they are paying the lowest possible price for the item – that being the Medicare-approved price.

What is the reason for this ?

Medicare enrolled suppliers are either

  • 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.

And if my parent’s supplier is not a “Participating” Supplier what happens ?

A Medicare-enrolled supplier who is not a “Participating” Supplier –

  • has agreed with Medicare to accept payment from Medicare for DME at the Medicare-approved price
  • but can sell the DME for up to 15% more to your parent

This means –

  • Medicare will pay the supplier their 80% of the Medicare-approved price for your parent’s DME
  • and your parent ends up paying their 20% co-pay of the Medicare-approved price for their item + the difference between the Medicare-approved price, and the price the supplier is selling the equipment at
  • And your parent will have to pay their annual Medicare deductible if it applies

 

So make sure your parent uses  a Medicare-enrolled “Participating” Supplier, and always asks if the supplier accepts “assignment”.

Once your parent has the prescription, what’s next ?

Your parent will need to pay their annual deductible (if this hasn’t already been met) along with a co-payment equal to 20% of the Medicare-approved price of the equipment being purchased. Medicare is then responsible for covering the remaining 80% of the Medicare-approved price.

With less expensive equipment Medicare will usually purchase the items outright, but with substantial purchases such as hospital beds, it is more common that they will rent a hospital bed on a monthly basis. 

If your parent’s equipment is rented by Medicare, from a Medicare-approved “Participating” supplier who accepts “assignment”, your parent will be responsible for a monthly co-payment of 20% of the Medicare-approved rental price.

What happens if your parent is being treated in a Skilled Nursing Facility ?

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 take care of supplying any DME needed for up to 100 days.

What about Medicare Advantage ?

Medicare contracts private companies to provide Medicare Advantage plans, and they must, by law, provide at least the same services and coverage as Original Medicare Parts A and B.

In some instances they provide more coverage than Medicare.

Advantage Plan providers will require participants to use their network suppliers, and if they don’t, they may find themselves footing the whole bill for their DME. 

Durable Medical Equipment normally 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.

And these are the 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 assistance with understanding Medicare

State Health Insurance Assistance Programs – SHIP

Your State Health Insurance Assistance Program, or SHIP offers free guidance on Medicare.

SHIP also offers free advice on Medicare Advantage, Medigap and Medicaid benefits.

To contact your SHIP click on this link  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 

Step 3 –

Pick your state and click on it.

Step 4 –

A window will open with the contact info and a phone number for you to call in your state.

If you don’t have Medicare, will Medicaid cover raised toilet seats ?

Medicaid functions differently from Medicare, as it is federal and state funded. Each state runs its Medicaid program in its own way, within the guidelines set out by the government.

This has led to there being differences from state to state, as to what can be covered by Medicaid.

A state will have Medicaid State Plan, and more often than not it will have Home Community Based Services (HCBS), or waivers (also Medicaid).

Each of these will have their own eligibility, criteria and goals, and it has resulted in hundreds of programs and waivers for Medicaid across the US.

So what can be considered as durable medical equipment can vary from program to program, let alone from state to state. 

Medicaid and state programs for in the home

Medicaid for home care, is called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”.

All of these exist, and operate, to help the participants to maintain their independence in their own home, providing the care and services required, which includes paying 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 allow for a wider range of DME for the home than others

There are HCBS programs, or waivers, which allow for what has been named Consumer Direction/ Self Direction.

A participant in the program is designated funding, or a specific budget, for living in their home.

The participant, with the help of a financial planner, will manage the use of the funds across their specific needs.

Durable medical equipment can be purchased as part of their living needs.

Items such as bathtubs, grab bars or shower chairs, which do not qualify as durable medical equipment under Medicare, if considered medically necessary, and within the beneficiaries allotted budget, may be purchased on some of these programs or waivers.

To find out more about Medicaid Self Direction click here.

Medicaid originally developed a program called Money Follows The Person to help the elderly to make the transition from nursing homes back to their own homes, and to reduce the numbers of elderly in state nursing homes.

Now, Medicaid funds the individual states to set up their own Money Follows The Person programs – this can be designing a whole new program from the ground up, or taking an existing program and adapting it.

