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Does Medicare Pay For Bathroom Safety Equipment ?

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As our parents get older and more frail, the bathroom can come to represent a considerable challenge to some, and can threaten their independence. With all the risks of slipping and falling, and I’m sure that you, like my Mom and I, have been frequently looking at bathroom safety equipment and wondering how you will ever manage to pay for it.

 

Original Medicare Part B only considers most bathroom safety equipment to be “comfort items”, and not “medically necessary”. As of the the fall of 2020, you may find some Medicare Advantage plans are offering some bathroom safety equipment benefits, but it depends on the individual policies.

Medicare Part B will cover walkers, crutches and commode chairs for use in the home, which can all be used as bathroom safety equipment to help diminish the risk of falling.

Medicare Part B also covers patient lifts in certain circumstances, and often these can also be used in the bathroom in the shower, or over the toilet.

You can read my two articles on Medicare’s cover of patient lifts and of Hoyer lifts (a very popular brand of patient lift), to find out what the guidelines are for qualifying, and where you may find grants if you don’t qualify for coverage with Medicare Part B.

However, Medicare Part B will not cover grab bars, non-slip mats, bath lifts, shower chairs, transfer seats or raised seats for the toilet, as it doesn’t consider these to be “medically necessary”, but instead views them as comfort items.

 

What if your item of bathroom safety equipment isn’t covered ?

 

If you only have Medicare Part B, and they won’t accept your device as “medically necessary” you will either have to pay for the items yourself, or improvise.

Rather than having me install grab bars, my mom prefers to use a walker to help her to get in and out of the shower, as it can be re-positioned in so many ways. She will also use it for other tasks when she needs to stand, if she’s going to be there a while.

I wouldn’t stand with a walker in the shower unless you have one which is waterproof, and specifically designed for the shower.

If your parent’s shower is large enough you may be able to put a 3 in 1 portable commode chair in it, which is just as easy to sit and wash on, as a shower chair – but again, only do this if your 3 in 1 commode is waterproof. Commode chairs are covered by Original Medicare Part B, so if you qualify for one this may be an almost cost free solution to a shower chair.

You can buy shower commodes which as the name suggests are commodes which can go in the shower.

If your shower is too small for your bedside commode, it is simple enough to give a sponge on the bedside commode in another room.

Certain bedside commodes – generally 3-in-1 commodes – can be placed over a toilet seat, once the potty part has been removed, thus acting as a raised toilet seat, and a very stable one at that.

I had bought a raised toilet seat for my Mom, but she found a portable 3-in-1 commode placed over the toilet to be much more secure and comfortable, and getting on and off using the arm rests proved much easier than a raised toilet seat.

 

Don’t despair if you can’t get what you want covered under Medicare Part B, there are other options which include funding for quite large equipment, such as walk in bathtubs and low threshold, or roll- in showers, from some different sources for which your loved one’s may qualify.

There are also sources of  financial assistance and funding grants if you need to re-model your bathroom for health reasons !

Before I get to those, I am just going to outline the Medicare process, and what you can get.

If you wish to jump ahead to the different sources of coverage and funding, click here.

If you are not sure which safety equipment you require for your loved one, I have a long article with 54 safety tips that I have researched over the years with my mom and dad to make the bathroom a safer place. It includes both practical tips, and items you may wish to look at. You can find that here,

or if you want to make bathing easier for your parent, and you are learning how to help them wash, you may be interested in this article here. 

Does Medicare cover walk in showers ?

 

Typically, Medicare Part B doesn’t cover bathroom safety equipment or modifications as I noted earlier, and unfortunately walk in showers fall into this area.

It is considered to be a comfort item and “not primarily medical in nature”.

But as I have also noted if you can prove that it it is unconditionally “medically necessary”, with a prescription certifying this from a Medicare-enrolled doctor, a diagnosis with “proof of need” that supports this, lots of supporting evidence of why you can’t live without it, evidence of why this particular walk in shower will do what you need, and that it can be reasonably expected that the shower will either maintain or improve your condition, then Medicare may agree to help cover.

