Unfortunately Medicare Rarely Covers The Cost Of A Shower Chair Or Other Bathroom Safety Equipment
As we age, we may need to make some home modifications in order to age in place, or remain in our homes and live safely, independently, and comfortably. Examples include installing ramps, safer flooring, or handrails making your kitchen more accessible and improving lighting. And, of course, you may wish to implement safety improvements in the bathroom, such as a shower chair or grab bars.
Shower chairs can help you prevent injury if you have mobility or balance issues, giving you the support you need to keep you safer while showering. However, Medicare does not consider shower chairs to be medically necessary, which means they are typically not covered.
Read on to learn more about Medicare coverage for shower chairs and other safety devices, as well as durable medical equipment coverage.
Medicare Advantage Plans Can Help Cover Other Home Health Devices
Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare and must cover everything that Part A and Part B covers.
Some Medicare Advantage plans may cover items if they provide primarily health-related benefits that are used to:
- Treat or prevent injuries or illness
- Compensate for physical impairments
- Reduce emergency medical care
- Address the psychological effects of injuries or illness
Some plans may offer services such as transportation to doctors offices, home delivered meals and bathroom grab bars if they meet the above criteria.
Though shower chairs may not be considered a primary health-related benefit, other types of coverage may be available from Medicare Advantage plans in your area that can help you live a healthier and more comfortable lifestyle.
Most Medicare Advantage plans offer prescription drug coverage. Some Medicare Advantage plans may also offer additional benefits, such as:
For California residents, CA-Do Not Sell My Personal Info, .
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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.
Does Medicare Advantage Cover Bathroom Equipment
Because Medicare Advantage is offered through private insurance companies, these plans may maintain a broader definition of whats medically necessary. Some policies may cover some or all of the cost of bathroom equipment that isnt reimbursable under Original Medicare, and beneficiaries should refer to the terms of their individual plan for details.
Some Medicare Advantage plans also include over-the-counter benefits, which may cover equipment that can be purchased without a prescription and isn’t considered medically necessary. This may include items such as shower chairs, transfer benches and raised toilet seats.
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How Medicare Helps Pay For Walkers For Seniors
Medicare Part B of Medicare generally pays 80-percent of the approved cost amount after you have satisfied your yearly Part B deductible. Then you will pay 20 percent of the approved price.
Medicare will pay this portion of walkers for seniors if you need to rent or purchase the equipment. In some cases, you may have the option to choose between buying and renting. In other cases, the decision may depend upon the temporary, long-term, or permanent nature of your medical issue.
When Does Medicare Pay For Walkers For Seniors
You can get to help pay for walkers for seniors and other DMEs under certain circumstances. Medicare might cover walkers for seniors and other durable medical equipment if:
- Your doctor wrote a prescription
- Medicare deems the equipment medically necessary
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What Is The Process For Purchasing Items Of Durable Medical Equipment On Medicaid And State Funded Programs And Waivers
The first step is to get the doctor, or therapist, to write a medical justification letter which states that the items in question are medically necessary.
The next step is to contact a DME Medicaid-approved supplier, and to furnish them with the medical justification letter.
The DME supplier then has to fill out a Prior Approval application.
Next, the Prior Approval document goes to the Medicaid state office where it will be either approved, or denied.
If the application is denied, you will be notified as to the reasons why, and if you wish to, how to appeal the decision.
If a purchase is approved, the beneficiary will receive their item with nothing to pay.
How To Buy A Shower Chair With Medicaid
Heres the easiest way to buy a shower chair with Medicaid. You dont need to do any guesswork or worry about whether your store accepts Medicaid.
Your first step is going to be finding a doctor that accepts Medicaid. You can use the Health and Human Services website to search through a database of doctors who take Medicaid. You can also call around to local physicians and see whose offices and which hospital are currently accepting Medicaid.
Your doctor can then prescribe you a medically necessary shower chair, transfer bench, or a different type of bath aide. The next step will be to get that prescription filled at a pharmacy that accepts Medicaid. Most major pharmacies, like Walgreens, accept Medicaid when paying for a shower chair.
If you’re not certain whether your pharmacy accepts Medicaid, make sure to call them in advance before the prescription order is placed.
