A bathroom is a place where we start and end our day, but for many older Americans it can also be a potential hazard due to mobility challenges that come with age.

That’s why bathroom modifications make a world of difference. They’re not just about convenience; they’re about safety and peace of mind. 

Now, you might be wondering if Medicare can lend a hand in making these changes. While Medicare does cover some of the bathroom safety equipment like commode chairs and grab bars, it will only cover those items if they are medically necessary and you have a written prescription. 

Does Medicare cover bathroom remodeling?

Remodeling is typically done to enhance the visual appeal and feel of the bathroom. It involves making significant changes to the design, layout, fixtures, and overall aesthetics of the bathroom. 

All of this provides convenience to the user and makes their bathroom experience better. If the bathroom is remodeled extensively, it can also increase the property value. However, none of this is medically necessary.

So, Medicare does not cover bathroom remodeling costs. It only helps pay for healthcare services that are essential to treat your medical condition. 

Does Medicare pay for bathroom safety equipment?

Yes, Medicare will pay for bathroom safety equipment in certain circumstances. This is because these specialized tools and fixtures help reduce the risk of slips, falls, and accidents in the bathroom. They also promote accessibility for individuals with mobility challenges.

However, please note that the installation of safety equipment is called bathroom modification. It is not called “remodeling”. If you use the wrong terminologies, Medicare can refuse coverage. 

Which Medicare part covers bathroom modification?

Original Medicare Part B may cover certain bathroom modifications. These modifications are typically considered durable medical equipment (DME) and fall under the category of home health care.

Medicare will pay 80% of the cost if you have already paid the annual deductible. Otherwise, you will first have to clear the deductible amount and then Medicare will start covering the costs at 80%

You may also receive coverage under Medicare Advantage (Part C) plans. However, it’s important to note that the extent of coverage will vary from plan to plan. 

It’s best to contact your plan provider to confirm how much coverage you will receive for a specific bathroom modification.

Who Qualifies for bathroom modification coverage?

Qualifying for bathroom modification coverage through Original Medicare or Medicare Advantage  typically involves meeting specific criteria. Here are some general considerations for eligibility:

1. Medical Necessity: The modification must be deemed medically necessary by a licensed healthcare provider. This means that the modification is required to address a specific medical condition or mobility limitation.

2. Prescription or Recommendation: A healthcare provider must prescribe or recommend a specific bathroom modification. This may involve a written order detailing the need for the modification.

3. Individual’s Health Status: The person seeking the modification must have a documented medical condition that necessitates the modification. This could include issues related to mobility, balance, strength, or other relevant health concerns.

4. Home as Primary Residence: The individual must consider the home in question as their primary residence. Modifications are typically not covered for secondary or vacation homes.

If you’re a Medicare Advantage (Part C) enrollee, you may have to provide other details like total household income and information about your supplemental insurance. Please contact your plan provider to learn about the eligibility requirements. 

Types of bathroom modifications and Medicare 

Let’s have a look at different types of modifications and Medicare policies regarding them.

Commode Chairs

Commode chairs are portable chairs with a hole in the seat and a container beneath for waste collection. They provide essential bathroom support for individuals with mobility challenges. So, Medicare covers them.

Raised toilet seats 

Toilet seat risers are attachments that elevate the height of a toilet seat. Medicare typically does not cover toilet seat risers as they are considered convenience items rather than medically necessary equipment.

Grab bars

Grab bars are sturdy, wall-mounted handles used to promote safety and prevent falls. They are not considered medically necessary and are rather self-help items, and thus are not covered by Original Medicare. If you a have a Medicare Advantage plan, though, it may cover grab bars.

Shower chairs

Shower chairs are portable seating devices designed for use in the shower or bath. They provide support for individuals who have difficulty standing for extended periods or maintaining balance in wet conditions.

Original Medicare does not cover them, however, you may receive coverage in Medicare Advantage (Part C) plans.

Toilet safety rails

Toilet safety rails are a type of grab bar installed on or around a toilet to assist with sitting down and standing up. While Medicare may cover grab bars for eligible participants, it doesn’t cover toilet safety rails because they are convenience items. 

But, if these rails are medically necessary, it’s advisable to consult the plan provider and discuss the situation in detail. In rare cases, you might receive coverage.

Walk-in shower

A walk-in shower doesn’t help treat a medical condition. It’s installed for convenience and comfort, which is why Medicare does not cover its cost. You may not receive coverage even if it’s medically necessary. You may receive coverage in Medicare Advantage (Part C) plans.

How to lower bathroom modification costs?

Most of the bathroom safety equipment is affordable and easily available online. However, if you want a walk-in shower or multiple modifications at once, the total cost can be too much to handle!

Luckily, Medicare isn’t your only option. You can also lower bathroom modification costs using the following ways:

• Explore Medicare Advantage Plans

These plans offer extra benefits, including coverage for bathroom modifications, which can significantly reduce out-of-pocket expenses. Just make sure you meet the eligibility criteria specified by the plan.

• Grants & Non-Profits

Various organizations provide financial aid for mobility improvements. You can apply for grants or seek assistance from non-profit groups to offset the costs of bathroom modifications.

• Medicaid 

Medicaid is a supplemental insurance that helps low-income individuals pay healthcare bills. It may cover your cost of bathroom safety equipment. It may also pay for your Medicare Part B deductibles and copayments. 

Questions about Medicare?

Shoot us an email at medicare@hihella.com.