Does Medicare Cover Shower Chairs ?

by | Beginners Info, Health Care, Personal Hygiene, Safety

A fall in the shower could be fatal for your elderly parent, and a shower chair is an easy option is for extra safety. With so many different items needed for safety and caregiving, it can be difficult to find the money to pay for it all. And is Mom, or Dad’s, Medicare going to cover all these things is one of the first questions we ask.

Original Medicare Part will not cover shower chairs as they are not “medically necessary”, and are seen as both “convenience items” and as “for comfort” by Medicare. But there are sources of state funding are available, which will pay, or help to pay for bathroom safety equipment if you are eligible.

So does Medicare cover any bathroom equipment ?

Certain items that can be used as safey equipment in the bathroom are covered by Original Medicare Part B.

Walkers, crutches and commode chairs are all covered by Medicare Part B, and they can all be used in the bathroom to help with stability and safety.

Medicare doesn’t cover bath lifts, shower chairs, transfer seats or raised seats for the toilet, as it doesn’t consider these to be “medically necessary”.

So what can you do ?

My mom uses a walker sometimes instead of a grab bar to help her get in and out of the shower, as it can be re-positioned in so many ways.

Walkers can also be used as an aid to standing at a sink or infromt of a bathroom mirror,

If your shower is large enough you may be able to put a 3 in 1 portable commode chair in it (only if it is waterproof – you need one which states that all the parts are waterproof), which is just as easy to sit and wash on as a shower chair.

If a 3 in 1 commode doesn’t fit in the shower, it is perfectly easy to get your loved one to sit on the commode chair and help them wash there.

3 in 1 commodes come with side arms which means your loved one will have more stability when sitting down, and getting up – we have used ours in many situations with my mom, and to great effect.

3 in 1 commodes can also be placed over the toilet as a raised toilet seat, and can be placed without their seat as a toilet safety rail around your toilet. 

So what can you do ?

My mom uses a walker sometimes instead of a grab bar to help her get in and out of the shower, as it can be re-positioned in so many ways.

Walkers can also be used as an aid to standing at a sink or in front of a bathroom mirror,

If your shower is large enough you may be able to put a 3 in 1 portable commode chair in it (only if it is waterproof – you need one which states that all the parts are waterproof), which is just as easy to sit and wash on as a shower chair.

If you want to use a 3 in 1 bedside commode in the shower, and you want to know about the different types available, you can take a look at my article “Can a 3 in 1 commode be used in the shower ?” where I discuss the different commodes for the shower, including a type of commode called a “shower transport commode” which also doubles as a transport chair. There are also static shower commode chairs, but there are very few examples of these. The articles has lists of examples of the different types and their weight capacities so you can easily investigate

If a 3 in 1 commode doesn’t fit in the shower, it is perfectly easy to get your loved one to sit on the commode chair and help them wash there – the commode chairs are portable and can be placed anywhere.

3 in 1 commodes come with side arms which means your loved one will have more stability when sitting down, and getting up – we have used ours in many situations with my mom, and to great effect.

3 in 1 commodes can also be placed over the toilet as a raised toilet seat, and can be placed without their seat as a toilet safety rail around your toilet.

If your parent isn’t sure which type of bathroom safety equipment they require, I have an extensive article with 54 safety tips, that I have used over more than 11 years with my mom and dad, to make the bathroom a safer place. The article includes both practical tips, and certain products you may wish to look at. Just click here,

or if you are learning how to help and you just want to make bathing easier for your parent you may be interested in this article here which is all about making the bathroom situation more comfortable, less stressful and safer.

Here’s Medicare’s basic coverage criteria for equipment ?

For Original Medicare Part B medical equipment for use in the home comes under the category for “Durable Medical Equipment” or DME.

You will find an extensive list of Durable Medical Equipment covered by Medicare below. If you wish to got straight to the list click here.

For Medicare to consider an item as part of the category of “Durable Medical Equipment” it has to meet these basic criteria:

  • Durable (needs to be able to resist repeated use over a sustained period of time)
  • It be being used for a medical reason, as opposed to just for comfort
  • Not usually useful to someone who isn’t sick or injured
  • You must be using it in your home
  • Generally has an expected lifetime of at least 3 years

So when searching for equipment, if it doesn’t meet these criteria you probably won’t be able to get it covered by Medicare.

Medicare give examples of Durable Medical Equipment in its own publications as walkers, commode chairs, hospital beds or wheelchairs.

To find a Medicare-enrolled supplier in your area you can use this link at Medicare.gov

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 

How do my Mom, or Dad, get equipment for their home through Medicare ?

To be able to get any DME’s covered by Medicare Part B for the home your loved one needs –

  • to be enrolled in Original Medicare
  • to have a prescription signed by their Medicare-enrolled doctor stating that the equipment is medically necessary
  •  to get the DME’s through a Medicare-enrolled subscriber

If your loved one is claiming DMEs for their “home”, hospitals and skilled nursing facilities don’t qualify as a “home”, however they are covered under Medicare Part A (hospital Insurance).

