Does Medicare Pay for Grab Bars for the Bathroom?
Foreword: This article is written by Madison Weinman. She’s an incredibly smart human completing her occupational therapy doctoral program at the University of Kansas Medical Center.
Thank you to Clarice Grote, founder of Amplify OT, for editing this article!
So, you want to know if Medicare pays for grab bars for the bathroom? It’s a valid question; Medicare can be confusing.
Before we dive into the nitty gritty of how to pay for grab bars, let’s talk a little bit about home modifications and what they could do for you.
What are Home Modifications?
Home modifications are changes you make to your home to help keep you safe and independent when doing your daily activities, like showering or using the toilet.
Johns Hopkins University created a program called Community Aging in Place, Advancing Better Living for Elders (CAPABLE) with the intent to reduce hospitalizations and nursing home placement in older adults by providing them with home modifications and adaptive equipment to increase safety and independence.
In a study examining the outcomes of the program, the authors identified four categories of home modifications that were completed during the CAPABLE program. The four categories were:
Structural adaptations: These include any changes you make to the structure of a room or space. Examples of this would be installing grab bars near your toilet, replacing your tub shower with a curbless shower, or widening the doorway to your bathroom.
Home repairs: General home repairs, such as fixing faulty wiring to restore light to a bathroom, allow a person to use a space more safely.
Assistive devices: This entails providing equipment to allow for easier and safer completion of daily activities, such as sitting on a shower chair while showering or using a commode chair when you cannot access the toilet.
Regular household items: The addition of regular household items, such as a trashcan placed next to the toilet for convenient disposal of hygiene products, can make a space easier and safer to use.
While not traditionally thought of as home modifications, home repairs and regular household items should be included in the scope of home modifications due to how effective than can be at increasing the safety and usability of a space. 4
Here at Toilet Talk, we focus on bathroom modifications because the bathroom is one of the most common places for falls to occur! 8
Making modifications to your bathroom can help you live at home for a lifetime.
How Can Home Modifications Help You?
If you find yourself reaching for something to hold on to as you’re getting into or out of the shower (i.e., almost EVERYBODY), it’s time to consider some grab bars! There are a lot of hard, slick surfaces in the bathroom, and when water is added into the mix it can be an accident waiting to happen.
Trust me on this one, installing a grab bar or two will always cost less than a trip to the emergency room.
Preventing a gnarly fall is great, but preparing for the inevitable (i.e., getting older) is a must. Being unable to take care of yourself is one of the main reasons for ending up in a nursing home, and a lot of self-care tasks take place in the bathroom.
The median cost for a semi-private room in a nursing home was $7,908.00 per month in 2021. 2 Talk about expensive! Investing in bathroom modifications now can help you save a lot of money in the long run.
Speaking of expense, you might be thinking: “How will I pay for these home modifications?” Prepare yourself, because it’s about to get technical.
Does Medicare Cover Grab Bars for the bathroom?
Medicare does not cover grab bars or grab bar installation.
In fact, Medicare does not cover any structural home modifications whatsoever. Medicare only pays for services that are deemed to be medically necessary based on specific diagnoses.
Since grab bars and other home modifications can be useful to all people, Medicare will not cover these expenses.
Does Medicare Cover Medical Equipment?
The third home modification category that we mentioned above was assistive devices, such as shower chairs and commode chairs. Medicare will sometimes cover what they call durable medical equipment (DME). Equipment must meet the following criteria to be considered DME by Medicare:
- Durable (can withstand repeated use)
- Used for a medical reason
- Not usually useful to someone who is not sick or injured
- Used in your home
- Generally has an expected lifetime of at least 3 years 3
Some common examples of DME include bedside commode chairs, walkers, or wheelchairs.
Unfortunately, shower chairs and other bathroom related equipment are not often covered because they can be useful to people who are not sick or injured.
This is an example of a bedside commode.
Medicare may cover up to 80% of the cost of DME, but only if the following conditions are met:
- You have met your Part B deductible amount
- The DME is medically necessary
- Both your doctor and DME supplier are enrolled in Medicare 3
Medicare will also only pay for new equipment once every five years, so you need to keep your equipment and not give it away to someone!
Something else to note is that stores like Amazon or Walmart are not registered DME providers. This means that you will not be reimbursed if you buy your DME there. However, it is worth doing some price comparisons because you may be able to find DME cheaper at those stores than what you would pay through a registered DME provider.
For more information on DME and Medicare Part B coverage, go here.
