Medicaids Policy On Walk
Medicaid is a state run program . It is more likely to pay for a walk-in tub than Medicare. But again, each state will have its own criteria so please contact your states Medicaid office for details and information on their HCBS waivers and if they will pay for durable medical equipment and if they consider walk-in tubs as DME.
Durable Medical Equipment Definition
When it comes to Medicare and whether it will cover the cost of a given piece of equipment, such as a walk-in bathtub or many other potential types, the language to consider is whether the piece is considered durable medical equipment. These definitions stem from the original version of Medicare, one thats still followed in several important ways.
Unfortunately, in most cases walk-in bathtubs are not considered durable medical equipment under original Medicare. This means original Medicare will not pay for their cost or their installation. However, this does not mean there is no chance for Medicare financial assistance for a walk-in tub, as well detail below.
How Does Medicare Cover Walk
Medicare Part B covers walk-in tubs if they considered durable medical equipment. Durable medical equipment is any kind of equipment that cant be reused like a wheelchair.
Pre-2018, Medicare did not cover any surgical supplies for men or women age 55 and older. Now, they do cover them.
In general, one has to give it a try to be the beneficiary of using a walk in tub that is a durable medical equipment.
In this regard, a sort of medical diagnosis will substantiate the needs of the enthusiastic beneficiary.
Either a medical report showing diagnosis or a prescription written by a registered physician may serve the purpose well.
The prescription or diagnostic report should essentially outline some authentic reasons which may prove the necessity of getting a walk-in tub.
Gathering all the above supportive documents does not necessarily mean that Medicare guarantees its assistance.
So, it can be the best idea to take the walk in tub as an out-of-pocket possession which means that people should look for some other sources for their financial assistance.
Moreover, concerned people should prefer taking preparation for bearing the cost personally to waiting for the best supports after submitting a claim and get approved.
The only thing that can be said is the support does not come in advance of purchasing such tubs.
Rather, the supports are provided in the form of pay yet these excellent tubs would require to get considered a medical necessity.
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Once Your Parent Has Their Prescription What Do They Do
If Medicare accepts to cover your loved ones purchase, your loved one will have to pay their co-payment of 20% of the Medicare-approved price of the item and their annual deductible .
Medicare will pay the remaining 80% of the Medicare-approved price.
For cheaper DMEs Medicare will usually purchase the products, but in cases such as hospital beds where the items are much more costly, it is more likely that Medicare would rent on a monthly basis.
If the equipment is rented by Medicare from a Medicare-approved supplier who accepts assignment, your loved one will pay a monthly co-payment of 20% of the Medicare-approved rental price, and Medicare will pay the other 80% of the Medicare-approved rental price.
What About Medicare Part B Covering Walk
Medicare Part B will cover walk-in tubs if they are considered to be durable medical equipment, and in some cases, they are. If you can prove that the walk-in tub goes above and beyond comfort and convenience measures, you might be able to get Medicare to foot the bill for your tub.
A medical diagnosis from your doctor that supports your need for the walk-in tub as medically necessary will be required. In most cases, your doctor will submit a medical report on your behalf to the insurance company or, at the very least, will write you a prescription for the tub.
Gathering the appropriate documentation and proofs before submitting a claim to Medicare Part B does not ensure youll get approval, but it does increase your chances.Columbus Walk-in Bath Solutions is a company that cares about the well-being of its clients. Helping people get the walk-in tub and shower that helps them perform daily hygiene activities is what the company does best. If Medicare doesnt cover the cost of the tub, you can count on the company to offer budget-friendly prices and flexible financing options to make paying for the tub much easier.
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Costs And Other Savings Options
Walk-in tubs can be costly. According to Consumer Affairs, walk-in tubs can cost anywhere from $1,500 to $20,000.
The average costs without hydrotherapy are estimated to be between $2,000 and $5,000. You must also pay for installation, which can range from $700 to $3,000.
While Medicare generally doesnt cover a walk-in tub benefit, there are other ways to potentially make this option more affordable. These include:
You may want to talk with your doctor and ask if theyre aware of any programs in your community that may provide assistance for home modifications. This may include:
- caregiver organizations
2014 article in the journal Injury Epidemiology:
- In older adults, an estimated 7.8 percent of falls without injury and 17.3 percent of falls with injury occur in the bathroom.
- Older adults were 2.5 times more likely to fall in the bathroom than in a living room.
- The highest injury rates that brought older adults to the emergency department for treatment were from falls getting into or out of a tub or shower.
A walk-in tub doesnt guarantee that a person wont fall while bathing. Also, no studies have proven that walk-in tubs improve safety.