A long stay care facility such assisted living can qualify as you loved one’s “home” for Medicare Part B. 

What does Medicare Part B consider to be a “home” ?

Medicare Part B considers the following to be a home –

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

What happens once you have the prescription ?

If Medicare agrees to cover the equipment,  your Mom, or Dad,  still need to meet their annual deductible (if they haven’t already) and their co-payment of 20% of the Medicare-approved price of the equipment. Medicare part B pays the remaining 80% of the Medicare-approved price.

Medicare will either buy, or rent, the equipment for your parent.

For cheaper items Medicare will normally purchase these, but in case of much more expensive items such as hospital beds, Medicare will rent the equipment on a monthly basis.

In the case of a rental by Medicare from a Medicare-approved supplier who accepts assignment, your loved one will need to pay a monthly co-payment of 20% the Medicare-approved rental price, and Medicare will pay 80% of the monthly rental.

Your parent will also have to meet their annual deductible if they haven’t done so yet.

How do I make sure my parent pays the lowest amount with Medicare ?

To get the coverage from Medicare Part B, and to pay the least amount yourself on any DME’s, once you have the prescription from a Medicare-enrolled doctor, you must make sure that you only purchase from a Medicare-enrolled “participating” supplier who accepts “assignment”. This way your parent will only have to pay the 20% co-pay of the Medicare-approved price of the item in question, and their annual deductible if they haven’t yet paid it.

So why is this the case ? –

The reason is that Medicare-enrolled Suppliers fall into two camps, and it really can change the price you pay if you choose the wrong supplier.

The two camps are –

  • Medicare Suppliers
  • Medicare “Participating” Suppliers

The difference is that –
Medicare “Participating” Suppliers have agreed to accept what is called “assignment” – this restricts the supplier to only charging the Medicare-approved price for any Durable medical Equipment.

This means that when your parent buys their DME’s from a Medicare-enrolled “participating” supplier, your parent will be paying the least possible amount – 20% of the lowest possible price, plus their annual deductible if they haven’t yet met that.

If my Mom, or Dad, doesn’t buy from a Participating supplier what happens ?

Buying DME’s from a supplier who is Medicare-enrolled, but not a “Participating” Supplier, means your supplier accepts payment from Medicare, but isn’t obliged to accept “assignment”.

The outcome for your loved one, is that the supplier is allowed to charge up to 15% on top of the Medicare-approved price for the item.

Medicare will then pay the supplier 80% of the Medicare-approved price of the item, and the supplier will be asking your parent to pay the difference between the Medicare-approved price, and their price for the item.

This payment is on top of paying the Medicare co-pay of 20% of the Medicare-approved price, and if they haven’t met it yet, their annul deductible.

Some states have legislation limiting the amount a supplier can add on to the price, such as New York State, where a supplier may only add on 5%.

What about skilled nursing facility residents ?

For those in hospitals or skilled nursing facilities, their Durable Medical Equipment is covered by Medicare Part A. The facilities are required to provide any medically necessary DME for up to 100 days. 

What happens if you have a Medicare Advantage Plan ?

For the Elderly with Medicare Advantage Plans (Medicare Part C) it’s necessary to check with the plan provider to see if their shower chair is covered.

All Advantage Plans are offered by private Medicare-approved companies, and have to provide the same coverage and services as Original Medicare Parts A and B as a minimum, by law, and often cover more – typically they have extra coverage benefits under their plans for hearing and sight.

It is also important to point out that Advantage Plan providers will usually require that you use the health care service providers and suppliers in their network.

What Durable Medical Equipment is covered by Medicare

For those who have Original Medicare Parts A and B here’s the list of Durable Medical Equipment generally covered.

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.

Corrective Lenses

Prosthetic Lenses
Cataract glasses (for Aphakia or absence of the lens of the eye)
Conventional glasses or contact lenses after surgery with insertion of an intraocular lens
Intraocular lenses

Important: Only standard frames are covered. Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare, no matter who submits the claim (you or your supplier).

Free assistance with understanding Medicare

SHIP – State Health Insurance Assistance Programs –

Your SHIP offers free guidance and advice on Medicare for anyone who needs some guidance.

SHIP is usually run as a phone service, but some state programs will also offer face-to-face appointments.

You can also get free advice on Medicare Advantage, Medigap and Medicaid benefits.

You can find your local SHIP by clicking on this link  hereand then follow the steps outlined below.

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.

Will Medicaid cover bathroom shower chairs ?

The system for Medicaid funding for programs is both federal and state funding. The result is that there are hundreds of Medicaid programs and waivers across the states, and they can vary quite widely as each state decides where they wish to put their funding.

