What Does Your Parent Do Now They Have The Prescription
If Medicare accepts to cover your parents DME purchase, your parent will need to pay their annual deductible 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%.
Examples Of Assistive Devices
The following are just a few examples of common activities and the types of assistive devices that can make them easier and safer:
- Bathing – grab bars, hand-held shower head, bath seat with arm rails, non-slip floor mat.
- Dressing – long-handled shoe-horn, velcro fastenings, sock pullers, rubber gloves .
- Preparing food – easy-grip utensils, side-opening oven door, height-adjustable cupboards and counters, automatic-stop kettle, pouring aid.
- Moving/physical activities – cane, walker, wheelchair, slip-resistant flooring
- Using the telephone – loud-ringing phone, flashing light ring indicator, large numbers and buttons, automatic dialling.
- Enjoying hobbies – playing card holder, long-handled gardening tools, television remote control with large buttons and a captioning button, modified keyboard that makes the computer more user-friendly, audio books, magnifying glass.
List Of State Medicaid Programs That Cover Home Modifications
Medicaid programs are state specific they can also be condition-specific and / or age-specific. In each state, they have different names. Our organization has researched and found the following states to have Medicaid programs that include some level of assistance for home modifications / environmental adaptations. To be clear, this list is not comprehensive of all Medicaid programs that pay for home modifications. Rather, it is a comprehensive list of those programs that are relevant to the elderly. As an example, those waivers that strictly serve developmentally disabled individuals have been excluded from this list. Finally, some of the programs listed below are consumer directed, meaning the beneficiary has the freedom to choose how they spend the financial assistance they receive. Therefore, the funds can be used for home modifications even if the language of the waiver does not specifically state that it includes home modifications.
Did You Know? For persons not Medicaid eligible, there may be other state and federal programs that help pay for home modifications for aging in place. Read more or search for programs here.
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Prosthetic And Orthotic Items
Orthopedic shoes only when theyre a necessary part of a leg braceArm, leg, back, and neck braces , as long as you go to a supplier thats enrolled in MedicareArtificial limbs and eyesBreast prostheses after a mastectomyOstomy bags and certain related suppliesUrological suppliesTherapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.
Cataract glasses Conventional glasses or contact lenses after surgery with insertion of an intraocular lensIntraocular 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 .
What Are Bathroom Safety Rails
Bathroom safety rails are key components in the bathroom or toilet to protect older people from falling. They are often placed on the walls of the toilet. They are like bars that older people hold on to when maneuvering their way to the bathroom. Bathroom safety rails are very specific terms when it comes to Medicare. If you want to know if the answer is probably yes, does Medicare covers toilet safety rails, and the answer is probably yes.
To give you a wider perspective, bathroom rails falls under the bathroom safety devices. They are devices wherein it provides safety around the toilet. Bathroom devices often include grab bars for the walls, shower chairs, a raised toilet seat, and a showerhead that can be held, which allows you to get bathed while seated. These are some of the few devices that fall under bathroom safety devices.
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Some Medicare Advantage Plans Pay For Walk
Medicare Advantage plans, or Medicare Part C, are sold by private insurance companies. By law, these plans must provide all of the same minimum coverage as Medicare Part A and Part B, which means all Medicare Advantage plans will provide the same coverage discussed above.
Once that minimum requirement is met, Part C plans may then offer some additional benefits of their own. Most Medicare Advantage plans offer prescription drug coverage, and many plans also offer dental, vision and hearing benefits that Original Medicare doesnt cover.
More and more Medicare Advantage plans now may cover bathroom remodeling and home renovations.
Some of the bathroom and home remodeling benefits that some Medicare Advantage plans may pay for can include:
- Walk-in tubs or showers
- Traction strips for stairs or tubs
- Wheelchair ramps
Does Medicaid Pay For Wheelchair Ramps
4.7/5MedicaidMedicaidpaying for wheelchair rampspay
Keeping this in consideration, are wheelchair ramps covered by Medicaid?
Wheelchair ramps are classified as durable medical equipment under Medicaid as well. This is a federal program for low-income seniors and individuals with disabilities and is administered at the state level. That means that a wheelchair ramp can be covered by Medicaid if it is deemed medically necessary.
Secondly, does the VA pay for wheelchair ramps? Called the Veteran Housing Grants Program, this part of their foundation will pay for wheelchair ramps plus much more in regards to modifying the home for accessibility purposes. Their grants typically range from $100,000 to $500,000.
In respect to this, how can I get a free wheelchair ramp?