Or you could wait until the fall of 2020 to see which Medicare Advantage plans may possibly be offering to cover modifications or walk in bathtubs, and switch from Medicare Part B to that plan.

Will Medicare pay for bathroom modifications ?

 

Almost all home modifications will not be covered by Medicare Part B.

Medicare Part B typically only covers what it considers to be “medically necessary”,  and unfortunately, and modifications are seen as not primarily medical in nature.

In the rare instances that Medicare will cover the cost of a bathroom modifications ie walk in bathtubs, your doctor will need to convince Medicare that it really is a “medical necessity”.

 

To do this, a medical diagnosis for proof of need is required, plus a prescription of “medical necessity” from and signed by a physician which demonstrates –

 

  • why you cannot live without the modifications – the necessity
  • what it is that is needed from the required equipment, or bathroom modification

 

Medicare Part B also requires that –

 

  • it can be  reasonably expected that the equipment, or modification will either maintain the patient’s condition, or
  • give rise to an improvement in their condition

 

Just because  has all the required documentation, diagnosis and prescriptions, it isn’t a guarantee that Medicare Part B will give any coverage.

And to top it all off, you will also have to pay up front hoping that Medicare will agree, and reimburse you to some extent afterwards.

 

If you don’t qualify through Medicare Part B for a bathroom modification, which is the most likely scenario, unfortunately, there are a number of other possibilities open to the elderly –

 

  • HCBS programs and waivers
  • 1915 waivers
  • Assistive Technology programs for equipment
  • State Financial Assistance Programs or Nursing Home Diversion Programs
  • USDA Rural Development grants
  • Veterans Direct HCBS
  • Low Income Energy Assistance Program
  • Weatherization Programs
  • Nonprofit groups offering services and assistance

 

 You can find out about all of these in my article on Medicare and bathroom modifications.

What about Medicare Advantage ?

 

For those Medicare Advantage plans there is good news, as there are going to be new benefits allowed for those policies as of the end of 2020.

In 2019, the Centers for Medicare & Medicaid released their plans to increase the competitiveness  and coverage of  Medicare Advantage and Medicare Part D plans.

Beginning in 2019, Medicare Advantage plans can now offer supplemental benefits that are not covered under Medicare Parts A or B, if they diagnose, compensate for physical impairments, diminish the impact of injuries or health conditions, and/or reduce avoidable emergency room utilization.

Source: “CMS finalizes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage”  April 1, 2019. You can read this on the CMS.gov website here.

Some Medicare Advantage plans may be offering new benefits for bathroom safety equipment, or modifications, at the 2020 fall enrollment.

 

What equipment does Medicare pay for  ?

 

Medicare covers certain durable medical equipment for use in the home when it considers it to be “medically necessary”.

Durable medical equipment is medical equipment for use in the home which is able to withstand repeated use over a sustained period of time.

Medicare has guidelines which outline what medical conditions and situations justify the coverage each different piece of durable medical equipment i.e. when it is “medically necessary”.

In their literature Medicare gives examples of Durable Medical Equipment as walkers, commode chairs, hospital beds and wheelchairs.

Medicare will not cover equipment, for use in the home, which it considers to be a comfort item, or an item which is “not primarily medical in nature”. Equipment such as grab bars, shower chairs and raised toilet seats fall into this category.

Medical supplies which are disposable, are also not covered by Medicare for use in the home. This would be items such as gloves, fabric dressings and gauze.

There are two exceptions for disposable medical supplies –

 

  • if a beneficiary is receiving the Home Health benefit some supplies are included
  • if a disposable medical supply is used in conjunction with an item of durable medical equipment which is being covered at the time by Medicare

 

Medicare considers durable medical equipment must be –

 

  • Durable (it has to be capable withstanding repeated use over a sustained period of time)
  • It has to be employed for a medical reason, as not just for comfort
  • Not usually useful to someone who isn’t sick or injured
  • It must be used in your home
  • It should have an expected lifetime of at least 3 years

 

If the equipment your loved one wishes to have doesn’t meet these criteria you probably won’t be able to get it covered by Medicare.