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Coverage For Disposable Medical Supplies
In most cases, Medicare does not cover disposable medical supplies that are used once and then thrown away. However, some can be covered, such as supplies like test strips for diabetes. Youll want to check with Medicare or your Medicare plan provider directly to see if the item you need is covered. Sometimes it may be that Part D provides coverage. For example, some diabetes supplies are also covered under Part D.
*Note: If you qualify for Medicare home health, Medicare may cover certain disposable supplies, such as intravenous supplies, gauze or catheters.
Types Of Shower Chairs
There are a few different types of shower seats.
Shower stool. A shower stool is a seat without a back. You can find foldable stools for easy storage, which can be helpful if you have a small shower and youâre mobile enough to move the stool around.
Shower chair. These chairs have a back and might have side handles for extra grip and support. The back gives extra support, and the handles make it easier to get up and down from the chair.
Tub bench. A tub transfer bench is a long seat with two legs sit in the tub and two legs sit on the floor outside the tub. You can sit on the bench and slide across into the tub to bathe. Some are extra long so you can slide across to the tub or sit over the toilet, too.
Fold-down chair. You can wall-mount these chairs in your shower. You flip the seat down when youâre ready to bathe and fold it back up out of the way when youâre done.
Rolling shower chair. These chairs look like a wheelchair except with a commode-style seat. The seat is open underneath so you can access a toilet. The chair rolls and has locking wheels for safety. These are best for accessible showers where you can easily maneuver in and out.
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Are There Special Requirements For My Doctor To Be Able To Order A Wheelchair
Both the doctor and the medical equipment supplier must be enrolled in Medicare in order for the claim to be covered, so double check before you purchase medical equipment.
And youll want to understand the difference between providers that accept assignment with Medicare and those that dont. A durable medical equipment supplier thats enrolled in Medicare might not accept assignment, which means that the patient will end up paying more for the equipment. As long as the supplier is enrolled in Medicare and also accepts assignment, the patient will not have to pay more than the Part B deductible and 20% of the rest of the cost.
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What Does Medicare Say About Shower Chairs
To understand why Medicare does not cover shower chairs, you must understand what Medicare says about Durable Medical Equipment . Medicare defines DME as equipment that fulfills the following criteria:
- It has to be used at home
- It has to be reusable
- It has to last a minimum of three years
- It has to be used for a defined medical purpose
You can say that the shower chair passes the first three tests, but it fails the fourth. It is not something that fulfills a specific medical necessity according to Medicare, at least.
Also, a DME must have a prescription from a physician who accepts Medicare. The doctor works with an equipment supplier approved by Medicare and agrees to accept Medicare for the DME.
A shower chair and many other bathroom conveniences like safety rails do not fall into this category.
Will Medicaid Pay For A Shower Chair
Medicaid is a federal-state partnership program that offers low- or no-cost health insurance to low-income Americans. Some low-income families, women who are pregnant, the elderly, and those with disabilities are included. Medicaid is funded in part by the federal government, which establishes rules and regulations for the program.
Medicaid does pay for shower chairs for people who a physician has deemed a shower chair medically necessary.
If you are low-income but have a Medicaid insurance plan instead of the government-state-funded program, you may have to pay a small portion of the cost of the shower chair.
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What Can You Do With Medicare B Coverage In The Bathroom
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.
Walkers can also be used as an aid to standing at a sink or in front of a bathroom mirror,
If your shower is large enough you may be able to put a 3 in 1 portable commode chair in it , or a shower commode, which is just as easy to sit and wash on as a shower chair.
If you want to use a 3 in 1 bedside commode in the shower, and you want to know about the different types available, you can take a look at my articleCan a 3 in 1 commode be used in the shower?where I discuss the different commodes for the shower, including a type of commode called a shower transport commode which also doubles as a transport chair. There are also static shower commode chairs, but there are very few examples of these. The article has lists of examples of the different types and their weight capacities, so you can easily investigate.
If a 3 in 1 commode doesnt fit in the shower, it is perfectly easy to sit on the commode chair outside the shower, and wash there the commode chairs are portable and can be placed anywhere.
3 in 1 commodes come with side arms which give more stability when sitting down, and getting up we have used ours in many situations with my mom, and to great effect.
