Does Medicare Pay For Bath Chairs ?

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

Getting in and out of the bathtub for our elderly parents can present many difficulties and risks, and it isn”t hard to imagine all the accidents you could have. A great solution to  these problems comes in the form of bath chairs and transfer benches.

Does Medicare pay for Bath chairs ? Original Medicare Part B does not cover bath chairs for use in the home, as it does not consider them to be “medically necessary”. However, Medicare Advantage Plus plans, Medicaid, veterans benefits and other state funding sources do cover bathroom equipment that Medicare does not.

Will Medicare cover any other bathroom safety equipment ?

Medicare will only cover equipment it considers to be “medically necessary”.

Crutches, walkers and commode chairs are all covered for the home by Original Medicare Part B, and  can all be used to help the elderly with standing and stability in the bathroom.

Items which aren’t covered such as bath lifts, grab bars, raised toilet seats and transfer seats are considered, by Medicare, to be “comfort” items which do not qualify for coverage.

So how to adapt ?

To get in and out of the shower my mom uses a walker instead of a grab bar. There are also waterproof walkers which can be used in the shower for help with standing.

Walkers can also be use for standing at sinks and counters for added stability, and infront of the mirror too.

If you a loved one with problems sitting on teh toilet they can use a walker to help them keep their balance while getting on and off the toilet seat.

If you have a larger shower  you may be able to put a 3 in 1 portable commode chair in it (only if it is waterproof though), which gives you the same possibilities as a shower chair.

If you can’t fit the commode chair in the shower, we have often given my mom a sponge bath seated in the 3 in one commode chair, and that works very well – this was post hip replacement surgery and we had extra help at home for a month.

The 3 in 1 portable commode can also be used as a raised toilet seat.

I have an article –  “Can a 3 in 1 commode be used as a shower chair ?” – which outlines the use of commode chairs in the shower and also tells about the types that you can get which are especially for the shower, and some of which have multiple uses around the home, even as transport chairs.

If you want to find out about using a bedside commode over the toilet I have another article – “Can a bedside commode be used over a toilet ?” which outlines which types of bedside commodes can be used over a toilet, how to go about setting it up, how to use it, and why it is a probably the best option for the elderly as a raised toilet seat.

If you decide to go with the portable 3-in-1 commode chair you will need to follow the proper process outlined below to get coverage from Medicare Part B.

However, if you qualify for Medicaid, state waivers, HCBS programs, other state funding or Veterans’ Benefits and pensions, you may wish to skip ahead to those, as you should be able to get a bath chair – just click here.

If you are not sure which way to go, I have a long article with 54 safety tips, that I  put together over the years caring for my mom and dad, so that we could make the bathroom a much safer place. There are both practical tips, and equipment you may wish to look at. You can find that article here.

If you are learning how to help your loved one wash you may be interested in my article all about helping someone bathe safely, whilst helping them to keep their dignity at the same here. 

How does Medicare decide what equipment to cover ?

Original Medicare Part B – covers the use of some medical equipment in the home, and classes it under a category called “Durable Medical Equipment”, also known as DME.

I have included an exhaustive list of Durable Medical Equipment covered by Medicare below. To jump ahead to the list click here.

For an item to be on the list of Medicare’s “Durable Medical Equipment” it has to meet some basic criteria:

  • Durable (needs to be able to resist repeated use over a sustained period of time)
  • It has to be 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

If a piece of equipment you are looking at doesn’t  meet these criteria you most likely won’t be able to get it covered by Medicare.

Examples of the equipment that Medicare gives as being in the DME category, in their literature, include walkers, crutches, hospital beds, commode chairs and wheelchairs.

If you are trying to locate a Medicare supplier in your area, you can use this link at Medicare.gov

If my list of Medicare covered DME’s below doesn’t contain an item you are looking for, you may want to follow this link to Mediace.gov 

How do my parents get the equipment they need for their home covered by Medicare ?

To be eligible for any durable medical equipment in your parent’s “home”, under Medicare Part B,  your parent has to –

  • be enrolled in Medicare Part B
  • have a signed prescription from a Medicare-enrolled doctor which states the desired item is “medically necessary” – the doctor may need to provide further documented proof of medical necessity in certain situations
  • purchase the durable medical equipment through a Medicare-enrolled supplier

A hospital or a nursing home cannot qualify as your parent’s home for Medicare Part B, but don’t worry as these are covered in their Medicare part A, and any durable medical equipment they require should be provided by the facility in which they receive their care.

What qualifies as a home for Medicare Coverage ?