 

Medicare-approved supplier near me  ?

To find a local Medicare DME supplier use this link at Medicare.gov

List of durable medical equipment covered by Medicare

 

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.

How does my parent get their medicare covered DME ?

 

For your loved one’s purchase of a DME to qualify for Medicare coverage they will need –

 

  •  to be enrolled in Medicare Part B
  •  a prescription signed by their Medicare-enrolled doctor which states the item is “medical necessity”
  • to acquire the DME’s through a Medicare-approved supplier

 

If your Mom, or Dad, is claiming DME’s for use at “home”, a hospital or nursing home cannot qualify as their “home” for medicare Part B, however they will be covered under Medicare Part A.

Long-term care facilities, such as assisted living  can qualify as a “home” for Medicare part B

 

What does your parent do now they have the prescription ?

 

If Medicare accepts to cover your parent’s DME purchase,  your parent will need to pay their annual deductible (if it hasn’t already been met) and a co-payment of 20% of the Medicare-approved price of the purchase. Medicare will then cover the payment of 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 so that my parent pays the least amount with Medicare ?

 

For your parent to pay the lowest amount possible, they must be sure that they use a Medicare-enrolled “participating” supplier who accepts “assignment”. This ensures that they are only going to pay their Medicare co-pay of 20% of the Medicare-approved price, plus, if they haven’t already met it, their annual Medicare Part B deductible.

 

So why is that ? –

 

Medicare enrolled suppliers fall into two groups –

 

  • Medicare Suppliers
  • Medicare “Participating” Suppliers

 

Medicare “Participating” Suppliers have agreed to what is known as “assignment” – this obliges them to only charge the Medicare-approved price.

So, your parent, when they  purchase their durable medical equipment from a Medicare Participating Supplier, will not be paying any more than the 20% co-payment of the Medicare-approved price for the equipment, plus, if they have not yet met it, their annual deductible.

 

What happens if the supplier is not a Participating Supplier ?

A supplier who is Medicare enrolled, but not a “Participating” Supplier, has agreed to take payment from Medicare, but isn’t obliged to accept “assignment”.

The supplier is then free to add up to 15% to the price of the item, which on higher priced items can make the price considerably higher than the Medicare-approved price, and your parent is the one who pays the excess amount.

Medicare will pay the supplier 80% of the Medicare-approved price, and your parent has to pay the supplier the difference between the Medicare-approved price and the suppliers price + the 20% co-pay of the Medicare-approved price + their annual deductible if they haven’t yet met it. 

What if your loved one is receiving treatment in a skilled nursing facility ?

 

If your parent is being cared for in a Skilled Nursing Facility or hospital, any necessary DME is covered by Medicare Part A (Hospital Insurance). The facility will take care of any equipment needed for up to 100 days.

Free Medicare advice

 

SHIP – State Health Insurance Assistance Programs – offers free advice on Medicare if you feel you need to talk to someone.

You can call your SHIP and have a chat over the phone.

As well as Medicare, SHIP offers free guidance on Medicare Advantage, Medigap and Medicaid benefits.

To contact your SHIP just use this link  here and follow the steps that I have outlined below.

 

How to get in touch with your SHIP, 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 – they both lead to the same menu to choose your state.

Step 3 –

Pick your state from the list and click on it.

Step 4 –

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

Does Medicaid cover bathroom equipment ?

 

Yes, Medicaid will cover different bathroom equipment, and often the range of equipment is greater than that offered by Medicare. In addition Medicaid often pays the whole amount, leaving you with no deductible or co-pay to make.

What makes medicaid different is that it is funded both at the federal level, and at the state level.

A state can have any 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. The facility is responsible for meeting a person’s DME needs for up to 100 days.

