Why Won’t Medicare Cover A Walk
Although it might be deemed a medical necessity for some people, especially seniors and others with limited mobility problems, original Medicare does not categorize walk-in tubs as durable medical equipment most of the time.
Another reason is the fact that it involves a physical change to the home, rather than an addition.
Having said that, there are some situations that might still qualify for some coverage, providing it is an absolute medical necessity.
Does Medicare Pay Walk In Tubs
A plethora of different medical items belong to the group which is considered as durable equipment.
Medicare program usually reimbursement for the following items:
Want Pricing & Installation Information ?
- Patient lift
- Special commodes
In fact, all these pieces are in place so that seniors can use a walk in tub shower easily and safety.
Financial Assistance For Walk
Although Medicare doesnt traditionally cover walk-in bathtubs, there are other means of financial assistance.
Did You Know: Medicaid offers different program options depending on the state you live in, and some of those programs will cover either part of all of a walk-in bathtub expense. However, you must do your research before buying a tub to make sure youre eligible for assistance.
What Veterans Benefits Can Be Used On Walk
According to statistics corroborated by National Institute on Aging studies, more than a third of people over the age of 65 suffer injuries due to slips and falls each year, and an alarming 81% of these accidents occur during showering and bathing. A top-quality, professionally installed walk-in tub is one of the best preventative measures that can be taken against injuries in the bathroom, which have been found to drastically increase with age.Read More
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
You May Like: What Age Can You Get Medicare Health Insurance
Why Should You Opt For A Walk
Walk-in tubs are modified bathtubs that companies design for elderly people. The modifications consist of an automatic door that opens independently and allows seniors to walk straight into the tub without requiring them to lift their legs.
Falls are dangerous for older people because they can severely injure them. The treatment for their injuries may cost them their savings. Hence, it is essential to take safety measures in the home as well as in the bathroom.
According to a 2014 study, seniors encounter 7.8% of fall incidents without injury and 17.3% of falls with injury in the bathroom. The percentage shows that older adults are 2.5 times more likely to trip in the bathroom than other rooms in a house.
The falls occur in the bathroom due to loss of balance and have the highest injury rates for older adults. A Walk-in tub may help prevent the risk of fall or injury. It contains more features such as handrails, modified safety seats, hydrotherapy jets, and an anti-slip floor.
While there is no definite evidence showing that a walk-in tub improves safety in the bathroom, it lowers the risk of falls for you or your loved ones.
Will Veterans Benefits Pay For Walk
Some veterans benefits may provide financial assistance for walk-in tubs. The two main health insurance plans available for veterans, TRICARE and CHAMPVA, generally don’t consider walk-in tubs medically necessary and are unlikely to provide coverage. However, as a veteran you may qualify for the following:
- Specially Adapted Housing program may pay for modifications to make homes wheelchair-accessible for veterans injured in the line of duty.
- Special Home Adaptation Grant program may pay for modifications to veterans’ homes if they suffered a single or double leg amputation, blindness or other serious injuries in the line of duty.
- Veterans Directed Home and Community Based Services may provide a set amount of money that veterans can use to improve their homes to increase accessibility so that they can age in place. If you qualify for this program, you can use some of the improvement allowance to buy and install a walk-in tub.
- VA pensions like the Aid and Attendance and Housebound pension programs provide money for veterans to use as they see fit, meaning the funds could go toward the purchase and installation of a walk-in tub.
You May Like: Is Upmc For You Medicare Or Medicaid
Under What Conditions You Can Get Medicare To Pay For Your Walk
Medicare usually does not pay for a walk-in tub because it differs from the other DME as it requires a specific installation and needs to make significant changes to your bathroom.
After installation, moving or reusing it is difficult, but most DME are reusable as you can rent or purchase it, then return it to the organizations. Most healthcare and insurance companies do not cover a walk-in bathtub because they dont find its medical necessity for veterans.
However, there is a way that you can use to get some cover on your walk-in tub. When you have original medicare insurance containing parts A and B, you can get a chance for your walk-in tub coverage.
You will need a doctor or healthcare professional to write you a prescription for the equipment to get coverage. You should include these things in your prescription
- Details about any diagnosed medical condition
- The reason why you require a walk-in tub, and
- How exactly it will improve your case.
Use specific wording in the prescription. It helps you qualify for getting financial support for the equipment. You will also need to shop the bathtub from a supplier that Medicare enrolls. The supplier should have a specific participant number from Medicare. If the private suppliers dont have it, you will not get reimbursement for your claim.
You may get financial support if you have a prescription and the participating supplier. However, approval of your claim for reimbursement is up to Medicare.
