As a general rule, Medicare doesn’t cover walk-in tubs but could be eligible for reimbursement with a doctor’s prescription demonstrating medical necessity.
Medicare does not classify a walk-in tub as Durable Medical Equipment (DME) under Medicare Part B, however, but some people with limitations or older can obtain a doctor’s prescription, and after that, they can make a claim for it.
Medicare’s Policy on Walk-In Tubs
According to Original Medicare, Part A (hospital insurance) and Part B (medical insurance) typically do not cover the cost of walk-in tubs.
Since these tubs are considered home modifications rather than medical devices, they fall outside the scope of Medicare’s coverage.
Medicare Part C, known as Medicare Advantage, is a privately offered alternative to Original Medicare. It may cover walk-in tubs if they are deemed medically necessary.
To qualify, your doctor must prescribe the walk-in tub, and it must be demonstrated that it is essential for improving your health or preventing further illness.
A plethora of different medical items belong to the group which is considered durable equipment.
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.
Medicare is designed to assist individuals with lower incomes and those who face obstacles in accessing healthcare.
Certain medical conditions, undocumented immigrants, and individuals who are blind or disabled may not qualify for coverage through private insurance markets in their states. In such cases, they might consider enrolling in Medicare, depending on their financial circumstances and the specific resources available in their state.
We’ll explain the steps you can take to get the coverage you need.
Coverage through a Medicare Advantage plan
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 that 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 preparation 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, originally 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 does not guarantee you will get a reimbursement.
Do everything calmly and as clearly as possible so that Medicare understands everything.
Coverage for Installation Costs
Medicare typically only reimburses the full purchase price of the walk-in tub, excluding installation costs. The installation cost, ranging from $1,000 to $3,000, is usually not covered. The price of a walk-in tub ranges between $2,500 to $25,000.
It’s very rare they pay the installation costs and other modifications at home that you may 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 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.
Financial Assistance for Walk-In Tubs
If you meet the eligibility requirements for Medicaid, your state’s program may provide financial assistance for the purchase of a walk-in bathtub.
Veterans Assistance may provide support for the acquisition of a walk-in tub, but this typically comes in the form of a grant rather than VA insurance coverage. If you’re a veteran enrolled in TRICARE or CHAMPVA insurance schemes, obtaining financial assistance for a walk-in tub may be challenging. However, home modification grants specifically for veterans requiring a walk-in bathtub are a feasible option. Not all of these grants are linked to military service, so veterans needing medical devices due to age-related needs could secure financial help. It’s essential to remember this isn’t a universal rule, so before purchasing a walk-in tub, ensure you qualify for the grant.
Some private insurance plans may include coverage for walk-in tubs. It is recommended to review the terms and conditions of your private insurance policy or contact your insurance provider to ascertain if this benefit is available to you.
Financial assistance programs
Numerous financial assistance programs are available to aid individuals in paying for walk-in tubs. These programs are frequently funded by state or local governments, as well as charitable organizations. Exploring these programs could potentially help alleviate the financial burden associated with acquiring a walk-in tub.
It is crucial to thoroughly research and explore all available options to determine the most suitable and cost-effective means of obtaining a walk-in tub that meets your specific needs.
Agriculture department grant
The USDA Rural Development provides a grant aimed at assisting low-income seniors who own homes to carry out home improvements and repairs. This could potentially cover the installation of a walk-in bathtub.
Medicare is a federal health insurance program administered by the U.S. Department of Health and Human Services (HHS). One of the most important brands of walk-in tubs like American Standard starts at $4,000 up to $12,000.
If you are a disabled veteran check out this article.
Last medically reviewed on October 18, 2022
- CMS finalizes Medicare Advantage and Part D payment and policy updates to maximize competition and coverage. (2019).
- Durable medical equipment (DME) coverage. (n.d.).
- Single-family housing repair loans and grants. (n.d.).
- What does Part B of Medicare (medical insurance) cover? (2014).
- What is Medicare Part A? (2014).