Does Medicare Cover Walk In Bathtubs ?
For our elderly parents stepping in and out of a bathtub can present great difficulties and risk, even if they are in relatively good shape. For many the ideal solution is going to be a walk in bathtub, where there is at least little to no risk of tripping over. But the same cannot be said for the cost, which can also leave you feeling wounded !
Does Medicare cover walk in bathtubs ? Original Medicare does not, as a rule, cover walk in bathtubs. However, Medicaid, Veterans Benefits, rural funding, state waivers and non-medicaid state financial assistance plans for the elderly can cover bathroom equipment and remodeling.
Is there any bathroom safety equipment covered by Medicare ?
Medicare will cover bathroom equipment which is “medically necessary”. You may even in extreme cases, if a doctor can persuade Medicare, be able to get Medicare to reimburse you for part of a bathtub purchase, but it is not in their policy to do so.
For home use Medicare covers walkers, crutches and commode chairs under Medicare Part B, each of which can be used in the bathroom to give extra stability.
Medicare won’t cover bath lifts, transfer seats, grab bars, matts, shower chairs or raised seats for the toilet, as it consider these to be comfort items.
What is Medicare’s criteria for covering equipment ?
Medicare Part B classifies medical equipment for use in the home as “Durable Medical Equipment” or DME’s.
Below is a list of Durable Medical Equipment covered by Medicare, to go straight to the list click here.
For an item to be in the category of “Durable Medical Equipment” it has to meet these criteria:
- Durable (must be able to withstand repeated use overtime)
- It can only be used for a medical reason, as opposed to just for comfort
- Not normally of use to someone who isn’t sick or injured
- You have to be using it in your home
- Should have an expected lifetime of at least 3 years
If the equipment you wish to purchase does not meet these basic criteria, you will likely not get coverage from Medicare Part B.
In their published literature Medicare gives examples of Durable Medical Equipment as walkers, commode chairs, hospital beds and wheelchairs.
If your parent wants to try to get their walk in bathtub covered, what must they do ?
To qualify for Medicare coverage for DME your loved one will need –
- be enrolled in Medicare Part B
- a signed prescription from their Medicare-enrolled doctor which states the item is medically necessary
- buy the DME’s through a Medicare-enrolled supplier
If your loved one is claiming for coverage for DME’s in their “home”, a hospital or nursing home cannot qualify as their “home” for Medicare Part B, however they are covered under Medicare Part A.
Long term care facilities in the community, such as assisted living facilities do qualify for Medicare part B.
What does Medicare Part B qualify as a home ?
- your own home
- a family home
- living in the community, such as assisted living
Once your parent has their prescription what do they do ?
If Medicare accepts to cover your loved one’s purchase, your loved one will have to pay their co-payment of 20% of the Medicare-approved price of the item and their annual deductible (if it hasn’t already been met).
Medicare will pay the remaining 80% of the Medicare-approved price.
For cheaper DME’s Medicare will usually purchase the products, but in cases such as hospital beds where the items are much more costly, it is more likely that Medicare would rent on a monthly basis.
If the equipment is rented by Medicare from a Medicare-approved supplier who accepts assignment, your loved one will pay a monthly co-payment of 20% of the Medicare-approved rental price, and Medicare will pay the other 80% of the Medicare-approved rental price.
What to do so that your loved one avoids over-paying with a Medicare purchase ?
If you want your parent to pay the least amount possible for their DME, you must make sure that your loved one uses a Medicare-enrolled “Participating” supplier who accepts “assignment”.
This ensures that your parent is only going to pay their Medicare co-pay of 20% of the Medicare-approved price, and if they haven’t already met it, their annual Medicare Part B deductible.
And why is that ?
There are two types of Medicare-enrolled suppliers –
- Medicare Suppliers
- Medicare “Participating” Suppliers
And the difference between the two is –
Medicare “Participating” Suppliers have agreed to what is known as “assignment” – this means that they are only allowed to charge the Medicare-approved price .
So when your loved one buys their durable medical equipment from a Medicare “Participating” Supplier, they will be paying the least possible amount, that is – a 20% co-payment of the Medicare-approved price for the equipment, and if they have not yet met it, their annual deductible.
And if they don’t use a Medicare “Participating” Supplier ?
A Medicare-enrolled supplier who is not a “Participating” Supplier, agrees to take payment from Medicare, but doesn’t have to accept “assignment”.
This means that the supplier is free to charge up to 15% more than the Medicare-approved price for an item, and that excess is passed on to the buyer.
Medicare will pay the supplier 80% of the Medicare-approved price, and your parent is going to have to pay the supplier the difference + their 20% co-pay of the Medicare-approved price + their annual deductible if they haven’t yet met it.