You can receive an application through your local AAAs office. If you cannot get approved through Medicaid, then you should consider free programs. The Habitat for Humanity provides a free handicapped ramp program for disabled, low-income and fixed income seniors.
Are handicap ramps covered by insurance?
Wheelchair ramps fall under the category of Medicare Part B, Durable Medical Equipment , and are therefore covered under the DME provision of the policy. However, the ramp must first be declared medically necessary by a licensed physician.
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Will Medicare Pay For Stair Lifts
Medicare Part B covers most handicapped equipment and supplies for use in the home, but it does not pay for home modifications, construction or installation of permanent equipment. So, Medicare Part B can cover chair lifts or bed lifts, but is not likely to cover curved stairlifts or stairlifts that carry you up and down narrow stairs. However, you should investigate other kinds of equipment available from medical equipment suppliers that might make it easier for you to get up and down stairs.
Medicare: Medically Prescribed Home Modifications
Other modifications such as grab bars fall under the banner of durable medical equipment if they are medically prescribed. Walk-in tubs and curbless showers are trickier to get coverage forbut not impossible.
Grab bars: Dr. Robert Mirsky, chief medical officer of Aetna Medicare, gives the theoretical case of 76-year-old Mary who lives alone. She deals with balance issues along with congestive heart failure and hypertension. Her home has obvious fall risks such as throw rugs and step-up thresholds for the bathtub and shower. Mary misses a blood pressure appointment because she cannot get to the doctor. The doctor then refers Mary to a care manager who eventually arranges for grab bars in the bathroom and other basic home modifications.3
Senior-friendly showers and tubs: Philip Moeller, a journalist specializing in aging and Medicare, was faced with this question from a man named David: Sooner or later, I will fall again. Prevention includes a shower stall for people like me. Will Medicare help cover the expense of a replacement shower? I am 70. Moellers answer: Shower and other senior friendly bathroom and home modifications may be useful and even lead to reduced falls and injuries. But Medicare usually does not consider such improvements to be medically necessary. So Im afraid that David would have to pay for such improvements out of his own pocket.4
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What Are Grab Bars
Grab bars are graspable bars to help someone maintain balance and lessen fatigue while standing. They are used to provide safety in the bathroom for seniors, people with disabilities and those recovering from an injury or illness that impairs balance or mobility.
Grab bars can be installed in the tub or shower area, near the toilet or sink and in other areas of a home, such as the kitchen, hallway and other rooms. In this guide, we focus primarily on bathroom grab bars.
Does Medicaid Cover Grab Bars
Please see benefit plan descriptions.,dose medicare or medicaid cover grab bars for the house? My mom is 81 and she needs gab bars in the house.So she can get to her room and back and she dose have medicare and medicaid can yall help, maximum payment amounts, and the members cost sharing are determined by Blue Cross, grab bars, reimbursement methodology, Under nonstandard plans that do not exclude safety items, and the members cost sharing are determined by Blue Cross, immunizations, not the equipment that is for comfort, or in-home respite care to give unpaid family caregivers a break from their Such adaptations may include the installation of ramps, modification of bathroom facilities, installation of specialized electric and plumbing systems needed to accommodate the medical equipment and supplies necessary for the welfare of the Because Original Medicare doesnt cover these items, for instance, such as electronic pill boxes to remind persons with dementia to take their medications, South Dakota Medicaid will cover the
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Medicaid Waiting List For Some Modifications
In many cases, Medicaids home and environmental accessibility modifications are available via home and community-based services waivers. In some states, you could be on a waiting list for HCBS waivers for several years. You must also demonstrate the functional need for these modifications.
- Your doctor submits a comprehensive report explaining your health, your ability to get around and your ability to perform the activities of daily living.
- Youre unlikely to qualify for HCBS waivers if youre in good enough health that you wouldnt otherwise go to assisted living or a nursing home.
- Part of the goal with these waivers is to keep people living at home longer.
- Given the waiting list in some states, it can be tempting to apply for waivers before you need them. The logic goes like this: By the time you get to the top of the list, youll actually need these supports. Unfortunately, it doesnt work like that. You must already show functional need at the time you apply.