Durable medical equipment which is considered to be necessary for the beneficiaries to relocate to their homes is bought by the program.

What is considered durable medical equipment, is again less restricted than that covered by Medicare.

To see what HCBS or Waiver programs there are available to your parent, and what the eligibility criteria are, you will need to check with your state.

All of the Medicaid programs are intended for those families with the lowest income, the elderly and the disabled.

What if your revenue is too high to qualify for Medicaid ?

The Spend Down Program

Spend-Down programs were developed so that individuals who earned a bit too much to qualify for Medicaid have a way of lowering their income and thus qualifying for Medicaid programs and waivers.

The method that is of interest here, is to subtract a person’s medical bills from their income, and if their  income level then falls below the eligibility limit for Medicaid, the person will then be allowed to apply for assistance.

It isn’t present in any state, and can be called by different names, so check with your Area Agency on Aging to see if you have the program or a similar one in your state.

You will find a good article on the subject by US NEWS here.

How to go about purchasing items 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 form the doctor, or therapist.

Step 3

– the 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.

Looking for HCBS programs, waivers and 1915 waivers and their eligibility criteria in your state

To find what is available in your state click here.

Step 1 –

Find your state on 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 the example below, with the programs and waivers in your state, and their eligibility criteria.

To find your State Medicaid State Agency

If you want to discuss things, or to email someone, you can contact you state Medicaid Agency here.

Step 1 –

Click the link to Medicade.gov and look for the section that I have 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.

State Funding Assistance

Assistive Technology Programs

State Assistive Technology Programs are present in all states thanks to a national grant.

The program has been designed to improve access to assistive devices in the home primarily for the elderly and the disabled.

Your  State Assistive Technology Programs typically provides the following services  –

  • an online equipment exchange for state residents on which you can register and participate – donating, selling and buying used devices and equipment
  • a main program website which outlines the program’s services, contacts, events, and answers specific questions individuals may have
  • reuse, recycling and refurbishment programs and centers, often run with community partners, to provide free, or extremely low cost, equipment for the disabled and the elderly
  • long and short term loan closets, or both

 

Your state Assistive Technology Program will, if you contact them, let you know when specific equipment becomes available.

All the information is to be found on the State Assistive Technology Program websites, and I have added a link below.

But, just to say if you have a problem navigating the your state’s website, and it can be a bit difficult with some, go to my article about donating equipment, and I have listed the different equipment exchanges and program centers in as many states as I could find – “Where can I donate a shower chair ?” – the part you will want is the list of states in the second half of the article.

To see what projects are in your state click here

Follow the steps below to see the projects in your state

 

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 register, or use their contact info .

State Financial Assistance Programs

State Financial Assistance Programs don’t exist in all states, but where they do, they provide loans and grants, or both, to help the elderly and disabled populations to maintain an independent living in their own homes.

The programs will help with purchasing Assistive Technology devices, medical equipment, and if it is needed so the participant can remain in their home, remodeling of rooms, and adding elements such as wheelchair ramps.

Local Area Agencies on Aging will be able to tell you if your state has a program, and if you can apply.

    How to get a raised toilet seat 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, or your parent, can find out about their local VA Medical Centers, Clinics and offices in each state at this link here.

    Below are just some of the different forms of assistance available if your parent is a veteran.

    •  Grants for remodeling homes due to disabilities inflicted during military service
    • Veterans Direct HBCS where the beneficiary allocates the budget to their specific needs
    • Veterans Pensions – certain pensions will allow for the purchase of equipment that veterans need for their homes

    All the above will pay for bathroom safety equipment, including raised toilet seats.

    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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    Article Name
    Does Medicare cover raised toilet seats ?
    Description
    No, Medicare does not pay for most forms of raised toilet seat, but it will pay for a portable bedside commode which can be used as a raised toilet seat. If you have Medicare Advantage Plus, Medicaid, if you qualify for a state waiver or HCBS program, are a veteran, or qualify for a non-Medicaid state financial assistance program you may be eligible for any type of raised toilet seat.
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    Lookingaftermomandad.com