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?
Obtaining Medicare Coverage
In theory, Medicare Part A and B will pay for what is considered “durable medical equipment” or DME. Part A, hospital insurance, will pay for certain aids for homebound individuals who cannot leave their home and to need skilled nursing care.
As long as the equipment is purchased from an approved supplier, Medicare will pay 80% of the allowable amount with the balance payable by the user or other insurance. Part B pays for 80% of medical equipment for more mobile individuals so long as they reside in a personal home that is not a nursing home. For those who have Medicare Advantage Plan or Part C the reimbursement is the same.
In order to be considered for reimbursement, Medicare insists that you have:
- A prescription from your doctor for a particular type of equipment.
- Documentation in your medical records that you need the equipment, with dates and signatures from the doctor.
- Already placed an order with the supplier for the equipment you need.
What Medicare Won’t 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.
Other Funding Sources
A senior who needs these aids might be able to get some help from Medicaid, which has rules that vary in each state or from other programs such as Veterans programs that have different rules than Medicare does. If you want one of these major improvements, you might be able to get help from one of these sources or from other organizations. You may also be able to write off the cost of some equipment and home modification on your taxes as medical connections.
When you need to install bathroom aids to help yourself or another person in the home, work with an experienced company such as Western Stairlifts that sells and installs equipment and makes home modifications. The staff there will help you understand what Medicare covers, and are experts in finding alternative ways to help you find funding for necessary bathroom aids and other medical equipment.