In this guide, you’ll learn what, if any, bathroom equipment and restroom modifications Original Medicare may pay for. We’ll also update you on what equipment and bathroom safety renovations might be covered by some private Medicare Advantage plans.
So, if you want answers to the question does Medicare cover bathroom equipment? Read on!
Does Medicare Cover Bathroom Remodels and Equipment?
Related Services Medicare Covers
- Original Medicare does usually pay for an occupational therapist’s in-home assessment to recommend what safety and independent living renovations your senior bathroom may need.
- If you’re receiving nursing care (skilled services) through Medicare, you may also be eligible for a health care aide to help you with bathing and toileting (unskilled care).
Medicare Part C Bathroom Equipment Coverage
Medicare Advantage plans (Part C) used to offer very little coverage for bathroom renovation equipment, yet as of January 2022, some of these private insurance companies do cover bathroom renovations and modifications.
The average Medicare enrollee has at least 39 Part C Advantage plans from which to choose. Not all of these will cover bathroom equipment.
You can contact insurance providers that operate in your state to find out if their Medicare Part C plans cover bathroom equipment such as grab bars, walk-in tubs, toilet lifts, shower lifts, and more. Providers to contact may include Aetna, Blue Cross Blue Shield, Cigna, Humana, United Healthcare, or other providers depending on where you live.
The goal of insurance covering home bathroom renovation is to help aging people remain in their homes rather than move to a nursing home. Nursing home care is more expensive for the government than home and community healthcare.
Private insurance Medicare Advantage Part C plans differ widely in the types of bathroom remodels and equipment they cover, so you’ll have to look at what each company offers. These kinds of restroom equipment may be covered:
- Walk-in tub
- Accessible shower
- Widening of the bathroom door and hallway to accommodate a wheelchair or walker
- Non-skid strips in the bathtub
- An emergency medical alert system in the bathroom
- Grab bars
- Shower chair
By federal law, private insurance Part C Medicare must also include the same Part A and Part B coverage as Original Medicare.
Does Medicare Cover Any Bathroom Equipment?
As with bathroom renovation, Original Medicare’s coverage is very limited for Durable Medical Equipment (DME) for home bathrooms. Medicare not only doesn’t cover walk-in tubs and accessible showers but also won’t pay for raised toilet seats, showerheads, shower chairs, bath lifts, or even grab bars.
So, does Medicare cover bathroom equipment at all? The one DME bathroom item Original Medicare does cover is a:
- Portable Toilet/Commode Chair (see Page 9) A toilet chair is covered by Medicare for use in a bedroom for those who can’t use, or don’t have, a bathroom toilet.
To get a commode paid for 80% by Medicare, you will need a doctor to prescribe this equipment to you. To get this prescription for a beside commode, you’ll have to be unable to get to a toilet in a bathroom or live on a floor or in a space without a toilet.
The doctor prescribing the commode must meet with the Medicare enrollee face-to-face and include notes to Medicare about the patient’s medical condition and the reason the portable toilet is necessary. The physician must also explain any needed features such as a heavy-duty, wide-seated type of commode if the person weighs over 300 lbs. or a portable toilet with armrests if the arms help the person’s medical condition.
Otherwise, the Medicare beneficiary will receive the lowest-cost alternative. Once the prescription goes through, a Medicare-enrolled supplier will inform you whether you will rent or buy the toilet chair depending on current policy.
Why Does Original Medicare Only Cover a Portable Toilet?
Original Medicare considers safety equipment such as grab bars, non-skid flooring, and raised toilet seats as “convenience” items and not medically necessary. The same goes for walk-in tubs and accessible showers even if a doctor prescribes one of these for a patient with mobility issues.
A portable commode/toilet chair, on the other hand, is covered under Part B Original Medicare as it’s classified as Durable Medical Equipment (DME). To get the 80% Medicare coverage for a commode, the patient must not be able to access a bathroom toilet and also have a doctor’s prescription.
For more information on Medicare coverage of bathroom equipment contact: 1-800-633-4227
Well, that’s the whole scoop on all the answers to does Medicare cover bathroom equipment? We hope you learned what you wanted to know about Original Medicare and Part C Advantage plan bathroom and remodeling coverage. For more detailed information, you’ll need to check with insurance providers in your state and area about restroom safety items and bathroom equipment coverage.