Does Medicare Cover Grab Bars
Medicare wont usually pay for grab bars, even if theyre a necessary bathroom safety device. Medicare covers bathroom safety devices that are medically necessary, not the equipment that is for comfort. Those with Part C may have some help paying for the cost of grab bars.
A simple install where studs are ready for mounting can cost about $75- $150, although a more complex job requiring additional support to the wall could cost more than $200.
Veterans with a prescription to make their homes more secure may get coverage from the Department of Veterans Affairs for shower chairs or grab bars.
Recommended Reading: How Do I Know If I Have Part D Medicare
Coverage Under Part B
If you have original Medicare, made up of parts A and B, and are seeking coverage for a walk-in tub, you first need a doctor to write a prescription for the equipment.
The prescription needs very specific wording, including details about any diagnosed medical condition you have and specific ways the tub would improve your condition.
You also need to purchase the tub from a supplier thats enrolled in Medicare. This supplier would have a specific participant number from Medicare, showing they accept Medicare assignment.
According to Medicare, you wont get reimbursement for your claim if the supplier doesnt have a Medicare number, even if the supplier is a large or well-known company.
With this prescription and a participating supplier, you may be able to purchase the walk-in tub, then submit the claim to Medicare for reimbursement.
Theres no guarantee that Medicare will pay any portion of the claim, but its likely your best chance at coverage with original Medicare.
Medicaids Policy On Walk
Even with Medicare Advantage plans offering new supplemental healthcare benefits in 2019, Medicaid is more likely to provide financial assistance for the purchase and installation of a walk in tub. Medicaid is not a single federal program. Instead each state has several different Medicaid programs. Therefore, there are possibly hundreds of different sets of rules governing Medicaids policy on the purchase of a walk in tub or low threshold shower. For example, Medicaid in California has a Medicaid program called Community Transitions that helps nursing home residents move back to private homes. This program very likely would cover the cost of a walk in tub.
There are also Medicaid programs for Home and Community Based Services . For example, Colorado has an Elderly, Blind and Disabled Persons Waiver, which will pay for specialized medical equipment and environmental accessibility modifications. Under these guidelines, when medically necessary to help an individual remain living in their home, Medicaid will pay the purchase price and installation costs for a walk in tub.
Each state has different Medicaid HCBS waivers. To determine if your state will pay for a walk in tub, you should examine the benefits of your states Medicaid waivers to see if they will pay for durable medical equipment, assistive technology, home modifications or environmental accessibility adaptations. A complete list of Medicaid waivers relevant to the elderly can be found here.
Don’t Miss: What Medications Are Covered By Medicare
What Equipment Does Medicare Pay For
Medicare Part B covers certain durable medical equipment when it considers it medically necessary.
Durable medical equipment is medical equipment for use in the home which is able to hold up to repeated use over a sustained period of time.
Examples of durable medical equipment which is covered by Medicare Part B for use in the home, when a beneficiary qualifies, are
There are two cases where disposable medical supplies may be covered
- for individuals receiving the Home Health Benefit, some supplies are covered
- if they are needed in conjunction with the use of an item of durable medical equipment which is being covered by Medicare Part B
For Medicare, durable medical equipment must fulfill the following criteria:
- It can only be used for a medical reason, as opposed to just for comfort
- Not normally of use to someone who isnt sick or injured
- You have to be using it in your home
- Should have an expected lifetime of at least 3 years
If the equipment you wish to purchase does not meet these basic criteria, you will likely not get coverage from Medicare Part B.
What Type Of Home Bathroom Aids Does Medicare Pay For
Adding bathroom aids such as walk in tubs, bath lifts, grab bars, handheld showerheads, and more can make them more accessible for seniors, but many such devices can be costly. Some add-ons such as handheld showerheads or grab bars are reasonably priced but installation drives up the total cost. Other devices, such as walk in tubs can cost thousands. Will Medicare assist seniors in offsetting the cost of these helpful devices?
Also Check: Why Is Medicare Advantage Free
Other Ways To Cover The Expenses Of Getting A Walk
Even if you cant get help from Medicare, you may be able to offset costs in a few ways. First, your tub installation is likely tax-deductible, especially if you can prove that it was installed for medical necessity. In this case, you can make the deduction through the medical expense deduction.
If you live with an adult child or other caretaker, the person who owns your home may be able to deduct the expense on their taxes. This is done through the Dependent Care Tax credit. Depending on your state, additional deductions or credits may be possible. Be sure to speak with your tax advisor about your options.
