Medicare's stance on walk-in tubs: Reviewing insurance coverage, appropriate equipment, and trusted providers
Medicare Advantage plans, part of the federal health insurance program, offer benefits for people with chronic illnesses, including changes to the home to improve overall function. However, it's essential to understand what is and isn't covered under these plans.
Durable medical equipment (DME) is equipment that helps people with certain illnesses or medical conditions by providing therapeutic benefits. Medicare Advantage plans cover DME when they are medically necessary and prescribed by a healthcare provider. These plans must provide coverage at least equal to Original Medicare (Part B), which typically pays 80% of the Medicare-approved amount after the deductible, leaving the beneficiary responsible for about 20% coinsurance.
Examples of DME that Medicare benefits may cover include blood sugar monitors and test strips, crutches, wheelchairs, walkers, canes, scooters, hospital beds, commode chairs, oxygen and related equipment, traction equipment, and more.
However, walk-in tubs generally are not covered by Medicare or Medicare Advantage plans because they are considered primarily for comfort or convenience, not medically necessary durable medical equipment. Other comfort or convenience items like standard tubs, grab bars, shower chairs are also not covered.
In 2024, the annual Medicare deductible for DME is $240. Part D, on the other hand, is coverage for prescription drugs and does not cover walk-in tubs or any DMEs.
It's important to note that some Medicare Advantage plans may cover the cost of a walk-in bathtub installation, but this is not a standard benefit. Some community organizations and manufacturers may offer financing for walk-in bathtub installation without interest.
To find a DME supplier, people can use an online tool to find a supplier by entering their zip code. It's crucial to check with a plan provider to see if a Medicare Advantage plan covers the cost of renting or buying DME.
The Medicare competitive bidding program aims to limit fraud, ensure access to trusted suppliers, and potentially save costs. Some Medicare Advantage plans manage DME orders through specialized entities like Synapse Health to streamline and coordinate prescriptions and fulfillment. Patients and providers must follow plan-specific procedures, including e-prescriptions and supplier selection within the network.
In summary, Medicare Advantage plans cover DME prescribed by a provider and medically necessary for home use, such as walkers, wheelchairs, and oxygen equipment. These plans cover at least what Original Medicare covers plus possible extra benefits. However, walk-in tubs are generally excluded due to not being medically necessary or durable medical equipment. It's always a good idea to check with a plan provider to confirm what is and isn't covered under a specific Medicare Advantage plan.
[1] Medicare.gov [2] CMS.gov [3] UnitedHealthcare.com [4] MedicareInteractive.org
- Although walk-in tubs are not typically covered by Medicare Advantage plans, as they are considered for comfort or convenience rather than medical necessity, some Medicare Advantage plans might cover the cost of their installation.
- Medicare Advantage plans, including UnitedHealthcare, cover durable medical equipment (DME) such as walkers, wheelchairs, and oxygen equipment that are medically necessary and prescribed by a healthcare provider, with coverage at least equal to that provided by Original Medicare.
- When navigating the medical devices sector, it's essential to understand that Medicare benefits may cover various medical devices, including blood sugar monitors, crutches, scooters, and hospital beds, while walk-in tubs, standard tubs, grab bars, and shower chairs generally aren't covered.
