Does Medicare Pay for Taller Toilets for Seniors? Here’s What You Need to Know

According to the Centers for Disease Control and Prevention, over 80% of falls among older adults happen in the bathroom. This makes bathroom safety equipment crucial, but many people question, does Medicare pay for taller toilets for seniors? The answer depends on your specific Medicare plan, as Original Medicare classifies raised toilet seats as convenience items and typically does not cover them.

Quick Summary

This guide explains Medicare's policies on covering bathroom safety equipment like raised toilet seats and commodes. It details the differences between Original Medicare and Medicare Advantage plan coverage, outlining eligibility and outlining potential out-of-pocket costs and alternative payment options for seniors.

Key Points

• Original Medicare does not cover raised toilet seats: Original Medicare considers raised toilet seats and permanent taller toilet installations as 'convenience items' and does not provide coverage for them.

• Medicare covers commode chairs under specific conditions: Medicare Part B covers bedside commode chairs as durable medical equipment (DME), but only if a doctor deems them medically necessary because the patient cannot use a standard toilet.

• Coverage may be available through Medicare Advantage: Some private Medicare Advantage (Part C) plans offer supplemental benefits that may include coverage for bathroom safety devices, including raised toilet seats or OTC allowances.

• Check your specific plan details: Beneficiaries with Medicare Advantage must contact their plan provider directly to determine if and what type of bathroom safety equipment is covered, as benefits vary widely.

• Alternative funding sources exist: If Medicare does not provide coverage, seniors can explore other options such as Health Savings Accounts (HSAs), Medicaid, VA benefits, or charitable organizations for financial assistance.

• Medical necessity is key for coverage: For any durable medical equipment to be covered, it must be prescribed by a Medicare-approved doctor and purchased from a Medicare-enrolled supplier.

Original Medicare (Part A and B) Coverage

Original Medicare, consisting of Part A (Hospital Insurance) and Part B (Medical Insurance), has specific and often strict rules regarding coverage for durable medical equipment (DME). While Part B covers certain items like wheelchairs, walkers, and hospital beds, it generally does not cover bathroom safety items deemed for convenience rather than strictly medical necessity. Unfortunately, this includes elevated or taller toilets, or even raised toilet seats that attach to existing fixtures.

Why are raised toilet seats not covered?

Medicare's classification system distinguishes between what is considered a medical device and what is a “convenience item.” For a piece of equipment to be covered under Part B as DME, it must meet several criteria, including being able to withstand repeated use, being primarily for a medical purpose, and not being useful to someone who is not sick or injured. Because a raised toilet seat or toilet riser can be seen as a convenience for a wide range of individuals and is not exclusively for a medical condition, it does not meet this strict definition.

What about commode chairs?

An important distinction to understand is the difference between a raised toilet seat and a commode chair. Medicare Part B will cover a bedside commode chair if it is deemed medically necessary and prescribed by a doctor for use in the home. This coverage typically applies if the beneficiary is confined to their bedroom or is otherwise unable to access or use a standard toilet. However, if the commode is used as a raised toilet seat over an existing toilet, it will not be covered. This distinction is critical for coverage, and your physician must provide documentation of medical necessity.

Potential coverage through Medicare Advantage (Part C)

Enrolling in a Medicare Advantage (Part C) plan can significantly alter your coverage for bathroom safety items. These plans are offered by private insurance companies approved by Medicare and are required to provide all the same coverage as Original Medicare. However, many also offer supplemental benefits that Original Medicare does not.

In an effort to promote “aging in place,” some Medicare Advantage plans may cover certain home safety items, including raised toilet seats or other bathroom equipment. Coverage can vary widely, with some plans offering specific allowances through over-the-counter (OTC) benefits or through special needs plans. It is essential to check with your specific plan provider to understand what is covered.