In addition to a tax credit, you can also consider payment plans to help you spread the cost of installation over many months. You can speak with your supplier about financing options. Just be sure to choose a monthly payment that fits your budget.
Getting The Best Price On A Walk
Chicago based manufacturer of acrylic walk-in bathtubs Ellas Bubbles is proud to announce the availability of an incredible array of best-in-class walk-in tubs at the most competitive prices in the nation. Budget-minded homeowners are now given the opportunity to make it easier for their family members, including their aging parents to enjoy a more comfortable, therapeutic, and safer bathing experiences in the comfort of their own home.
Also Check: How To Apply For Medicare Card Replacement
What Are Good Alternatives To Walk
If you cant afford a walk-in tub, consider a low-threshold or no-threshold shower. Most low- or no-threshold showers can be installed for far less money than a walk-in tub. A no-threshold shower is an excellent option for people who use a wheelchair for mobility. While you cant soak in a shower, the ease of use may be more beneficial to you, depending on your needs. For example, with a walk-in tub, you need to sit inside while it fills up and while it empties.
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.
Don’t Miss: How To Pay Medicare Premium
Customers Of Ellas Bubbles Frequently Ask If Medicaid Will Pay For A Walk
Although Medicare expanded supplemental benefits in 2018, Medicaid is still the more likely of the two programs to cover the costs of purchasing and installing a walk-in bathtub. Financial assistance, however, is by no means guaranteed.
Medicaid is fundamentally different from Medicare. While Medicare Part A and Part B are single programs administered by the Federal Government, Medicaid is managed on the state level. Furthermore, each state has multiple Medicaid programs. There are literally hundreds of Medicaid programs out there, each with its own set of rules.
Which programs you are eligible for depends on your state of residence and a number of other factors. For example, under the umbrella of Medi-Cal are separate programs for infants, pregnant women, assisted living, and nursing home care, none of which offer assistance in purchasing walk-in bathtubs.
Broadly speaking, Medicaids offers financial assistance for durable medical equipment. Unfortunately, walk-in tubs termed low-threshold showers under program rules are not usually recognized as durable medical equipment. The language is vague to allow for new technology, but the burden of interpretation is in the hands of Medicaid administrators. Historically, walk-in tubs have not usually made the cut.
A list of applicable waivers can be found at this website: https://www.payingforseniorcare.com/
Medicaid Supplemental Healthcare Benefits
As of 2019, Medicaid also offers new supplemental healthcare benefits, which are very similar to the Medicare Advantage Plan. Instead of being a single Federal program, there are many State programs that are governed by a multitude of different rules that include Medicaid HCBS waivers. You should examine the benefits of your states Medicaid waivers to establish your options for the installation of a walk-in tub.
You May Like: Does Medicare Cover Bladder Control Pads
Are There Times When Medicare Might Cover A Walk
Insurance is a complicated thing and Medicare isnt an exception. There may be a time under limited circumstances when a walk-in tub reimbursement applies, or some assistance is available.
You would need a doctors prescription that details the medical necessity for a walk-in tub. Included would need to be specific details about your medical condition and ways the tub would improve your condition.
The doctor and the supplier would both need to accept Medicare assignment for you to qualify for a reimbursement. Of course, there is still no guarantee that Medicare will pay any portion of the claim.
Medicaid could be an option for you if you have a low income. Some state Medicaid programs help pay for things like a walk-in shower. Since Medicaid is a state program, coverage varies. Contact your local Medicaid office for information about your eligibility.
Purchase And Installation Costs Of Walk In Tubs
Walk in tubs, the most basic versions, can be purchased for between $2,000 $5,000. However, the most basic versions often are not designed to accommodate individuals who predominantly use wheelchairs and those who have difficulty transferring themselves. Wheelchair accessible walk in tubs are typically twice as expensive as the basic version one should expect to pay between $5,000 $10,000. There is a great deal of variance in the installation costs of walk in tubs, largely depending on ones existing bathroom design and if other changes are needed to accommodate for wheelchair access. The most basic installation can take only 4-8 hours of work, but rarely are the installations so cut and dry. There are tilework, plumbing, hot water heater, and old tub removal considerations. As well as the cost of labor in ones local area . One should expect to pay between $700 $5,000 to have a tub installed.
The easiest way to determine your costs is to get a free, non-binding installation quote. You can obtain multiple quotes from several local home modification professionals at no obligation by completing this short form.
There are other costs associated with the installation of a walk-in tub. The table below shows cost ranges for common related bathroom safety products.
To see our in-depth coverage on walk-in tubs, see our review here.
Don’t Miss: Does Medicare Cover Biologics For Ra