However, in theory, increased tub safety through interventions like walk-in tubs may help some individuals reduce their risk of falling and offer peace of mind to loved ones.
Programs That May Help Cover Costs
There are several programs that may help cover the costs of DME.
Medicaid
Medicaid is a program for people with low income and resources. It is means tested, and criteria vary between states.
Agriculture department grant
USDA Rural Development offers a grant to helps low-income older adults, who are also homeowners, to repair and improve their homes. This may include the addition of a walk-in bathtub.
Community organizations
Some community nonprofit organizations may have an initiative to help pay the cost of installing a walk-in tub. Manufacturers may also offer financing without interest.
Tax deduction
A person may want to check with a tax professional to find out if home modifications for medical safety may qualify as a medical expense and therefore be tax-deductible.
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And If They Dont Use A Medicare Participating Supplier
A Medicare-enrolled supplier who is not a Participating Supplier, agrees to take payment from Medicare, but doesnt have to accept assignment.
This means that the supplier is free to charge up to 15% more than the Medicare-approved price for an item, and that excess is passed on to the buyer.
Medicare will pay the supplier 80% of the Medicare-approved price, and your parent is going to have to pay the supplier the difference + their 20% co-pay of the Medicare-approved price + their annual deductible if they havent yet met it.
So, if the suppliers price for a DME is $60 above the Medicare-approved price, your parent will have to pay their co-pay + their deductible + the $60 !
How Fast Does A Walk
Another cost factor to consider when deciding whether or not to purchase a walk-in tub is the amount of water that it takes to fill it up.
Walk-in tubs generally take anywhere from 6 minutes to 15 minutes to fill up.
Most walk-in tubs need 40 to 80 gallons of water to fill up. That means bringing the water up to chest level while sitting. In contrast, standard bathtubs take 25 to 45 gallons of water.
The average cost for water in the USA is about $1.50 per 1,000 gallons. So, if you took 12 baths a month and your tub took 80 gallons of water each time you filled it up, then it would only cost you $1.50 for those 12 relaxing baths.
Its a factor to consider when choosing the size of the tub. The more water, the higher your water bill will be. So choose carefully.
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Medicare Pays For Some Types Of Durable Medical Equipment
Medicare advantage covers the costs of certain types of durable medical equipment. Walk-in tubs are covered only if they are classed as being medically necessary. To prove necessity, a beneficiary would need to submit evidence of a medical diagnosis proving that need and a prescription specifying why a walk-in tub is required.
The prescription should also outline any specific features the tub should have, especially if those features mean the beneficiary would need to purchase a particular brand or model of bathtub. Original Medicare will not cover the cost of a tub up-front. The beneficiary must purchase the tub as an out-of-pocket expense and then submit the receipts for the purchase along with the evidence required for their claim.
How Much Do Columbus Walk
Truthfully, the cost of walk-in tubs for Columbus consumers varies depending on the vendor, brand, and features. Plus, if you opt to have the tub delivered and professionally installed, there will most likely be a service fee.
The average cost of just the walk-in tub itself ranges from $2000 to $12,000, and the typical cost of installation is around $700 to $3000.
If you are someone who qualifies for both Medicare and Medicaid, you could fall under the Dual-Eligible Special needs Plan. That is a sector of the Medicare Advantage plan that customizes benefits for beneficiaries who are dual-enrolled in both state-funded programs, also known as “dual-eligibles.”
If you’d like to know if you qualify for help paying for your walk-in tub, you can contact the State Health Insurance Assistance Program .
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What If Your Loved One Has Medicare Advantage
For Medicare Advantage Plans, also known as Medicare Part C, you will need to check with the plan provider to find out if any bathroom safety equipment benefits are included.
Legally, Medicare Advantage Plans beneficiaries are entitled, as I noted earlier, to the same services and equipment as those on Original Medicare, but they may, as of 2020, find that they are offered additional benefits beyond the typical extras of hearing and vision aids.
The Centers for Medicare & Medicaid announced in 2019 an expansion of 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. The full text is available here.
Some new benefits which are for chronic conditions, and among these will be certain items of bathroom safety for individuals with mobility conditions, are now allowed.
You will need to look for the plans on offer which have bathroom safety equipment as a benefit for chronic conditions, and always remember to stick within the plan providers Network.
What Medicare Wont Cover
The government program is only interested in paying for specific items that are medically necessary and wants to make sure that the money is used for the designated purpose. Even if you follow the rules, there are specific bathroom aids and other DME that Medicare will pay for and others not.
