Subscribe
One may think that since Original Medicare Part B covers DME (Durable Medical Equipment), it also helps finance a walk-in shower. However, this is not the case – Medicare does not consider walk-in showers a medical necessity and therefore they are typically not covered, except in certain situations.
Does Medicare Advantage cover walk-in showers?
Medicare Advantage plans typically cover medical equipment and services, but walk-in showers seem to be an exception here.
Why not included?
- Home Modifications vs. Medical Equipment: Medicare Advantage plans typically cover medical equipment and services, but walk-in showers are seen as home modifications. Since they’re not classified as essential medical equipment, they often don’t make the cut.
- It’s About Health, Not Convenience: Medicare focuses on what’s medically necessary for your health. While a walk-in shower can be super helpful, especially for safety and ease, it’s often viewed more as a comfort or convenience thing rather than a medical must-have.
However, some Medicare Advantage (Part C) plans have more flexibility and might pay for a walk-in shower as a part of their additional supplemental benefits.
Be sure to check with your specific Advantage plan about their rules. Coverage could include things like a ceramic tile tub or acrylic shower with safety bars.
The rare cases where Medicare does cover walk-in showers and tubs
Medicare covering walk-in showers and tubs is like finding a needle in a haystack – it’s pretty rare, but not impossible. Here’s when it might happen:
- Doctor’s Orders: If your doctor says a walk-in shower is crucial for treating your specific health condition, Medicare might listen. This would usually be part of a larger treatment or care plan.
- Part of Medical Care: Think of situations where the inability to use a regular shower safely is directly linked to your medical condition.
For coverage to be possible, your doctor would need to document why a traditional tub poses health risks or barriers to care, and how a different setup could safely help address those issues.
Some examples where Medicare may cover a walk-in if deemed medically essential:
- Mobility impairment – If you use a wheelchair or cannot safely transfer in and out of a standard tub due to arthritis, back/joint problems, paralysis, etc. Lifting and positioning could endanger you.
- Someone who is paralyzed from the waist down and lifting into a tub would endanger their condition.
- Dizziness, risk of falling, or inability to stabilize safely in a tub due to conditions like Parkinson’s disease or previous fall injuries.
- Brain injury/illness – Conditions affecting cognition like stroke, dementia could put one at risk if unable to safely maneuver, remember steps, or call for help in a tub.
Note: Remember, these are just examples of when a walk-in shower might be useful. It doesn’t mean for sure that Medicare will cover the costs.
To even have a shot at coverage, you’ll need detailed documentation from your healthcare provider. They have to spell out why a regular shower or tub just won’t cut it for your medical needs.
What are the costs of walk-in showers?
The price tag for a walk-in shower ranges from $3,000 to $9,000 on average for complete installation based on size and materials. Costs vary greatly depending on:
- Size of the shower space
- Building materials (tile, fiberglass, etc.)
- Need for structural changes in the bathroom
- Labor costs based on shower complexity
- Additional features like multiple showerheads
A basic 36×36 fiberglass unit with grab bars would be on the lower end at $3,000-4,000 installed. High-end luxury walk-in units can reach $9,000 or more. Having a contractor install a ceramic tile model would also drive costs higher due to increased labor and materials.
Usually, Medicare only covers the basic model that you need. Also, they don’t pay upfront, so you’ll have to cover the costs first. And there’s no promise that Medicare will pay for all or even some of it after they check your records.
Source: https://www.forbes.com/home-improvement/bathroom/walk-in-shower-cost/
How to get financial assistance for a walk-in shower?
If your Medicare/Medicare Advantage Plan does not cover a walk-in shower, here are potential sources of help:
- State Medicaid Waivers – Many states offer waiver programs to cover home modifications for low-income seniors and people with disabilities.
- Regional Centers – Centers provide assistance to those with developmental and intellectual disabilities. Grants may help retrofit homes.
- VA Benefits – If you’re a veteran, you might be eligible for assistance through the Department of Veterans Affairs. They offer several grant programs for home modifications to accommodate disabilities.
- State-Specific Programs – Many states have their own programs that provide financial assistance for home modifications to assist elderly or disabled residents. These programs might offer grants, loans, or other forms of aid.
- HCBS Waivers – Home and Community Based Services waivers can provide funding for modifications that enable you to live more independently in your home.
- Home Equity Loans/Reverse Mortgages – Consider these lower-interest loan options for covering costs if other sources aren’t available.
- Community Development Block Grants – Some local governments use these federal grants to assist residents with home repairs and modifications.
- USDA Rural Repair and Rehabilitation Grants – For low-income homeowners in rural areas, these grants (up to $7,500) can help fund home improvements, including walk-in showers.
Don’t lose hope
While Medicare typically doesn’t cover walk-in showers, there are some rare cases where it might.
The cost of installing one can vary, but there are several financial assistance options available, from Medicaid waivers to non-profit programs and even specific grants like the USDA Rural Repair and Rehabilitation Grants. It’s worth exploring these options to make your bathroom safer and more accessible.