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 very in depth explanation of HCBS programs and waivers at the following link to medicaid.gov –

https://www.medicaid.gov/medicaid/hcbs/authorities/index.html

These programs and waivers for services in  the home, like Medicare, will also pay for “home medical equipment”, and unlike Medicare, often cover 100% of the cost.

The term “home” for HCBS programs and waivers purposes means that a recipient  must be in –

 

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

 

The HCBS programs have been developed to help individuals to live in their own homes, and to provide the care services and equipment needed so that they may be able maintain their independence there.

If your parent needs certain safety equipment to live safely, and they qualify for the program, or waiver, they will usually get that equipment.

There are many state waivers which will allow for home modifications, including bathroom modifications, to adapt the home to the beneficiary’s needs.

The HCBS and Waiver programs do vary from state to state, but most allow for a good range of DME’s, and are often broader in their range than Medicare.

Consumer Direction/ Self Direction

 

Some waivers allow for a system called “Consumer Direction” or “Self Direction”.

The origin of the system was in “consumer-directed personal care services” run by certain states in the 1990’s which, over time, and with the Affordable Care Act,  have developed into what is now called Self Direction by Medicaid.

The beneficiary is given a budget, which they may spend to cover their requirements, under the guidance of a financial planner. The allotted budget can be used to buy products including durable medical equipment. If a walk in bathtub, grab bar, bath lift, or shower chair is considered a medical necessity and is within the allotted budget, they may well be able to have one.

You can find out more about this and the different waivers here at Medicare.gov

Money follows the person

 

The program Money follows the person was designed specifically to help people to leave nursing facilities, and to return them to their homes, or assisted living facilities.

Durable medical equipment which is required for the persons to return to their homes is bought by the program, so if the beneficiary is deemed by the program to have to have a walk in tub, grab bars, or a bath lift they will most likely get them, as without this equipment they would not be safe if returned home. 

What if your revenue is too high for Medicaid assistance ?

 

Spend Down

 

.Medicaid Spend Down, and other similar programs, were designed to a person to reduce their income and asset levels, so that they may qualify for Medicaid, HCBS’s and waivers.

 

“Spend Down” has two types of program  –

 

  • Income Spend Down
  • Asset Spend Down

 

“Income Spend Down” is the one I am briefly looking at here.

If your assets are too high, or both your assets and income are too high, you need to look into “Asset Spend Down”, which is present in all states.

Income Spend Down

“Spend Down” programs may also be known as “Surplus Income”, “Share of Cost”, “Excess Income” and “Medically Needy”,

Unfortunately the programs are not present in all states.

The method the programs use to help a person reduce their income, is one which allows them to deduct their medical costs from their income, and if subsequently their income level drops below the Medicaid eligibility limit, the person will be considered as qualifying for Medicaid and state run programs.

You will find a much more in depth article on the “Paying for Senior Care” website here, and another good article on this on the US News website here.

You may wish to find help from a Medicaid Planner, an Elder Resource Planner, or a Life Resource Planner.

SHIP which I mentioned earlier, will give guidance on Medicaid planning (although not legal advice) and could be a good place to start before you use any service you will have to pay.

The American Council on Aging website has more information about Medicaid Planners, here.

If you wish to find a Medicaid Planner you can use a free tool on the American Council on Aging website which will (1) determine your eligibility status, and (2) find you a Medicaid Planner – you can find that here.

 

How to go about purchasing items in these 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.

Find the HCBS programs, waivers and 1915 waivers in your state

 

The link below will take you to CMS.gov. to look at the different “HCBS programs”, “waivers” and “1915 waivers” offered by your state and Medicaid.

Select your state on the map and it will show you a section with your state waivers and programs, as well as their eligibility criteria – click here.

Step 1 – Find your state on the map.

Step 2 – Click on you state – I chose N.Dakota as an example

Step 3 – You will come to your state and it’s resources, and here you can choose

 

  • your state Medicaid Agency which I marked with a (1), or
  • your Home and Community Based Services, Waivers and 1915 Waivers which I marked with a (2)

Below is an example of the type of page you will get if you click on the HCBS programs and waivers link.

