Original Medicare (Part A and B) and shower chairs
Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), does not typically cover the cost of a shower chair. The key reason for this stems from Medicare's strict definition of Durable Medical Equipment (DME). For an item to be classified as DME, it must meet several criteria, including being deemed "medically necessary" to treat or diagnose a specific illness or condition. Unfortunately, Medicare considers a standard shower chair to be a "convenience item" or an "aid to personal care" rather than essential for medical treatment.
The DME criteria not met by shower chairs
To qualify as DME, an item must meet the following criteria:
- Be durable: Capable of withstanding repeated use.
- Be primarily for medical purpose: Necessary to treat or manage a specific medical condition.
- Not be useful to someone who isn't sick or injured: Primarily used by people with a medical need.
- Be used in the home: Intended for patient use within their residence.
- Have a life expectancy of at least three years: Expected to last for a reasonable period.
A standard shower chair often fails the "primarily for a medical purpose" and "not useful to someone who isn't sick or injured" criteria. Medicare officials assume individuals can use other methods, such as grab bars or stationary surfaces, making the chair not critical for managing a specific medical condition.
Medicare Advantage (Part C) plan coverage
While Original Medicare doesn't cover shower chairs, some Medicare Advantage (MA) plans, offered by private insurers, may offer coverage. MA plans often provide additional benefits beyond what Original Medicare covers, sometimes including home safety equipment or over-the-counter (OTC) spending allowances.
How to check for Medicare Advantage coverage
- Contact your plan provider: Call your MA plan's customer service to ask about specific benefits. Coverage for items like shower chairs or other assistive devices varies significantly by plan.
- Check OTC benefits: Some MA plans offer a quarterly or annual allowance for purchasing health-related products, which might include a shower chair. Review your plan's catalog to see if it qualifies.
Potential alternatives and funding options
If you don't have a Medicare Advantage plan that covers a shower chair, or if you need a solution beyond standard coverage, several alternatives are available.
Medicaid
Medicaid is a state-administered program for low-income individuals. Unlike Medicare, many state Medicaid programs may cover the cost of a shower chair if it is deemed medically necessary and prescribed by a doctor. Eligibility is based on income and requires a prescription stating the medical need.
Department of Veterans Affairs (VA) benefits
Veterans may be eligible for assistance with home safety equipment, including shower chairs, through the VA. Programs such as the Home Improvements and Structural Alterations (HISA) grant may help cover these costs. Veterans should contact their local VA office for eligibility details.
Community and charitable organizations
Many local organizations and nonprofits offer free or low-cost medical equipment, including shower chairs. These can be excellent resources if you need assistance quickly and affordably. Look into organizations such as:
- Area Agencies on Aging (AAA)
- The Lions Club
- Easterseals
- Local centers for independent living
- Nonprofits that redistribute donated medical equipment
Using a commode chair as an alternative
In some cases, a commode chair can serve as a covered alternative. A commode chair is primarily used for toileting and meets Medicare's criteria for DME. Many commode chairs are waterproof and can be used in the shower. If a doctor prescribes a commode chair for a medical reason, it may be covered by Medicare. Beneficiaries must ensure they get the prescription and use a Medicare-approved supplier.
Comparison table: Original Medicare vs. Medicare Advantage
| Feature | Original Medicare (Part A & B) | Medicare Advantage (Part C) |
|---|---|---|
| Shower Chair Coverage | No, considered a convenience item. | Possibly, coverage depends on the specific plan. |
| Durable Medical Equipment (DME) | Covers medically necessary items like walkers, wheelchairs, and commode chairs. | Covers all DME under Original Medicare, with potential for additional benefits. |
| Over-the-Counter (OTC) Benefits | Not offered. | Often includes an OTC allowance that can be used for health-related items, including some bathroom safety devices. |
| Home Safety Items | Does not cover convenience items like grab bars or toilet risers. | May offer additional coverage for home modifications or safety equipment. |
| DME Supplier | Must use a Medicare-approved supplier. | Must use suppliers within the plan's network, which may also be Medicare-approved. |
How to get a shower chair with Medicare Advantage
- Check your plan details: First, review your plan's benefits or contact customer service to confirm if shower chairs or OTC allowances are included. This is the most crucial step, as coverage is not guaranteed.
- Obtain a prescription: If required by your plan, get a prescription or a letter of medical necessity from your doctor. This documentation strengthens your case for coverage.
- Purchase from an approved supplier: Even with an MA plan, you must use a supplier within your plan's network and approved by Medicare. Buying from an unapproved vendor will likely result in a denial.
- File a claim: Submit your claim with the necessary documentation, including the prescription and receipt, to your MA plan provider.
Conclusion
To the question of how often will Medicare pay for a shower chair, the answer for Original Medicare is almost never, as it does not meet the requirements for Durable Medical Equipment. However, beneficiaries have multiple avenues to explore. If enrolled in a Medicare Advantage plan, you might find coverage through supplemental benefits or an OTC allowance. For those with lower income, state Medicaid programs are a viable option, provided a doctor deems it medically necessary. Veterans can investigate benefits through the VA. Finally, community resources and charitable organizations can offer low-cost or free options for those who need a shower chair. Before making a purchase, always verify your specific plan's details and explore all available alternatives to determine the best path forward.