Medicare Advantage vs. Original Medicare for bathroom aids

Feature	Original Medicare (Part A & B)	Medicare Advantage (Part C)
Raised Toilet Seat	No coverage (considered a convenience item).	Possible coverage through supplemental benefits or OTC allowances.
Bedside Commode	Covered if medically necessary and used as a portable toilet away from a standard toilet.	Generally covered, sometimes with broader circumstances than Original Medicare.
Toilet Safety Frame	No coverage (considered a convenience item).	May be covered under supplemental benefits or OTC allowances.
Grab Bars	No coverage (considered a convenience item).	Some plans may cover grab bars, particularly for those with qualifying chronic conditions.
Installation of Equipment	Never covered for permanent modifications.	Coverage for installation is highly unlikely, but benefits vary.

Other avenues for assistance

Since Original Medicare offers no assistance for taller or raised toilets, and Medicare Advantage coverage is not guaranteed, beneficiaries should explore other options:

• Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA): If you have an HSA or FSA, you can often use these pre-tax funds to purchase medical equipment, including raised toilet seats and commode chairs.
• Medicaid: Eligibility and benefits vary by state, but some Medicaid programs may provide coverage for bathroom safety equipment for low-income seniors with mobility issues.
• Veterans Affairs (VA) Benefits: Veterans may be able to obtain assistance with bathroom safety equipment and home modifications through VA benefits, particularly through programs like the Aid and Attendance program.
• Non-profit Organizations: Some charitable organizations, such as Rebuilding Together, provide free or low-cost home modifications for eligible low-income seniors.

How to proceed with your bathroom safety needs

1. Consult your doctor. A medical professional can assess your mobility needs and provide a prescription for any necessary durable medical equipment, which is a prerequisite for any potential Medicare coverage.
2. Review your plan. If you have a Medicare Advantage plan, contact your carrier directly to review your specific benefits package. Ask about supplemental benefits for bathroom safety equipment and any available OTC allowances.
3. Check for approved suppliers. For any covered DME, ensure you purchase from a Medicare-enrolled supplier. If not, you may be responsible for the full cost.
4. Consider low-cost options. Raised toilet seats and other simple toilet aids are relatively inexpensive and can be purchased easily from medical supply stores or online.
5. Look into alternative funding. Explore resources like your state's Assistive Technology Program, local non-profits, and VA benefits to see if you qualify for other forms of assistance.

Conclusion

While the need for increased toilet height and other bathroom safety equipment for seniors is clear, the answer to does Medicare pay for taller toilets for seniors? is generally no under Original Medicare. Standard raised toilet seats and similar modifications are considered convenience items. However, a bedside commode is covered under specific medically necessary conditions, and some private Medicare Advantage plans offer supplemental benefits that may cover a broader range of bathroom aids. It is essential for seniors and their caregivers to understand the nuances of their specific plan and explore all available resources to ensure bathroom safety at home.

Medicare interactive offers additional guidance on home modifications and Medicare coverage.

Frequently Asked Questions

Will Medicare pay for a commode chair used over the toilet?

No, Medicare will not cover a commode chair if it is used simply as a raised toilet seat over an existing toilet. Coverage for a commode chair is only provided if it is medically necessary for use as a bedside portable toilet.

Are grab bars covered by Original Medicare?

No, grab bars are not covered by Original Medicare, as they are considered home modifications for convenience rather than durable medical equipment.

Can a Medicare Advantage plan cover a raised toilet seat?

Some Medicare Advantage (Part C) plans may offer coverage for a raised toilet seat through supplemental benefits or an over-the-counter (OTC) allowance. You must check with your specific plan provider to confirm your benefits.

Does Medicare pay for the installation of safety equipment?

No, Medicare does not cover the installation of permanent bathroom modifications like taller toilets, even if they are recommended by a doctor.

Can I use an HSA or FSA to pay for a raised toilet seat?

Yes, funds from a Health Savings Account (HSA) or Flexible Spending Account (FSA) can typically be used to purchase medical equipment, including raised toilet seats.

What is the difference between durable medical equipment (DME) and a convenience item?

Durable medical equipment must be primarily for a medical purpose and not useful to someone who is not sick or injured. A convenience item, like a raised toilet seat, is considered useful to a broader range of people and is not covered.

How do I know if my supplier is enrolled in Medicare?

Before purchasing any equipment, it is important to ask your supplier if they are enrolled in Medicare. You can also use the supplier search tool on the Medicare website to find approved providers in your area.