Does Medicare Cover Bathroom Equipment?
- Safety equipment can make a home bathroom more accessible and reduce the risk of falls. Learn what Medicare's coverage criteria is for bathroom equipment.
For older adults with mobility concerns, adaptive equipment can greatly improve a home bathroom’s accessibility. Items such as handrails and raised toilet seats may promote independence and lower an older adult's risk of falling. However, this equipment can be costly, and Medicare beneficiaries should understand the program’s coverage criteria for durable medical equipment before making a purchase. So, does Medicare cover bathroom equipment? The answer depends on whether the items are deemed medically necessary.
Does Medicare Cover Bathroom Equipment?
As part of Medicare's durable medical equipment (DME) benefit, the plan covers items that are considered medically necessary to the beneficiary. Approved items are reimbursable under Medicare Part B, with the plan paying 80% of the cost if the beneficiary has met their deductible.
For Medicare to consider an item DME, it must meet the following criteria:
- It satisfies a medical need.
- It’s appropriate for home use.
- It’s durable enough for repeated use.
- It isn’t useful for an able-bodied individual.
- It has an anticipated lifetime of three or more years.
Unfortunately, under this criteria, Original Medicare categorizes most bathroom equipment as comfort or convenience items, which are not covered under program benefits.
Does Medicare Advantage Cover Bathroom Equipment?
Because Medicare Advantage is offered through private insurance companies, these plans may maintain a broader definition of what’s medically necessary. Some policies may cover some or all of the cost of bathroom equipment that isn’t 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.
Medicare Coverage Criteria for Specific Bathroom Equipment
Under Medicare’s coverage criteria, most bathroom equipment is categorized as a convenience and isn’t reimbursable. However, certain items may be considered medically necessary and reimbursable. Coverage criteria may also vary between Original Medicare and Medicare Advantage for the following common bathroom equipment.
Medicare Part B may cover the cost of a commode chair for an enrollee who is unable to use a standard toilet. To qualify for reimbursement, this equipment must be ordered by a plan-approved physician for at-home use due to medical necessity, and the chair must be purchased through a Medicare-approved supplier.
Shower and bath chairs aren’t generally considered medically necessary, so they’re not covered under Original Medicare. However, some or all of the cost may be covered by the over-the-counter benefit offered by some Medicare Advantage plans.
Grab Bars and Handrails
Although many older Americans consider grab bars and handrails essential for bathroom safety, Original Medicare doesn’t consider them medically necessary, and coverage isn’t provided. However, Medicare Advantage plan enrollees may be reimbursed for some or all of the cost of bathroom grab bars or handrails.
In most cases, Medicare doesn’t classify walk-in tubs as medically necessary and doesn’t provide coverage. However, in cases where an enrollee has severe mobility limitations, making a walk-in tub an absolute necessity, Medicare may make an exception.
Beneficiaries who think they may qualify for an exception should be prepared to pay out of pocket at the time of purchase. They should then submit a claim accompanied by the relevant documentation, including a diagnosis that supports the medical need and a written prescription detailing why a walk-in tub is medically necessary. The prescription should also outline any essential features the product should have. If Medicare approves coverage, the beneficiary is then reimbursed. Some Medicare Advantage plans may also cover the cost of a walk-in tub.
Transfer benches are considered comfort items and are not covered under Original Medicare. However, Medicare Advantage Plans that include OTC benefits may offer full or partial coverage for these items.
Elevated Toilet Seats, Safety Frames and Risers
Medicare generally considers toilet safety equipment such as risers, elevated toilet seats and safety frames to be personal convenience items and does not cover them. Medicare Advantage may offer some coverage if your plan includes supplemental OTC benefits.
Does Medicare Cover Bathroom Modifications?
Although a doctor may recommend bathroom modifications to improve accessibility and reduce the risk of falling, Medicare doesn’t cover the cost of this work.
Can You Apply for Coverage for Nonreimbursable Items?
Although most bathroom safety items aren’t covered under Original Medicare, it may be worth submitting a claim anyway. The claim should be accompanied by supporting documentation, including a prescription from a Medicare-approved physician with a relevant diagnosis code and requested product features. Your physician should also provide a written statement explaining the medical need for the equipment. If you plan to request reimbursement, always purchase equipment from a supplier that accepts Medicare assignment.
Does Medigap Pay for Bathroom Equipment?
Medigap plans are designed to supplement Original Medicare coverage by paying for copays, coinsurance and deductibles. As such, these policies typically only provide additional coverage for Medicare-approved items and can't be used on nonreimbursable items.
How to Finance Bathroom Safety Equipment
Although Original Medicare doesn’t reimburse for most bathroom safety equipment, the following financing options may be available to help seniors pay for essential items and home modifications:
- Medicaid: Low-income seniors may qualify for medical coverage under Medicaid. Program terms vary by state, but some Medicaid plans may provide coverage for bathroom safety equipment for enrollees with mobility issues. Rules regarding equipment type, brand and price may apply.
- VA benefits: Federal veterans benefits include programs such as the VA Aid and Attendance program and Housebound benefits, which help disabled vets and their surviving spouses pay for care-related services and support. Several VA housing grants are also available to help veterans pay for accessibility-related home modifications. Qualified veterans can apply for assistance online or at their local VA benefits office.
- Manufacturer financing: Seniors may be able to receive financing help directly through the manufacturer or seller. Qualified seniors can receive the equipment immediately and pay it off by making affordable monthly payments to the manufacturer or financing company.
- Charitable organizations: Nonprofit organizations such as Rebuilding Together complete home modifications for eligible low-income seniors who need help making their houses more accessible. Services may include the installation of bathroom safety equipment, such as grab bars and shower seats.
Some seniors may find it less costly to purchase bathroom equipment directly from an online store than to purchase it from a medical supplier and receive partial reimbursement through insurance.