Does Medicare Pay For Bathroom Grab Bars ?
As the bathroom presents so many different risk factors for the elderly, it has become the next terrain to be combed in my search to discover which items are, and are not, covered by Medicare.
And for my first bathroom item I have chosen the humble, and yet I think, a vital piece of safety equipment for my mom and your parents, the grab bar.
Original Medicare Part B does not cover bathroom grab bars. However, if you have Medicare Advantage, Medicaid, are on state waiver program, or are a veteran you may be able to get coverage for grab bars.
So does Medicare cover any bathroom equipment ?
Yes it does, as long as it considers it medically necessary.
Medicare covers walkers, crutches and commode chairs under Medicare Part B, and they can all be used in the bathroom to help with stability.
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, but rather as comfort items.
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.
If you have a waterproof walker, it can be used as a standing aid in the shower – there are walkers made just for this.
Walkers can also be used as an aid for standing at a sink or in front of a mirror, and for sitting on a raised toilet seat.
If your shower is large enough you may be able to put a waterproof “3 in 1” portable commode, a static shower commode, or a shower transport commode in it, which are just as easy to sit and wash on as a shower chair.
If you want to find out more about using a portable commode in the shower, I have an article about using a “3 in 1” commode in the shower, and about more specialist shower commodes, which you can read here.
If a portable 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 – you can place a portable commode chair anywhere there is space.
My Mom was washed by nurses in our home on a portable commode after a hip replacement for a few weeks as it was the safest option other than the bed, which my mom didn’t want to use.
3-in-1 commodes can also be used as a raised toilet seat, and as a toilet safety rail if you remove the seat.
If you want to find out more about how to use a bedside commode as a raised toilet seat, you can read my article on that topic here.
If you are not sure what you can get instead of a grab bar, I have a long article with 54 safety tips put together over the years of caring for my mom and dad to make the bathroom a safer place. You can find that here.
What is Medicare’s basic coverage criteria for equipment ?
For Original Medicare (Parts A and B) re-usable medical equipment for use in the home comes under the category for “Durable Medical Equipment” or DME’s.
You will find an lengthy 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 must 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
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 gives examples of Durable Medical Equipment as walkers, commode chairs, hospital beds or wheelchairs.
How does my Mom or Dad get equipment for their home with Medicare coverage ?
To qualify for any DME for “use in the home” under Medicare Part B, your loved one will have to –
- be enrolled in Medicare Part B
- have a signed prescription from your Medicare-enrolled doctor which states the item is medical necessity – the doctor may need to provide further documented proof of medical necessity in certain situations
- purchase the DME’s through a Medicare-enrolled supplier
If your loved one is claiming DMEs for their “home”, a hospital or nursing home cannot qualify as their “home”, although a long-term care facility, such as an assisted living, can qualify as “home”.
What qualifies as a home for Medicare Coverage ?
The following forms of residence qualify as living at “home” for Medicare –
- living in your own home
- living in the family home
- living in the community, such as assisted living
What happens next ?
If Medicare accepts to cover the purchase, your loved one will still have to pay their annual deductible (if it hasn’t already been met), and their co-payment of 20% of the Medicare-approved price of the item. Medicare will pay the remaining 80% of the Medicare-approved price.
In the case of cheaper items Medicare will usually purchase the items, but in cases such as hospital beds, it is more likely that they would rent a hospital bed on a monthly basis.
If the item is rented by Medicare from a Medicare-approved supplier who accepts “assignment”, your loved one will have to pay a monthly co-payment of 20% the Medicare-approved rental price, and Medicare will pay 80%.
What to avoid when purchasing, so my loved one pays the least amount with Medicare ?
If you want to pay the least amount possible, you must make sure that your loved one’s Medicare enrolled “participating” supplier accepts “assignment”. This ensures that your loved one 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.
Here’s Why –
Medicare enrolled suppliers are divided into two groups –
- Medicare Suppliers
- Medicare “Participating” Suppliers
Medicare “Participating” Suppliers have agreed to what is known as “assignment” – this means that they have agreed to charge the Medicare-approved price only.
When your loved one buys their durable medical equipment from a Medicare Participating Supplier, they will not be paying more than the 20% co-payment of the Medicare-approved price for the equipment, and if they have not yet met it, their annual deductible.
What happens if they are not a Participating Supplier ?
Dealing with a supplier who is Medicare-enrolled, but not a “Participating” Supplier, means that the supplier takes payment from Medicare, but doesn’t have to accept “assignment”.
The upshot of this is that they are then free to charge as much as 15% for the item, which can drive the cost of more expensive items considerably higher.
Medicare then pays the supplier 80% of the Medicare-approved price, and your loved one has to pay their 20% co-pay of the Medicare-approved price, their annual deductible if they haven’t yet met it, plus the difference, over and above, the Medicare-approved price for the equipment to the supplier.
So, if the price for an item were 50$ above the Medicare-approved price, your loved one would have to pay it all.
What if your loved one is in a skilled nursing facility ?
If your loved one, is in a Skilled Nursing Facility or hospital, the facility is required to supply any necessary medical equipment for up to 100 days. It is covered by Medicare Part A (Hospital Insurance).
What if your loved one has Medicare Advantage ?