So, if the supplier’s price for a DME is 60$ above the Medicare-approved price, your parent will have to pay their co-pay + their deductible + the 60$ !
What if your loved one is being treated a skilled nursing facility ?
If your loved one, is is recieving care in a Skilled Nursing Facility or hospital, all necessary medical equipment is covered by Medicare Part A (Hospital Insurance). The facility is required by Medicare to provide any DME needed for 100 days.
What do you do if your parent has Medicare Advantage Plan ?
Medicare Advantage plans are run by private Medicare-approved companies to provide at least the same Medicare services as Original Medicare Parts A and B. This is a legal minimum obligation.
Advantage Plans may offer extra benefits that are not part of Original Medicare Parts A and B.
You must also be aware that Medicare Advantage Plan providers will want your parent to use their network doctors and suppliers, or they may find themselves footing the whole bill for their DME.
Durable Medical Equipment usually 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
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
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)
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Cushion Lift Power Seat
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Infusion pumps and supplies (when necessary to administer certain drugs)
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mobile Geriatric Chair
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)
Postural Drainage Boards
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Urinals (autoclavable hospital type)
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.
Free assistance with understanding Medicare
SHIP – State Health Insurance Assistance Programs –
SHIP will give you free guidance and advice on Medicare.
You can also get free advice on Medicare Advantage, Medigap and Medicaid benefits from SHIP.
To find your local SHIP click on this link here
How to contact a SHIP counselor in your state, step by step
Step 2 –
Click on one of the two buttons to find your state
Step 4 –
A window will open with the contact info and a phone number for you to call in your state.
Does Medicaid cover bathroom walk in bathtubs ?
The funding for Medicaid programs is both federal and state level funding. A state can have a number of different Medicaid programs and waivers, each with different eligibility guidelines, resulting in hundreds of programs for Medicaid across the US.
Medicaid in skilled nursing facilities and hospitals
In hospitals and skilled nursing facilities the job of ordering the equipment needed for your loved ones will be handled by the facility.
Medicaid and state programs for in the home
Medicaid programs which are for outside of skilled nursing facilities are called “Home and Community Based Services”, “Waivers” or “1915 Waivers”.
You can get a comprehensive explanation of HCBS programs and waivers by following this link to medicaid.gov –
These programs and waivers for the home, like Medicare, will also pay for “home medical equipment”, but unlike Medicare, often cover 100% of the cost.
For HCBS programs, and waivers, the term “home” is used to mean that the beneficiary must be living in –
- their own home
- their family home
- a group home
- an assisted living facility
- a custodial care facility
The HCBS and Waiver programs do vary from state to state, but most allow for a good range of DME, and are often broader in their range of what they will allow than Medicare.
Self Direction/Consumer Direction
Certain waivers allow for what is called Consumer Direction or Self Direction.
The beneficiary is allotted a budget, which, with the help of a financial planner, they may spend to cover their requirements.
The allotted budget can be used to buy products including durable medical equipment.
If a walk in bathtub, or shower, is considered a medical necessity and is within the allotted budget of the beneficiary, they may well be able to purchase one with their budget.
To find out more about Medicaid Self Direction click here.
Money follows the person
Other Medicare programs help participants to transition from nursing home care back into their own homes, or the community, such assisted living.
An example of this is Money follows the person.
Durable medical equipment which is required for the beneficiaries to return to their homes is bought by the program, and if the beneficiary is deemed to have to have a walk in tub they will most likely get one.
You will need to check with your state to see what HCBS or Waiver programs there are available to your parent, and what the eligibility criteria are. 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 devised as a method for reducing a person’s income level so that they may become eligible for Medicaid, HCBS’s and waivers, if they earned a little too much to qualify.
The simplest method used is to subtract a person’s medical expenditure from their income, and if their income level goes below the Medicare eligibility limit, the person will be able to apply for assistance.
Now, not all states have a Spend-Down program, but do check with your Area Agency on Aging, as some states have a similar program but under a different name.
There is an article on the US NEWS website which covers the topic here.
What is the path to purchasing DME’s with Medicaid waivers and HBSC programs ?
– get the doctor, or therapist, to provide a medical justification letter, stating that the equipment desired is medically necessary.
– contact a DME supplier, who is Medicaid approved, and give them the medical justification letter form the doctor, or therapist.
– the supplier should fill out a Prior Approval Application.
– the document goes to the Medicaid state office where the purchase is either approved, or denied.
– if the purchase is unsuccessful, you will be notified as to the reasons why, and how to appeal the decision.
– 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
Step 2 –
Click on you state
Step 3 –
- 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
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.
How to get a walk in tub covered as a Veteran ?