The following types of residence qualify as living at “home” for Medicare –

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

What next stage ?

Once you parent has seen a Medicare-enrolled doctor and has been given a signed prescription saying the equipment is medically necessary, they will need to go to a Medicare-enrolled supplier for the equipment.

In terms of payments, your parent will still have to meet their annual deductible (if it hasn’t already been met) and their co-pay of 20% of the Medicare-approved price of their item.

Medicare will cover 80% of the Medicare-approved price of the equipment, as long as you used a Medicare-enrolled supplier.

With cheaper items Medicare tends to purchase the item, but in cases of much more expensive equipment, such as hospital beds, it is more likely that Medicare will rent the equipment on a monthly basis.

In a case where Medicare rents an item for your parent on a monthly basis, if the item is rented from a Medicare-approved supplier who accepts “assignment”, your parent will pay a monthly co-pay of 20% of the Medicare-approved price, and Medicare will pay the remaining 80%.

What to avoid when purchasing DME’s with Medicare Coverage ?

To pay the least amount possible, and to get the Medicare Part B coverage you must make sure that your Mom, or Dad’s, Medicare-enrolled supplier is a “participating” supplier who accepts “assignment”.

It will ensure that your parent is only going to have to pay their Medicare co-pay, and if they haven’t already met it, their annual Medicare Part B deductible.

Why is that the case ?

Medicare-enrolled suppliers can be divided into two kinds –

  • Medicare Suppliers
  • Medicare “Participating” Suppliers

Medicare “Participating” Suppliers have agreed to “assignment” – this means that they can only charge the Medicare-approved price.

If your Mom, or Dad, buys their DME from a Medicare Participating Supplier, they will not be paying more than their 20% co-payment of the Medicare-approved price for the equipment, and their annual deductible.

What happens if your parent is not using a Participating Supplier ?

If a person is buying from a Medicare-enrolled supplier, but who is not a “Participating” supplier, it means the supplier is not obliged to accept “assignment”.

A supplier who does not accept “assignment” is allowed to charge up to 15% above the Medicare-approved price for an item, and the customer pays all of the extra, plus their co-pay and policy deductible.

Medicare will pay the supplier 80% of the Medicare-approved price, and your Mom or Dad has to pay their 20% co-pay of the Medicare-approved price, plus their annual deductible (if they haven’t yet met it), plus the extra the supplier has decided to add on to Medicare-approved price (up to a maximum of 15% extra.

Some states have legislation to stop suppliers charging any extra, and some lower the percentage they can add on, and other states let them charge the full 15% extra.

And if your Mom or Dad is in a skilled nursing facility ?

If your parent, is in a Skilled Nursing Facility or hospital, medicare Part A (Hospital Insurance) covers their care.

Medicare requires that any necessary medical equipment needed for your parent is provided by the facility for up to 100 days.

And if your parent has a Medicare Advantage Plan ?

If your parent has a Medicare Advantage plan (or Medicare Part C) they will have to check with their provider to see what extras are covered by their policy.

Medicare Advantage plan holders are legally entitled to the same DME’s as Original Medicare, but often have extra benefits such as hearing and visual under their plan.

You must be aware though, that your parent’s Advantage plan provider may require that any DME be purchased from a supplier in their network. If they don’t they may be refused coverage.

Durable Medical Equipment – list of items usually covered by Medicare

 To qualify you need to have Original Medicare Parts A and B.

  • Part A (Hospital Insurance) covers DME’s for beneficiaries who are living in skilled nursing facilities
  • Part B (Medical Insurance) covers DME’s for elderly loved ones living at “home” – the definition of “home” outlined 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.

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 guidance and advice on Medicare.

This is usually a phone service, but some programs will offer face-to-face appointments as well.

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

To find your local 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.

Does Medicaid cover bath chairs ?

Medicaid programs are designed for those with extremely low incomes; mainly the elderly, the disabled and low income families.

Medicaid funding is both federal and state level funding. As each state can have any number of different programs, each with it’s own eligibilities, there are literally hundreds of different programs.

Medicaid will also pay for “home medical equipment”, and will very often cover 100% of the cost.

What qualifies as a “home” under Medicaid for a person to be eligible for these programs –

 

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

Medicaid In-home services

The Medicaid state funded programs below are designed to help the beneficiaries to remain residing in their homes.

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

The programs can vary a great deal from state to state, and can also be somewhat broader in what they allow as DME than can Medicare.

Some of these waivers allow for what is called Consumer Direction.