3 in 1 commodes can also be placed over the toilet as a raised toilet seat, and can be placed without their seat as a toilet safety rail around your toilet.
What Happens If You Have A Medicare Advantage Plan
For the Elderly with Medicare Advantage Plans its necessary to check with the plan provider to see if their shower chair is covered.
All Advantage Plans are offered by private Medicare-approved companies, and have to provide the same coverage and services as Original Medicare Parts A and B as a minimum, by law, and often cover more but as of last year Medicare Advantage has been allowed to add some new benefits.
In 2019 the Centers for Medicare & Medicaid announced their plans to expand the coverage of Medicare Advantage and Part D
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.
The text source CMS finalizes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage April 1, 2019. You can read the text here.
The new benefits can include equipment for individuals with chronic health conditions, and so some Advantage plans may offer coverage for certain types of bathroom equipment, such as grab bars.
You will have to scour the market to see which benefits Medicare Advantage plans are offering, and you must be aware, though, that Advantage Plan providers may require that any DME be purchased from a supplier in their network. If they dont, they may be refused coverage.
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What If I Have Coverage Through Medigap Or Medicare Advantage
If a person has a Medigap plan, it will likely pay all or a portion of the 20% coinsurance for durable medical equipment like wheelchairs. And if a person still has Medigap Plan C or Plan F, it will also cover the Part B deductible .
Coverage of durable medical equipment will vary from plan to plan if the enrollee has Medicare Advantage coverage. These plans are required to cover the same things that Original Medicare covers, so they do provide benefits for durable medical equipment. But the specifics of the coverage will vary depending on the plan. In that case, the Medicare Advantage insurer will be able to explain the coverage details and what steps need to be taken in order to have coverage under the plan.
Used wheelchairs, walkers and basic medical supplies can also be found at even greater savings as church bazaars, estate sales, garage sales, and online.
Louise Norris is an individual health insurance broker who has been writing about health insurance and health reform since 2006. She has written dozens of opinions and educational pieces about the Affordable Care Act for healthinsurance.org. Her state health exchange updates are regularly cited by media who cover health reform and by other health insurance experts.
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Medicare Durable Medical Equipment Coverage
Shower chairs are not considered durable medical equipment, which is covered by Part B. DME is defined as:
- Durable, with an expected lifetime of at least three years
- Used for a medical reason
- Not usually useful to someone who is not sick or injured
- Used in your home
If your doctor prescribes the DME for use in your home, it may be covered. After meeting the Part B deductible, youd pay 20% of the Medicare-approved amount if your supplier accepts assignment. Medicare pays the other 80%. Depending on the type of equipment, you may need to rent it, buy it, or choose whether to rent or buy.
Medicare Advantage Plans Can Cover Wheelchairs Walkers And Wheelchair Ramps
While wheelchair ramps are not covered by Original Medicare , they may be covered by certain Medicare Advantage plans .
A Medicare Advantage plans provides all the same basic benefits as Original Medicare, which means that Medicare Advantage plans cover wheelchairs and walkers the same way that Original Medicare does.
Most Medicare Advantage plans also offer additional benefits not covered by Original Medicare. Starting in 2019, a set of additional benefits approved for coverage by Medicare Advantage plans may include a number of aging in place items, such as home wheelchair ramps and bathroom grab bars. Check plan benefits to see if these services or items may be covered.
To learn more about Medicare Advantage plans and to compare plans in your area, call to speak with a licensed insurance agent today.
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About the author
Christian Worstell is a senior Medicare and health insurance writer with MedicareAdvantage.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles hes written, helping Americans better understand their health insurance and Medicare coverage.
Christians work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
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What Does Capped Rental Mean
Medicare will pay for the rental of the equipment for 13 continuous months of use with the exclusion of oxygen equipment which rents for 36 months. After Medicare has paid for 13 months of continuous use on capped rental equipment, the supplier shall transfer the title to the beneficiary. Oxygen equipment does not transfer title to the beneficiary and the supplier is required to maintain the equipment until the 60th month under Medicare guidelines. After the 60th month the beneficiary can opt for new equipment and a new 36 month rental period begins.
