Original Medicare's stance on shower expenses
Original Medicare, which includes Part A (Hospital Insurance) and Part B (Medical Insurance), typically does not cover home modifications, even if they are medically recommended. The program considers major structural changes, such as installing a walk-in shower, to be a home renovation rather than durable medical equipment (DME). Therefore, for most beneficiaries, Original Medicare will not help pay for a new or converted shower.
However, this does not mean all bathroom-related costs are excluded. Medicare Part B can cover certain items deemed medically necessary DME, provided a doctor prescribes them for use in the home. While the installation of a new shower unit is not covered, some individual pieces of equipment that improve bathroom safety might be. To qualify for DME coverage, the item must be reusable, used for a medical reason, and prescribed by a physician.
Home health services and personal care
In some limited scenarios, Medicare may cover intermittent home health aide services, which can include help with personal care like bathing. However, this is only covered if you are also receiving skilled nursing care or therapy services simultaneously and are certified as homebound by a doctor. Medicare will not pay for an aide if personal care is the only assistance needed.
Potential coverage through Medicare Advantage (Part C)
For many seeking assistance with shower and bathroom modifications, Medicare Advantage (Part C) plans offer more potential flexibility. These plans, offered by private insurance companies, are required to cover everything that Original Medicare does, but many also provide additional, expanded benefits. Some Medicare Advantage plans have started offering coverage for home modifications to help members age in place.
Examples of potential Medicare Advantage benefits
- Walk-in showers or tubs: Some plans may cover these if deemed medically necessary and prescribed by a doctor.
- Shower chairs and grab bars: While generally not covered by Original Medicare, some Part C plans may cover these items as supplemental benefits.
- Over-the-counter (OTC) allowances: Some plans provide a quarterly or annual allowance for health-related items, which could potentially be used for certain shower safety equipment.
It is essential to remember that coverage varies widely by plan, and specific benefits depend on the insurance provider and the details of your selected plan. Contacting your Medicare Advantage company directly is the best way to understand your coverage options.
Comparison of Original Medicare and Medicare Advantage coverage
| Feature | Original Medicare (Parts A & B) | Medicare Advantage (Part C) |
|---|---|---|
| Full Shower/Remodel | Not Covered. Considered a home modification. | Potentially Covered. Some plans offer benefits for medically necessary home modifications. |
| Durable Medical Equipment | Covered (e.g., commode chairs, patient lifts) if medically necessary and prescribed by a doctor. | Covered (must match Original Medicare coverage). Can also include broader coverage for bathroom items like shower chairs. |
| Shower Chair/Bench | Not Covered. Considered a convenience item, not DME. | Potentially Covered. May be offered as a supplemental benefit or through an OTC allowance. |
| Grab Bars | Not Covered. Also considered convenience items. | Potentially Covered. Similar to shower chairs, some plans may offer coverage. |
| Home Health Aide for Bathing | Covered only if receiving skilled nursing or therapy services concurrently. | Coverage may vary; must match Original Medicare standard. Some plans may offer more extensive in-home support. |
Alternative financial assistance programs
If Medicare coverage is not available for your specific needs, several other programs may offer financial assistance for bathroom modifications and safety equipment. These can include:
- Medicaid: State-level Medicaid programs often have Home and Community-Based Services (HCBS) waivers that can cover home modifications and assistive technology for eligible individuals. Eligibility and benefits vary by state.
- Veterans Affairs (VA) Benefits: Veterans may be eligible for grants, such as the Home Improvement and Structural Alteration (HISA) grant, to make medically necessary improvements to their homes.
- State and Local Programs: Many states and municipalities offer grants or low-interest loans for seniors and people with disabilities to help with home modifications. Contact your local Area Agency on Aging for information on available programs.
- Non-Profit Organizations: Organizations like Rebuilding Together provide home repairs and accessibility modifications for low-income homeowners.
Steps to seek coverage
- Consult your doctor: Discuss your mobility issues and needs. Your doctor can help determine if any equipment is medically necessary and write a prescription. This is a critical first step, especially for Medicare Advantage plans.
- Contact your plan: If you have a Medicare Advantage plan, call them directly to ask about specific benefits related to home modifications or bathroom safety equipment. Be prepared to provide details from your doctor.
- Explore alternatives: If Medicare will not cover your needs, research Medicaid waivers, VA benefits, and other local and state programs that offer assistance for home modifications.
- Use approved suppliers: For any covered DME, ensure you use a Medicare-approved supplier to facilitate billing and reimbursement. You can search for suppliers on the Medicare website.
Conclusion
While Original Medicare does not cover the cost of a shower installation or remodeling, it may cover specific durable medical equipment items, such as commode chairs, if they are deemed medically necessary and prescribed by a doctor. For those with Medicare Advantage (Part C) plans, there may be more extensive coverage options, including benefits for shower chairs, grab bars, and sometimes even walk-in tubs, depending on the specific plan. Individuals should not rely on Original Medicare for major bathroom renovations but can explore Medicare Advantage and other assistance programs like Medicaid or VA benefits for support. The best approach is to start with a doctor's evaluation and then contact your specific plan provider to understand your unique coverage options. Being proactive can ensure you find the necessary equipment and modifications to age safely in your home.
Sources
- Centers for Disease Control and Prevention
- Medicare.gov
