Does Medicare cover bathroom equipment?

Does Medicare cover bathroom equipment? If you have Medicare as your health insurance service provider, they should cover a limited selection of bathroom equipment. This is as long as your doctor deems it meets the medical necessity criteria defined by your insurance company. The Medicare Part B durable medical equipment coverage pays for qualifying equipment, but you will be responsible for your Part B deductible and coinsurance. A Medicare Supplement can help to pay these expenses.

If you have a Medicare Advantage plan, you may have additional coverage for some bathroom equipment. Like other health insurance plans, Medicare Advantage covers some over-the-counter needs, which can include bathroom safety equipment.

To compare rates and find a Medicare Advantage plan to cover bathroom equipment, enter your ZIP code now.

What coverage for bathroom equipment does Medicare provide?

Original Medicare has some coverage for bathroom equipment under the Part B durable medical equipment coverage. The medical insurance coverage is limited only to a convenience item for a medical condition that is considered medically necessary, such as commode chairs. You will need a doctor to confirm the medical necessity. Medicare doesn’t cover bathroom safety equipment or any equipment that is considered to be for comfort or convenience.

Medicare doesn’t cover any type of equipment that is considered as a raised toilet seat, a shower chair,a walk-in shower, or any bathroom renovations or adjustments.

If you have a Medicare Advantage plan, you may have some coverage for over-the-counter medical supplies, which can include things like shower chairs. Check with your provider to find out what your plan provider covers.

What does bathroom equipment cost with Medicare?

If your bathroom equipment is covered by Medicare, you will be responsible for the Part B deductible as well as a 20 percent health care coinsurance on the approved cost of the equipment. If you have a Medicare Supplement plan, both the deductible and the coinsurance may be covered, depending on the plan.

Out-of-pocket costs for bathroom equipment with a Medicare Advantage plan will vary depending on the plan. Since these plans are offered by private insurers, the deductible and any coinsurance differ greatly.

Speak with your Medicare Advantage provider to find out what you will have to pay,

Case Studies: Medicare Coverage for Bathroom Equipment

Case Study 1: John’s Bathroom Safety Needs

John is a Medicare beneficiary who recently experienced a fall in his bathroom. His doctor recommended the use of bathroom safety equipment to prevent further accidents. Since the equipment is medically necessary, Medicare Part B covers a limited selection of bathroom equipment.

However, John will need to pay his Part B deductible and coinsurance. Fortunately, John also has a Medicare Supplement plan that helps cover these expenses. This case highlights the importance of having additional coverage to manage out-of-pocket costs.

Case Study 2: Mary’s Medicare Advantage Plan

Mary, another Medicare beneficiary, has opted for a Medicare Advantage plan. These plans often provide additional coverage beyond Original Medicare. Mary’s plan includes coverage for bathroom safety equipment as part of its over-the-counter benefits.

This means she can receive coverage for items like shower chairs, enhancing her safety and independence in the bathroom. Medicare Advantage plans offer more flexibility in coverage options, making them a suitable choice for individuals with specific needs.

Case Study 3: James’ Out-of-Pocket Costs

James has Original Medicare and relies on bathroom equipment for his daily living. He pays the Part B deductible and 20% coinsurance for his bathroom equipment.

However, James is considering switching to a Medicare Advantage plan to potentially reduce his out-of-pocket costs. Different Medicare Advantage plans have varying deductibles and coinsurance, so James plans to research and compare his options to find a plan that offers more favorable coverage for bathroom equipment.

Does Medicare cover bathroom equipment? The Bottom Line

Medicare does have limited coverage for bathroom equipment that is considered to be medically necessary. Items considered to be for comfort or convenience are not covered. Medicare Advantage plans may offer additional coverage over Original Medicare.

To compare your Medicare Advantage options for bathroom equipment coverage, enter your ZIP code below.