Everything Medicare Covers Around The House: Home
Chronically ill seniors enrolled in certain Medicare Advantage plans could be eligible for better indoor air quality equipment and home modifications such as grab bars, The safely items covered by this benefit include: Shower/bathtub grab bar Tub stool or transfer bench Commode rails Elevated toilet
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Purchasing Used Walk In Tubs
It is possible to purchase a walk in tub in used condition. However, in reality, this rarely happens due to the removal and shipping challenges. Both of which can easily damage a tub. Most individuals decide the cost savings of purchasing used does not warrant the risk of a damaged or leaky tub as well as the hassles associated with transporting the tub to a new location. Furthermore, many families have hygiene concerns when it comes to purchasing used bathing equipment.
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What Is Upgraded Equipment And How Does One Purchase It With Medicare
Sometimes suppliers will reduce the cost of upgraded equipment in order to make a sale.
Typically, when Medicare approves an item of durable medical equipment, they will approve only the most basic item available. For example, Medicare may approve the purchase of a walker, but not one with wheels and a hand brake this would be considered upgraded equipment.
It is possible that an upgrade is medically necessary, and if so, Medicare will pay for its part of the upgrade cost. Ones prescription must state specifically the medical reason for why an upgrade is necessary. For example, the individual does not have the physical strength or balance required to lift a standard walker, and therefore, one with wheels is required.
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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 ones purchase were approved, unlike with Medicare, there would be nothing to pay.
Plan Medicare B: Medical Insurance
Unlike hospital insurance, this type of insurance covers doctors fees, medical supplies, outpatient care, and other precautionary facilities. It covers healthcare service and preventive measures, ambulance services, durable medical equipment, other types of outpatient prescription drugs, and mental health coverage.
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Grab Bars And Handrails
Although many older Americans consider grab bars and handrails essential for bathroom safety, Original Medicare doesnt consider them medically necessary, and coverage isnt provided. However, Medicare Advantage plan enrollees may be reimbursed for some or all of the cost of bathroom grab bars or handrails.
Saving Money On Shower Chairs
The price of a shower chair can vary widely based on the kind of chair you need. Basic shower chairs can cost as little as $15, but more advanced models can cost up to $300.
If you need help paying for a shower chair, there may be ways to save money. Here are some tips that could save you money on the chair you need:
- Know your Medicaid benefitsIf you have both Medicare and Medicaid, it is possible that Medicaid will cover the bathroom equipment that Medicare wont, depending on which state you live in. Medicaid likely wont cover your chair if your need is for showering or bathing only, but it might cover it if you need a more advanced chair that can also help you use the toilet. Check with your state Medicaid office to see if you are eligible.
- Check with the VAVeterans may be able to get a shower chair or grab bar through the Department of Veterans Affairs if the chair is deemed necessary for treating a medical condition.
- Shop onlineLarge retailers, such as Walmart or Amazon, may offer lower prices than your DME provider. When you shop online, you can compare products and prices to ensure youre getting the best deal.
- Ask a friend to build oneIf you dont need anything fancy, there are simple ways to build your own shower chair. If you have a handy friend or adult child willing to help you build it, you could get an effective chair at a fraction of the cost it takes to purchase one new.
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What Are Medicare Suppliers Vs Medicare Participating Suppliers
To ensure that Medicare beneficiaries pay the minimum out-of-pocket for durable medical equipment, it is important to distinguish between Medicare Suppliers and Medicare Participating Suppliers.
Medicare Participating Suppliers are suppliers that have agreed to accept assignment. Assignment is the Medicare approved price for a specific item of DME. Purchasing from a Medicare Participating Supplier ensures the individual will not pay more than the 20% co-pay of the Medicare approved price for an item. This is usually the least expensive route for Medicare beneficiaries.
Medicare Suppliers are enrolled in Medicares program. This means they will accept Medicare as a form of payment, but they dont have to accept assignment. This means they have the flexibility to set their own prices, but they can still accept assignment. By using a Medicare Supplier, the individual may or may not spend the least amount out-of-pocket.
There are also DME Suppliers that are not approved by Medicare. If one purchases from these suppliers, Medicare will not pay any portion of the cost. Thus, before purchasing DME, it is important to ensure DME Suppliers are approved by Medicare and that they accept assignment.
How Do I Enroll In A Medicare Advantage Plan That Covers Grab Bars
To learn more about Medicare Advantage plans in your area that may cover grab bars, you can speak with a licensed insurance agent. Find out more about the benefits you may be able to receive and compare the costs of plans that are offered where you live.
Explore Medicare Advantage plan benefits in your area
Or call speak with a licensed insurance agent. We accept calls 24/7!
About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.
Plan availability varies by region and state. For a complete list of available plans, please contact 1-800-MEDICARE , 24 hours a day/7 days a week or consult www.medicare.gov.
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