Those with Medicare Advantage Plus (or Medicare Part C) will need to check with their provider, as they are legally entitled to the same DMEs as Original Medicare, but they may also have extra benefits such as hearing and visual under their plan.
Durable Medical Equipment usually covered by Medicare
Here’s the list of Durable Medical Equipment generally covered by Medicare once you have qualified.
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 those living at “home” – I outlined the definition of “home” here
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.
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
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.
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
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).
Does Medicaid cover bathroom grab bars ?
Medicaid funding for programs is both federal and state level funding.
Each state can have a number of different Medicaid programs, each with different eligibility guidelines, which has resulted in hundreds of programs for Medicaid across the US.
Medicaid programs are designed for people with extremely low incomes; mainly the elderly and the disabled, but also low income families.
Medicaid, like Medicare, will also pay for “home medical equipment”, and unlike Medicare, will very often cover 100% of the cost.
When Medicaid uses the term “home” for it’s programs, it means that for a person to be eligible for those programs they can be in –
- their own home
- their family home
- a group home
- an assisted living facility
- a custodial care facility
Certain programs and waivers offer greater latitude in what they are willing to consider as DME
The Medicaid state programs which are for delivering Medicaid to people in their homes, as opposed to in skilled nursing facilities, are called Home and Community Based Services (HCBS) Waivers, or 1915 Waivers.
The programs do vary from state to state, but most allow for a good range of DME’s, and some are broader in their range than Medicare.
Certain waivers allow for what is called Consumer Direction.
The beneficiary is allotted a budget, which with the help of financial planning, they may decide how to use to cover their requirements. The allotted budget can be used to buy products including durable medical equipment.
The program Money follows the person was designed to assist people in leaving nursing facilities, and to return them to live in their homes, or assisted living facilities. Durable medical equipment which is required for the beneficiaries to return to their homes is bought by the program.
What if your revenue is too high to qualify for Medicaid ?
The Spend Down Program
Spend-Down programs will try lower a person’s income level so that they may qualify for Medicaid, HCBS’s and waivers.
This can be achieved by subtracting a person’s medical bills from their income, and if their income level as a result falls below the Medicaid eligibility limit, the person is able to apply to different Medicaid and state programs and waivers.
Not all states have a Spend-Down program, but if yours does it may be able to help you qualify for assistance, so check with your Area Agency on Aging, as some states have a similar program but under a different name.
If you wish to find out more US NEWS has an article which covers the topic here.
What is the process for purchasing items in these Medicaid and state funded programs ?
As a participant in a program of this type, your loved one would get their doctor, or therapist, to provide a medical justification letter, saying that the equipment they want is medically necessary.
Your loved one would then contact a DME supplier, who is Medicaid-approved, and give them the medical justification letter form the doctor, or therapist.
The supplier would then fill out a Prior Approval application.
The document is sent to Medicaid at the state office where the purchase is either approved, or denied, and your loved one and the supplier would be notified.
If your loved one were unsuccessful, they will be notified as to the reasons why, and how to appeal the decision.
If your loved one’s purchase were approved, unlike with Medicare there would be nothing to pay.
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.
State Funding Assistance
Assistive Technology Programs
Thanks to a Federal grant, all states across the US now have what is called a State Assistive Technology Program.
The programs are designed to improve access to assistive devices in the home, and it’s primarily for the elderly and the disabled.
Your State Assistive Technology Programs should have the following services –
- an online equipment exchange on which state residents can register, and then post used assistive devices and medical equipment to donate, swap or sell, with one another
- a main website which coordinates the whole project, lists the different ongoing events and projects, and where you can contact the projects to see if you are eligible for assistance and equipment
- recycling, refurbishment and reuse programs – these can be run by the state program, but are also run by no-profit and community groups in partnership with the state AT project to provide either free or low cost used equipment for the disabled and the elderly
- loan closets are usually part of the programs, and can be either long or short term, or sometimes both – they may just loan equipment to a person before they actually purchase it, so they have time to make sure it is the right fit for them, or it can be a permanent loan
To find out more go to your State Assistive Technology Program website.
Follow the steps below to see the program 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
Non-Medicaid financial assistance programs to help the elderly and the disabled to live independently in their own homes exist in a number of states.
Grants and loans will be given to pay for assistive devices, safety equipment, durable medical equipment, as well as home modifications.
To find out if your state has a financial assistance program for the elderly you can just contact you local Area Agency on Aging.
To locate the nearest Area Agency on Aging to you, use the locator on this link here.
How to get bathroom equipment and DME’s 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 that are defined as “needed”, to eligible veterans.
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.
Below are just some of the different forms of assistance for you to look at if your loved one is a veteran.
- Tricare for life
- Veterans Directed Home and Community Based Services – these programs are designed to help veterans to stay living in their own homes
- ChampVA for Life – this program is for 65’s and over who are family members of veterans who died in the course of their duties, or who were permanently disabled – it covers the beneficiary’s Medicare co-pays and deductibles
It isn’t possible to get grab bars covered by Medicare Part B, or for that matter most other bathroom safety equipment.
There are, though, possibilities of getting grab bars covered by Medicaid state programs, non-medicaid state programs for the elderly, StateAssistive Technology Projects, or if you are a veteran certain programs may be able to cover them through 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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