If your loved one is a veteran, the Department of Veterans’ Affairs has many different grants, programs and forms of financial assistance which will help to cover the cost of DME’s and also Home Care Supplies.
Veterans are entitled to receive healthcare under the VA Medical Benefits Package.
The law provides that the VA has to provide hospital care and outpatient care services, to eligible veterans that are defined as “needed.”
The VA defines “needed”as a care, or a service, which promotes, preserves or restores health.
Your loved one can find out about their local VA Medical Centers and different clinics and offices in each state here.
Veterans can receive –
- Grants for remodeling their homes due to disability inflicted during service
- Veterans Direct HCBS where they can allocate their budget to pay for required equipment
- Veterans Pensions
All of the above will pay for walk in tubs.
Is there any other state help my Mom, or Dad, can get for a bathtub ?
State Assistive Technology Programs
All states across the US have what is called a State Assistive Technology Program, which is funded by a national grant.
The AT Programs were set up to improve access to assistive devices in the home primarily for the elderly and the disabled.
Your State Assistive Technology Program should have the following services –
- an online equipment exchange which state residents can just register on and participate in
- a main website giving all the relevant information on their services, events, projects, and also acting as a hub for the contact with the community of eligible individuals
- refurbishment, recycling and reuse programs and centers to provide free, or extremely low cost, equipment for the disabled and the elderly
- loan closets
Your Assistive Technology Programs will contact individuals in need when specific equipment becomes available.
Look up your State Assistive Technology Program website to find out more.
Follow the steps below to see the projects in your state
Pick your state on the map or the drop down menu, and click on “Go to state”
– I chose Florida for this example
Click on the link “Program Title” – for my example I outlined it in red.
The AT Program state website will come up, and you can register, or use their contact info .
State Financial Assistance Programs
Some states have non-Medicaid financial assistance programs for the elderly and the disabled to help them to remain living safely and independently in their own homes.
Using grants and loans the programs will pay for assistive devices, safety equipment, durable medical equipment, as well as home modifications.
To find out if your state has a State Financial Assistance Program check with your local Area Agency on Aging ,and they should be able to advise you on programs for the elderly in your state.
USDA Rural development Section 504 Home Repair program
It is possible for your Mom, or Dad, to get a grant for a walk in bathtub or a low threshold shower if they live in a rural area.
The USDA allows for loans to low-income homeowners 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 amount for a grant is $7500.00, which is also a lifetime limit for grants. The grant must be repaid if the house is resold within three years of receipt of the grant.
To get the Home Repair program grant you must be the home owner, 62 yrs and over, have a family income of less than 50% of the local average income, and to be unable to repay a home repair loan.
Applications are accepted year round at your local Rural Development office here
To talk to a local USDA Home loan specialist for advice here
Alternatives to walk in bathtubs ?
Bath transfer seats –
Seats called “transfer seats” are designed to give safe access to a bathtub, for those with mobility and stability problems.
One half of the seat is outside of the bathtub and the other half is over the water in the bathtub.
Your loved one would sit on the seat outside of the tub, and raising their legs slide the seat over until it is above the water in the bathtub.
Your loved one could then either lower themselves into the water, or remain on the seat just above the water to wash.
There is far less risk with a transfer seat than there is stepping in and out of a bathtub.
Grab bars and poles –
If your loved one just needs a little more stability you can add grab bars on the wall and the bathtub, and also a ceiling to floor pole with a grab handle.
Alternatives we use at home –
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.
You can also buy walkers which are waterproof and for use in the shower.
If you have shower and it is large enough you may be able to put a waterproof 3 in 1 portable commode chair, a shower commode, or a shower transport commode in it, all of which are just as easy to use as a shower chair – commode chairs are covered by Medicare Part B if your qualify.
If a commode chair doesn’t fit in the shower, it is perfectly easy to get your loved one to sit on the portable commode chair in another room and give them a sponge bath.
Of course only the walker and the portable commode may be covered by Medicare, but a transfer seat at least is far less expensive than a walk in tub if your parent is going to have to pay the bill.
I have long article with 30+ caregiver tips on helping an elderly parent to bathe should you wish to become involved in washing your loved one, and are looking for some practical advice and tips. You can read that here.
It isn’t possible to get walk in bathtubs covered by Medicare Part B, except in the most extreme cases – it is not Medicare policy to cover them, or for that matter most other bathroom safety equipment.
There are, though, possibilities of getting walk in bathtubs and other bathroom modifications covered by Medicaid and state programs, non-medicaid state programs for the elderly, rural assistance programs, or if you are a veteran by certain programs under the VA medical Benefits Package.
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I’m Gareth and I’m the owner of Looking After Mom and Dad.com
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