 The elderly, the disabled, and low income families are the designated beneficiaries of Medicaid programs.

Medicaid, like Medicare, will also pay for “home medical equipment”, and very often covers 100% of the cost

To qualify for Medicaid coverage for “home medical equipment”, your loved one must be in –

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

Medicaid and state funded programs which support people in their homes

The programs are called Home and Community Based Services (HCBS) Waivers, or 1915 Waivers.

Most program’s allow for a good range of DMEs, and some cover more items than Medicare.

Some HCBS programs, or waivers, allow for what is called Consumer Direction.

The beneficiaries are allotted a budget and financial planning assistance. The recipient can allocate the budget in the ways they wish to cover their requirements. This means that the recipient may use the budget to purchase DMEs.

Another program, Money follows the person is for people who wish to leave nursing facilities, and to return to their homes, or to assisted living facilities.

The program will buy DMEs which are required for the individuals to do this.

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

The Spend Down Program

Spend-Down programs reduce a persons income their income level, so that they may qualify for Medicaid, HCBS’s and waivers.

The simplest method is to subtract a person’s medical bills from their income, and if subsequently their income level is below the Medicare limit, the person can apply for assistance from Medicaid based programs.

Not all states have a Spend-Down program, so check with your Area Agency on Aging, as not all states call their program Spend-Down.

A very good US NEWS article covers the topic here.

What is the process for purchasing items in these programs with Medicaid ?

The first step is to get the doctor, or therapist, to write a medical justification letter which states that the items in question are medically necessary.

The next step is to contact a DME Medicaid-approved supplier, and to furnish them with the medical justification letter.

The DME supplier then has to fill out a Prior Approval application.

Next, the Prior Approval document goes to the  Medicaid state office where it will be either approved, or denied.

If the application is denied, you will be notified as to the reasons why, and if you wish to, how to appeal the decision.

If a purchase is approved, the beneficiary will receive their item with nothing to pay.

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

The US government gives all states what is known as the State Grant for Assistive Technology Program, which is to be used by the state to build its own State Assistive Technology Program to improve access to assistive devices in the home, with a focus on the disabled and elderly.

State Assistive Technology Programs have at least the following services –

  • an online equipment exchange where state residents where people can register and post used assistive devices and medical equipment for sale, to donation or to exchange
  • a main program website which coordinates the program’s activities, lists upcoming events and ongoing projects, answers the public’s enquiries, and registers people who are eligible and need help
  • recycling, refurbishment and reuse centers which are either run by the state program, or community groups which they partner with, to provide free, or very low cost used equipment for disabled and elderly state residents
  • most have loan closets as part of their program, which can be either long term or short term

 

Assistive Technology Programs can also register individuals who need help, and will contact them when specific equipment becomes available.

To find to more about your State Assistive Technology Program go to their website.

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

There are non-Medicaid State Financial Assistance Programs, in some states, designed to make it possible for the elderly and the disabled to live in their own homes.

The programs will pay for assistive devices, safety equipment, durable medical equipment, and home remodeling, such as bathroom modifications, wheelchair ramps and kitchen modifications, with grants, loans or a combination of the two.

Contact your local Area Agency on Aging to find out if your state has any programs for the elderly.

Can you get financial assistance for  a shower chair, or other bathroom safety equipment, if you are a veteran ?

For those whose Mom, or Dad, are veterans, the Department of Veterans’ Affairs has different grants, programs and forms of financial assistance, which will cover the cost of items needed in the home.

Veterans receive healthcare under the VA Medical Benefits Package.

In the case of veterans, the law provides that the VA has to give eligible veterans hospital care and outpatient care services,  which are defined as “needed.” The VA defines “needed” as “a care, or a service, which promotes, preserves or restores health”.

You can find out about their local VA Medical Centers, clinics and offices in each state here.

Below are some of the different forms of financial assistance for veterans and their families –

  • Tricare for life
  • Tricare
  • Veterans Directed Home and Community Based Services – programs which have been designed to help veterans to stay in their own homes
  • ChampVA for Life 

Summary

Even though you can’t get shower chairs covered by Medicare Part B, you may be able to get them covered if you have a Medicare Advantage plan.

If your shower is large enough, Medicare does cover commode chairs if they are “medically necessary”, and if you can get a portable commode, shower commode, or shower transport commode it is just as stable as a shower chair.

There are also possibilities of getting shower chairs with –

 

  • Medicaid state HCBS programs, waivers and 1915 waivers
  • non-Medicaid State Financial Assistance Programs for the elderly
  • State Assistive Technology Projects
  • VA Medical Benefits Package

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 shower chairs ?
Description
Medicare does not cover shower chairs as they do not consider them to be medically necessary. However there are alternatives to a shower chair which are covered, and there are also alternatives to Medicare that you may qualify for, which will cover a shower chair.
Author
Publisher Name
Lookingaftermomandad.com