Original Medicare does not usually pay for a walk-in bathtub or help cover the cost of installing one. 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.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
In general, DME is certain equipment that helps a person who has certain illnesses or medical conditions by providing therapeutic benefits.
Medicare helps cover medically necessary DME as long as the equipment is prescribed by the doctor to use in the home. It must also meet Medicare’s criteria for DME, which includes:
- it can be used repeatedly
- is used solely for a medical reason
- is used in a person’s home
- is expected to last 3 years or more
- is not useful to people who are not injured or sick
Some DME that may be covered by Medicare benefits include:
- blood sugar monitor and test strips
- crutches, wheelchair, walker, cane, or scooter
- hospital bed
- commode chair
- oxygen and equipment
- traction equipment
The Medicare federal health insurance program has four parts: original Medicare (Part A and Part B), Part C, also known as Medicare Advantage, and Part D. A person may get coverage for DME from original Medicare Part B, or from a Medicare Advantage plan.
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 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
From 2020, Medicare Advantage plans could offer more benefits for a person with a chronic illness that would help improve or maintain a person’s health. Such benefits may include grocery shopping, meal delivery, and changes to the home to improve overall function.
A person can check with their plan provider to see if their Medicare Advantage plan covers the cost of walk-in tubs.
Part D is coverage for prescription drugs. It does not cover walk-in tubs or any DMEs.
The choice to rent or buy DMEs often depends 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 responsibility of the supplier.
If a person owns DME, Medicare covers replacement parts and repairs.
Other factors that affect coverage
How much a person will pay for DME depends on:
- other policies a person may have
- 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, it means they will accept payment directly from Medicare, and costs are regulated.
For example, Medicare pays 80% of the approved amount, while a person pays 20% after paying the standard Part B deductible of $203 per month in 2020, provided that a person’s income is $87,000 or less. However, if the doctor or supplier is not enrolled in Medicare, a person may have to pay 100% of the cost.
Similarly, if a person is buying DME, they should check if the supplier participates in Medicare, which means the supplier will charge only 20% coinsurance and any remaining deductible for Part B. If the supplier does not participate in Medicare, they can charge higher costs.
A person can use this online tool to find a DME supplier. People enter their zip code and are taken to a page where they can choose five products. If the product is not listed, 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:
- phone number
- 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, make sure 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 they live in a competitive bidding area.
The costs for 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
There are several programs that may help cover the costs of DME.
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 helps low-income older adults, who are also homeowners, to repair and improve their homes. This may include the addition of a walk-in bathtub.
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.
A person 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.