You will be able to find out what programs and waivers there are in your state, and what the eligibility criteria are.

How to get bathroom equipment and DME’s covered as a Veteran

 

The Department of Veterans’ Affairs has a range of grants, programs and forms of financial assistance and pensions which will help to cover the cost of DME’s for veterans.

You, or your parent, 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 available if your parent is a veteran –

 

  •  Grants for remodeling their homes to adapt them due to disabilities inflicted during military service
  • Veterans Direct HBCS on which the beneficiary has control over the way the budget is spent, and what it is spent on
  • Veterans Pensions – some specific pensions will allow for the purchase of equipment that veterans need for their homes

 

All of the above will pay for bathroom safety equipment and even bathroom remodeling.

 

To find your State Medicaid State Agency

 

If the documents are too technical I wouldn’t waste your time trying to work your way through them, I would contact your state Medicaid Agency, and you can do that here.

Step 1 – Once you have clicked the link to Medicade.gov,  just look over to the right on the website page and you will see the section I have outlined in the image below.

 

If the documents are too technical I wouldn’t waste your time trying to work your way through them, I would contact your state Medicaid Agency, and you can do that here.

Step 2 – select your state and click on the button they have marked “GO” – it will take you to your State medicaid Agency, and you will be able to get all the contact info and make calls 0r do emails to get all the help you need.

 

Is there any other financial assistance my parent can get for bathroom safety equipment ?

 

Assistive Technology Programs

 

A national grant is given to all states to be used in “Assistive Technology Programs”. The “programs” are meant to increase access to assistive devices in the home for those who need them.

The elderly are one of the primary groups who are meant to benefit from these projects.

The terms “Assistive Technology” and “DME” are pretty much interchangeable, and it covers all manner of equipment which can help in the home, so bathroom safety equipment is part of this.

Your parent would need to contact the State offices and find out how to apply.

To find out what projects your state runs click here.

Step 1/

Select you state from the map or from the drop down menu.

Then click on “Go to state”

– I chose Florida for this example

Step 2/

Look  “Program Title”  and click on it – In this example I outlined it in red.

Step 3/

This takes you to your state AT Program website where you can sign up, or use their contact info to get in touch and find out what they offer to help the elderly.

State Financial Assistance Programs

 

These are non-Medicaid programs, which exist to lower the number of elderly persons entering Medicaid run nursing homes.

The programs run on a state-by-state basis and are designed to help the elderly to remain living in their homes – not all states have them.

The programs will pay for home modifications and also purchase necessary equipment, which includes bathroom safety equipment and walk in tubs and showers.

Eligibility for the programs differs with each one, but generally they are for the elderly and the disabled.

USDA Rural Development Section 504 Home Repair program

 

It is possible for the elderly, to get a grant for bathroom remodeling and safety equipment if they live in a rural area.

This program gives 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 grant is $7500.00, which is also the lifetime limit for grants.

 

To be eligible for the grant you must –

 

  • be the home owner
  • be 62 yrs and over
  • have a family income of less than 50% of the local average income
  • be unable to repay a home repair loan.

 

Applications are accepted at any time at local Rural Development offices here.

 

Protection and Advocacy Programs

 

These are legal services providing assistance to the elderly who are disputing denied claims.

Summary

 

Original Medicare Part B doesn’t cover much bathroom safety equipment for use in the home, but there are possibilities of getting the equipment through other Veterans, Medicaid and state run programs, and independent state programs and grants, at a time when administrations are doing as much as they can to help the elderly to age in their own homes.

 

Related Articles

 

Does Medicare cover walk in bathtubs ?

https://lookingaftermomanddad.com/does-medicare-cover-walk-in-bathtubs/

Does Medicare pay for bathroom grab bars ?https://lookingaftermomanddad.com/does-medicare-pay-for-bathroom-grab-bars/

54 Bathroom safety tips for seniors

https://lookingaftermomanddad.com/54-bathroom-safety-tips-for-seniors-a-helpful-guide/

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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