Original Medicare does not usually pay for a walk-in bathtub or help cover the installation cost. However, some Medicare Advantage plans may cover this service.
This article discusses durable medical equipment (DME), including walk-in tubs, and where to rent or buy the equipment. It also looks at Medicare coverage and how to get help paying for a walk-in tub.
Glossary of Medicare terms
- Out-of-pocket cost: This is the amount a person must pay for care when Medicare does not pay the total amount or offer coverage. Costs can include deductibles, coinsurance, copayments, and premiums.
- Premium: This is the amount of money someone pays each month for Medicare coverage.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before Medicare starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, coinsurance is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
The Medicare federal health insurance program has four parts:
- Part A and Part B, which form original Medicare
- Part C, also known as Medicare Advantage
- Part D
A person may get coverage for DME from original Medicare Part B or a Medicare Advantage plan.
Original Medicare
Original Medicare has two parts.
Part A is hospital insurance and helps pay for costs when a person is in a hospital, a skilled nursing facility, or a hospice. It may also pay for some home healthcare if the services are medically necessary.
Part B is medical insurance and helps pay for medically necessary services, including doctor’s visits, tests, and DMEs if a doctor has prescribed them for home use and both the doctor and the supplier are enrolled in Medicare.
Part C, Medicare Advantage
Medicare Advantage plans can offer benefits for people with a chronic illness that may help improve or maintain their health. Such benefits may include grocery shopping, meal delivery, and changes to the home to improve overall function.
In 2022, over 99% of Medicare Advantage plans offered at least one supplemental benefit, and the most frequent benefits addressed vision, hearing, fitness, and dental needs.
A person can check with their plan provider to see if their Medicare Advantage plan covers the cost of walk-in tubs.
Part D
Part D is coverage for prescription drugs. It does not cover walk-in tubs or any DMEs.
In general, DME is equipment that helps someone with certain illnesses or medical conditions by providing therapeutic benefits.
Medicare helps cover medically necessary DME as long as a doctor prescribes the equipment to use in the home. It must also meet Medicare’s criteria for DME, which includes the following expectations:
- a person can use it repeatedly
- they use it solely for a medical reason
- they will use it at home
- it will last three years or more
- it is not useful to people who are not injured or sick
Some DME that Medicare benefits may cover include:
- blood sugar monitor and test strips
- crutches, wheelchairs, walkers, canes, or scooters
- hospital beds
- commode chairs
- oxygen and related equipment
- traction equipment
The choice to rent or buy DMEs may depend on the equipment. For example, a person might buy a walker or a cane but choose to rent more expensive items.
In general, if a person rents DME, Medicare covers the monthly payments, while repairs are the supplier’s responsibility.
If a person owns DME, Medicare may cover 80% of the Medicare-approved amount for replacement parts and repairs, up to the cost of replacing the item entirely. The Medicare-approved amount is the price Original Medicare sets for DME.
Other factors that affect coverage
How much a person will pay for DME depends on:
- other policies a person may have
- the type of equipment
- how much the doctor charges
- if the doctor and supplier accept Medicare assignment
If a person’s doctor and the DME supplier are enrolled in the Medicare program, they will accept payment directly from Medicare, and costs are regulated.
People can use this online tool to find a DME supplier. People enter their zip code and the tool takes them to a page where they can choose five products. If the product is not there, the advanced search option may be useful.
Options include purchasing from separate medical suppliers or from one supplier who has all the products a person may need. The supplier contact information will include:
- name
- address
- phone number
- map
- distance from the person’s home
Competitive bidding program
Medicare’s competitive bidding program includes DME, orthotics, and prosthetics. It is designed to limit fraud and abuse, ensure a person has access to equipment from trusted suppliers, and may help save costs.
Medicare uses supplier bids to determine how much it will pay for supplies and equipment. The Medicare contract suppliers are chosen from accredited, qualified suppliers with winning bids.
A person may be affected by the program only if they get an item that falls into the competitive bid category or if they live in a competitive bidding area.
The cost of installing a walk-in bathtub vary depending on several factors, including options such as hydrotherapy function or if the tub is a two-seater model. Installation costs may also vary.
A person may want to use this online tool to find suppliers and compare costs.
Programs that may help cover costs
The following programs may help cover the costs of DME:
- Medicaid: Medicaid is a program for people with low income and resources. It is means-tested, and criteria vary between states.
- Agriculture Department grant: USDA Rural Development offers a grant to help low-income older adults who are also homeowners to repair and improve their homes. This may include the addition of a walk-in bathtub.
- Community organizations: Some community nonprofit organizations may have an initiative to help pay the cost of installing a walk-in tub. Manufacturers may also offer financing without interest.
- Tax deduction: People may want to check with a tax professional to find out if home modifications for medical safety may qualify as a medical expense and, therefore, be tax-deductible.
Medicare may help with costs for DMEs if a doctor has prescribed them for home use, and both the doctor and the supplier are enrolled in Medicare.
Some Medicare Advantage plans may also provide coverage, and Medicaid may also help pay for walk-in bathtubs when they are medically necessary.