Consumer Direction allows for the recipient of the program to manage an allotted budget, and to allocate the amounts required to pay for their care and home equipment. Durable Medical Equipment is of what they are allowed to purchase in with their budget

Money follows the person is a program which was designed to assist people to return, and live in their homes, or assisted living facilities, after living in skilled nursing facilities. Durable medical equipment which is required for the program participants to return to live in their homes is bought by the program.

How do you purchase items if you are in a Medicaid and state funded program ?

As a particpant in a program of this type

  • your parent must obtain a written medical justification from their doctor or therapist for a piece of equipment
  • your parent contacts a DME supplier, who must be Medicaid approved, and furnishes them with the medical justification letter 
  • the supplier fills out a Prior Approval application for the equipment
  • the application is sent by the supplier to Medicaid at the state office where the purchase is either approved, or denied, and your parent and the supplier wait to be notified of the decision
  • if your parent is unsuccessful, they will be notified as to the reasons why, and as to how they may appeal the decision
  • if your parent’s purchase is approved they will simply receive the equipment

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

The Spend Down Program

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

One way this is done, is to subtract a person’s medical bills from their income, and if subsequently their income drops below the Medicaid eligibility limit, the person may then qualify for assistance with Medicaid programs..

Not every state has a Spend-Down program, so do check with your Area Agency on Aging, as some states have a similar program but under a different name.

US NEWS has an article which covers the topic here.

What’s the procedure for getting DME’s with Medicaid state waivers and HBSC programs ?

Step 1

– the doctor, or therapist, has to provide a medical justification letter, stating it is medically necessary

Step 2

–  find a Medicaid-approved DME supplier , and give them the medical justification letter

Step 3

– the Medicaid-approved supplier fills out a Prior Approval Application form for Medicaid

Step 4

– the Prior Approval Application is sent to the Medicaid State Office

Step 5

– if you are unsuccessful you will be contacted  and given the reasons as to why, as well as advice on how to make an appeal

Step 6

– if approved, you will receive the DME

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.

The grant is to be used by the state to develop its own State Assistive Technology Program to improve access to assistive devices in the home, with a focus on the disabled and elderly.

Assistive Technologies are devices which help any individual to complete a task or action, that they otherwise cannot complete – these can be simple devices for opening jars, wheel chairs or digital technologies.

Assistive Technologies as a term is synonymous with durable medical equipment,

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 to sell, to donate, or to swap
  • a main program website which coordinates and lists the program’s activities, lists upcoming events and projects answers enquiries, and will register people who are eligible and need help
  • recycling, refurbishment and reuse centers which are either run by the state program, or by non-profits and community groups they partner with, to provide free, or cheap equipment for disabled and elderly state residents
  • most states have loan closets as part of their program, these can be either long term or short term

 

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

To find to more go to State Assistive Technology Program 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

In some states there are non-Medicaid State Financial Assistance Programs which will pay for assistive devices, safety equipment, durable medical equipment, as well as home modifications, so that elderly and disabled individuals may maintain their independence in their own homes.

The assistive devices, durable medical equipment and remodeling are paid for with grants or loans, or sometimes a combination of the two.

Your local Area Agency on Aging will be able to advise you on financial assistance programs for the elderly, and if your state has any.

    How to get bath chairs and other DME’s covered as a Veteran

    For Veterans, the Department of Veterans’ Affairs has many grants, programs and forms of financial assistance which cover the cost, or part of the cost, of DME’s and also Home Care Supplies.

    The law stipulates that the VA has to provide “needed” hospital care and outpatient care services, to eligible veterans”.

    Any care, or a service, which promotes, preserves or restores health is defined as “needed” and is eligible.

    Veterans are entitled to receive healthcare through the VA Medical Benefits Package.

    You can find local VA Medical Centers, clinics and offices in each state here

    Here are some of the different forms of assistance for you to look for if your parent is a veteran.

    • Tricare for life
    • Tricare
    • Veterans Directed Home and Community Based Services – these programs are designed to help to keep veterans living in their own homes
    • ChampVA for Life – this program is for family members of veterans (65’s and over) who died in the course of their duties, or who were permanently disabled – it covers the beneficiary’s Medicare co-pays and deductibles

    Summary

    It isn’t possible to get bath chairs covered by Medicare Part B, as they are not considered to be medically necessary, but you can try to use walkers or portable commode chairs, as these are covered by Medicare if they are medically necessary.

    You may though be able to get bath chairs covered by Medicaid state programs, non-medicaid state programs for the elderly, or through the 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

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