Unfortunately, Medicare usually does not cover the walk-in tub but you could be eligible for reimbursement after installing the tub if you have a medical diagnostic that shows your medical need.
In most cases, Medicare does not consider a walk-in tub as Durable Medical Equipment (DME) under Medicare Part B, but some seniors need special care when looking for a comfortable and safe bath, and in these cases with the doctor’s prescription, you can claim it.
Medicare provides coverage for lower-income people and people with barriers to care. People with certain medical conditions, undocumented immigrants, and people who are blind or disabled may not be eligible for coverage through their state’s private insurance market. These people might choose to enroll in Medicare depending on their financial circumstances and state-specific resource lines. But we are going to explain how you can get it.
Medicare’s Policy on Walk-In Tubs
A plethora of different medical items belongs to the group which is considered durable equipment.
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Medicare program usually reimbursement for the following items:
- Special chairs
- Patient lift
- Adjustable bed (hospital-style)
- Special commodes
In fact, all these pieces are in place so that seniors can use a walk-in tub shower easily and safely.
Will Medicare Pay Walk-in Tub?
Medicare can cover walk-in tubs if you provide a medical diagnosis proving the beneficiary’s need, detailing the medical reasons for the necessity for a walk-in tub. You never will receive an upfront payment, but maybe you can get a reimbursement. So it’s never guaranteed that they will pay.
Before 2018, Medicare did not cover any surgical supplies for men or women aged 55 and older. Now, they do cover them.
In general, one has to give it a try to be the beneficiary of using a walk-in tub that is a durable medical equipment.
In this regard, a sort of medical diagnosis will substantiate the needs of the enthusiastic beneficiary.
Either a medical report showing a diagnosis or a prescription written by a registered physician may serve the purpose well. The doctor must pass you a letter of medical necessity for the walk-in tub.
The prescription or diagnostic report should essentially outline some authentic reasons which may prove the necessity of getting a walk-in tub.
Gathering all the above supportive documents does not necessarily mean that Medicare guarantees its assistance.
It can be the best idea to take the walk-in tub as an out-of-pocket possession which means that people should look for some other sources for financial assistance.
People should prefer taking prepare for bearing the cost personally to waiting for the best support after submitting a claim and getting approved.
The only thing that can be said is the support does not come in advance of purchasing such tubs.
Rather, the support is provided in the form of pay; yet these excellent tubs would require to get considered a medical necessity.
Well, it is simply a modification of the home that Medicare is not willing to cover. Such installation does not mean any addition but an absolute modification at a certain place in the home.
Medicare Claim Process – Step by Step
You may make a compelling presentation for your Medicare claim by using the suggested approach below:
Ask your doctor for a prescription.
Request from your doctor a “Letter of Recommendation”
This is a letter of support from your doctor.
It demonstrates the walk-in tub’s practical medicinal necessity.
Depending on what your doctor decides to write, it might discuss your medical condition, how it improves your living circumstances, the tub’s advantages, how it treats your conditions or something else entirely.
Purchase the walk-in tub of your choice.
Complete CMS-1490S Medicare Form
To submit any claims, you must be registered in Medicare Part B (Medical Insurance).
Download the instructions and Form CMS-1490S. (Document included in the booklet)
Visit the Medicare website at www.medicare.gov if you have any additional queries.
Save a copy of the product specification sheet
The company cannot file the claim for you because walk-in tubs are not yet officially designated DMEs… You must file it on your own.
As a result, unless you include the following statement, Medicare will reject your claim:
“The supplier did not refuse to file a Medicare claim or refuse to enroll in Medicare.” Because this claim is for a walk-in tub that is not currently listed as ‘Durable Medical Equipment,’ the supplier cannot file the claim, so I am filing it.”
Please include a copy of the Claim Filing Statement with your claim.
Claim Filing Declaration
Put together your initial claim, which should include:
Doctor’s Prescription Form CMS-1490S…
Doctor’s Letter of Recommendation, original attached to the back of Form CMS-1490S
Model Specification Sheet Tub
Invoice and Claim Filing Statement with Proof of Payment
Anything else you think might help your case
Send your original Claim through the mail.
Your claim should be stapled together to prevent loss.
Keep everything flat and put it all in a 9″ x 12″ envelope.
Inscribe your return address on the package.
Put the relevant Medicare address for your state on the envelope using the Address Table in this booklet.
Include enough stamps and mail.
This is the complete process for which Medicare will look at your case, it not be guaranteed you going get a reimbursement.
Do everything calmly and as clearly as possible so that Medicare understands everything.
Will Medicare Cover the Installation Cost of a Walk-in Tub?
If Medicare accepts reimbursement of your walk-in tub, they only going to reimburse the full purchase price of the walk-in tub. The installation cost $1,000 to $3.000. The price of a walk-in tub ranges between $2,500 to $25,000. One of the most important brands of walk-in tubs like American Standard starts at $4,000 up to $12,000.
It’s very rare they pay the installation costs and other modifications at home that you maybe need to fit your walk-in tub in your bathroom, like accessibility modifications.
For those who may have trouble with balance or mobility issues, it can be difficult to step over the edge of a high bathtub into hot water without risking injury.
They also come equipped with safety features such as seats which allow you to take advantage of all their benefits while keeping yourself safe at all times.
Medicare is a federal health insurance program administered by the U.S. Department of Health and Human Services (HHS).
If you are a disabled veteran check out this article.
Last medically reviewed on October 18, 2022
Sources
- CMS finalizes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage. (2019).
https://www.cms.gov/newsroom/press-releases/cms-finalizes-medicare-advantage-and-part-d-payment-and-policy-updates-maximize-competition-and - Durable medical equipment (DME) coverage. (n.d.).
https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage - Single-family housing repair loans and grants. (n.d.).
https://www.rd.usda.gov/programs-services/single-family-housing-repair-loans-grants - What does Part B of Medicare (medical insurance) cover? (2014).
https://www.hhs.gov/answers/medicare-and-medicaid/what-does-medicare-part-b-cover/index.html - What is Medicare Part A? (2014).
https://www.hhs.gov/answers/medicare-and-medicaid/what-is-medicare-part-a./index.html