In some cases, the rules determine that certain aids are not medical in nature or are more comfort, convenience, or self-help items than medical. Some of the items not covered include air cleaners or air-conditioners, bath lifts, bath seats, bed trays, grab bars, massage devices, raised toilet seats, or conventional toilet seats. Many big-ticket items such as walk in bathtubs, bath lifts, or exercise equipment are also not covered.
Medicare has a different logic that it uses for denying coverage for some of these items. Even though most bathroom injuries among seniors result from them trying to stabilize themselves on towel racks, shower doors, or other nonstructural items, Medicare refuses reimbursement for grab bars.
They assume that certain aids are inexpensive enough that the program considers that an average user can pay for them out of pocket. Considering that many seniors are on a limited income, this is an assumption that is often false. Other equipment such as walk in tubs or stair lifts are considered home modification that the program does not pay for.
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Veterans Benefits And Walk In Tubs
It is difficult to make a blanket statement about the Department of Veterans Affairs policy of paying for a walk in tub, as well as the home modification costs to install the tub. It is perhaps more beneficial to consider individual programs offered by the VA.
TRICARE and CHAMPVA with these insurance programs, it would be difficult to receive assistance for a walk in tub, as they do not consider them to be durable medical equipment. TRICARE for Life and CHAMPVA for Life function much like Medicare Supplemental Insurance programs. If TRICARE and CHAMPVA will not pay, then it is unlikely TRICARE for Life and CHAMPVA for Life will pay either.
Home Modification Grants On a more positive note, there are several VA programs that provide assistance that can be used for the purchase and installation of a walk in tub or roll in shower. The VA offers 3 different grants for disabled veterans:
Of these, the HISA Grant is the most applicable to aging veterans as their disability need not be connected to their military service. In other words, veterans who require a roll in shower simply because of aging challenges may qualify under the HISA Grant. Please note that a roll in shower is different from a walk in tub and HISA Grants do not cover walk-in tubs.
Medicare Response To Claims
Medicare responds to all claims. These claims are submitted directly to Medicare by your providers, and it can take about 30 days or more for Medicare to process these claims. You can check the status of your Medicare Part B claims by visiting MyMedicare.gov and logging into your account. You will be able to see a claim within 24 hours of Medicare processing it.
Its important to remember that there is no guarantee for the reimbursement from Medicare. Gathering all of the necessary information and documents doesnt mean that Medicare will pay for all or even part of the walk-in tub.
Medicare will respond to your claim as either
How to Fill out the
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Other Financial Assistance For Walk In Tubs
There are several other options which can help pay for a walk in tub, though it should be noted that these are not necessarily available to everyone.
Somewhat surprisingly, there is a grant available from the U.S. Department of Agriculture that helps elderly, low income residents of rural areas make home modifications to enable aging in place. These grants can be used for home and safety improvements including the addition of a walk in tub to ones bathroom. Learn more here.
Some states have non-Medicaid financial assistance programs for the elderly that can be used for home modifications such as walk in tubs. Unfortunately, only a handful of states have these programs at present. A list is available here.
On occasion, non-profit organizations have community initiatives that can offset the installation costs of a walk-in tub. It should be noted that these organizations typically do not pay for the cost of materials . One such program with a national footprint is called Rebuilding Together.
Finally, some manufacturers of walk in tubs offer financing which can convert a large upfront payment into a monthly bill. Monthly payments of between $80 and $150 can be expected.
Where Do I Get Dme
A person can use this online tool to find a DME supplier. People enter their zip code and are taken to a page where they can choose five products. If the product is not listed, the advanced search option may be useful.
Options include purchasing from separate medical suppliers or from one supplier who has all the products a person may need. The supplier contact information will include:
- name
- distance from the persons home
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Are There Any Exceptions To These Rules
Although walk-in tubs are not considered durable medical equipment, on rare occasions they can qualify for coverage. The first step is to have a doctor write you a prescription for the tub. A physician will only do this if theres a real physical need for such a bathing enclosure. Hydrotherapy for a degrative condition such as osteoarthritis or multiple sclerosis would be a valid reason for writing a prescription, which has to be very specific in its explanation of why a walk-in tub is a medical necessity.
Once a prescription is obtained, you will need to be sure to purchase a tub through a supplier thats enrolled in Medicare. If the company doesnt have a Medicare number, you wont qualify for reimbursement, even if you do have a prescription. Thats right, reimbursement. Medicare will not cover a walk-in tub at the time of purchase. The initial costs must be paid by you. If you meet the qualifying conditions, you will then be compensated, either fully or partially.
