Why Original Medicare Doesn't Cover Shower Benches
Original Medicare, which includes Part A and Part B, has specific criteria for covering Durable Medical Equipment (DME). To be covered under Part B, an item must be:
- Durable: It can withstand repeated use.
- Medically necessary: A healthcare provider must prescribe it to treat a specific medical condition or illness.
- Used in the home: It must be for use in your place of residence.
- Primarily useful to someone who is sick or injured: Its use is limited to people with a medical condition.
Medicare classifies shower benches and bath chairs as "convenience items" because they are not considered essential for treating or managing a specific medical condition. The program assumes that individuals can use alternative methods, such as grab bars, to bathe safely. Because shower benches do not meet the definition of medically necessary DME, Original Medicare beneficiaries are responsible for the full cost out-of-pocket.
Comparing Medical Equipment Coverage
To illustrate Medicare's distinction between covered DME and non-covered convenience items, consider the following comparison:
| Item | Original Medicare Coverage? | Reason | Out-of-Pocket Cost (Original Medicare) |
|---|---|---|---|
| Shower Bench | No | Considered a convenience item, not medically necessary for treating a specific condition. | 100% |
| Bedside Commode | Yes | Covered as DME if the patient is confined to a room or unable to use a standard toilet due to physical limitations. | 20% coinsurance after Part B deductible. |
| Walker | Yes | Covered as DME if prescribed by a doctor as medically necessary for mobility issues. | 20% coinsurance after Part B deductible. |
| Raised Toilet Seat | No | Considered a convenience item, similar to a shower bench. | 100% |
| Wheelchair | Yes | Covered as DME if a doctor confirms it is medically necessary for use within the home. | 20% coinsurance after Part B deductible. |
| Grab Bars | No | Considered a home modification or convenience item, not covered by Medicare Part B. | 100% |
Potential Alternatives for Coverage
While Original Medicare does not cover a shower bench, there are other avenues to explore that may provide financial assistance.
Medicare Advantage (Part C) Plans
Medicare Advantage plans are offered by private insurance companies approved by Medicare and are required to cover all the services of Original Medicare. However, many of these plans offer supplemental benefits that Original Medicare does not. Some Medicare Advantage plans include coverage for health and wellness items, which may include bathroom safety equipment like shower benches. Coverage varies significantly between plans, so beneficiaries should contact their plan provider directly to inquire about specific benefits or over-the-counter (OTC) spending allowances.
Medicaid
Medicaid is a state-administered program that provides health coverage to low-income individuals. Unlike Medicare, many state Medicaid programs may cover the cost of a shower bench if a doctor deems it medically necessary and provides a prescription. Eligibility is based on income and other criteria, which differ by state, so beneficiaries should check with their local Medicaid office.
Veterans Affairs (VA) Benefits
For veterans, the Department of Veterans Affairs (VA) offers assistance for home safety equipment. Programs like the Home Improvement and Structural Alteration (HISA) grant or VA healthcare benefits may cover shower benches and other assistive devices when medically necessary. Veterans should contact their local VA office to learn about their eligibility and the required documentation.
Non-Profit and Community Programs
Several non-profit organizations and local communities run programs that distribute unwanted medical equipment to those in need. These centers for independent living or equipment loan programs can be a valuable resource for obtaining a shower bench at a low or no cost. Some states also have Assistive Technology Act programs that help individuals with disabilities get necessary equipment.
Tax Deductions
If a shower bench is purchased to accommodate a medically documented condition, its cost may be included as a medical expense when itemizing deductions on your tax return. It's recommended to save the receipt and consult a tax professional for guidance on eligibility.
Important Steps to Take
If you believe you may be eligible for an exception or alternative coverage, follow these steps:
- Get a prescription: Obtain a prescription from your doctor that clearly explains the medical necessity of the shower bench for your specific condition.
- Contact your insurer: If you have a Medicare Advantage plan, call the customer service number to inquire about any specific coverage or allowances.
- Explore alternatives: Investigate programs like Medicaid, VA benefits, or local community resources that may offer coverage or low-cost options.
- Use an approved supplier: When seeking coverage for any DME (like a commode), ensure the supplier is enrolled and accepts assignment with Medicare to minimize out-of-pocket costs.
Conclusion
In summary, Original Medicare does not cover shower benches because they do not meet the criteria for medically necessary durable medical equipment. However, this does not mean that all hope is lost. Individuals can find financial assistance through other sources, such as specific Medicare Advantage plans, Medicaid, VA benefits, or community programs. By obtaining a doctor's prescription and exploring all available alternatives, beneficiaries can find a solution that helps them maintain safety and independence in the bathroom.