Do Medicare Advantage Plans Cover Home Modifications?
Medicare Advantage plans, also called Part C or MA Plans, are offered by Medicare-approved private health insurance companies that are subsidized by the federal government.
Having a Medicare Advantage plan means that you will get most of your Part A and Part B coverage through your Medicare Advantage plan and not through original Medicare.
Some Medicare Advantage plans may offer benefits that are not included in original Medicare, such as dental or vision coverage. 5
New in 2020, Medicare Advantage plans can now offer Special Supplemental Benefits for the Chronically Ill (SSBCI). These benefits include non-healthcare services that contribute to one’s health and overall well-being.
Some of the benefits may include meal delivery, transportation for non-medical needs, pest control, and structural home modifications. Home modifications that will increase or maintain the function, health, or mobility of an enrollee may be covered, such as adding a wheelchair ramp or widening doorways. 1
It is important to note that not all people qualify for Medicare Advantage plans offering SSBCIs. 7
If you are considering enrolling in a Medicare Advantage plan, there are people who can help you decide if it’s right for you, in addition to answering any other Medicare-related questions you may have. The National Council on Aging provides a free service where you can schedule a virtual appointment with a licensed Medicare enrollment specialist as soon as the same day.
Using Retirement Funds to Pay for Home Modifications
Wouldn’t it be nice if you could pull from your hard-earned retirement accounts without penalty to help fund modifications for your home?
Introduced in the 117th Congress, the Home Modification for Accessibility Act of 2022 acknowledged how important home modifications are to increase accessibility, safety, and security for people aging in place.
If passed, this bill would allow people to make early withdrawals from a retirement account with a lifetime tax deduction of $30,000 in order to fund home modifications. 6
Since we are now in the 118th Congress (as of February 2023), this is no longer an active bill. If this is something that is important to you, you can let your legislator know so that it might increase the likelihood of being reintroduced in the next Congress. You can go here to find your legislator and access their contact information.
Financial resources to pay for home modifications
Making changes to your home can be expensive! We searched far and wide for financial resources that you may qualify for to help lower your personal expense.
Some of the resources include grants, loans, and Medicaid waivers. To see the full list and for more information go here.
Did we answer your questions about whether Medicare pays for grab bars for the bathroom?
Whew! I told you that was going to get technical.
More often than not, Medicare does not pay for home modifications or medical equipment for the bathroom.
We recommend that you speak to your medical provider prior to making any decisions as there may be instances where some services are covered. If you have any questions, please contact me here.
Have you made any changes to your home? Do you have plans to make changes to your home in the future? We would love to hear about them in the comments below!
References
1. Coleman, K. (2019, April 24). Implementing Supplemental Benefits for Chronically Ill Enrollees. Centers for Medicare & Medicaid Services. Retrieved January 24, 2023, from https://www.cms.gov/Medicare/HealthPlans/HealthPlansGenInfo/Downloads/Supplemental_Benefits_Chronically_Ill_HPMS_042419.pdf
2. Cost of Care Survey. Genworth. (2022, June 22). Retrieved January 27, 2023, from https://www.genworth.com/aging-and-you/finances/cost-of-care.html
3. Durable medical equipment (DME) coverage. Medicare.gov. (n.d.). Retrieved January 19, 2023, from https://www.medicare.gov/coverage/durable-medical-equipment-dme-coverage
4. Granbom, M., Evelyn-Gustave, A., Gitlin, L. N., & Szanton, S. (2018). Helping Older Adults: Environmental Modifications of the CAPABLE Program. The American Occupational Therapy Association, 23(16), 8-15. doi:10.7138/otp.2018.2316.mods
5. How do Medicare Advantage Plans Work? Medicare.gov. (n.d.). Retrieved February 14, 2023, from https://www.medicare.gov/sign-upchange-plans/types-of-medicare-health- plans/medicare-advantage-plans/how-do-medicare-advantage-plans-work
6. H.R.7676 - Home Modification for Accessibility Act of 2022. Congress.gov. (n.d.). Retrieved January 24, 2023, from https://www.congress.gov/bill/117th-congress/house-bill/7676
7. Kornfield, T., Kazan, M., Frieder, M., Duddy-Tenbrunsel, R., Donthi, S., & Fix, A. (2021, February 10). Medicare Advantage Plans Offering Expanded Supplemental Benefits: A Look at Availability and Enrollment. The Commonwealth Fund. Retrieved January 24, 2023, from https://www.commonwealthfund.org/publications/issue-briefs/2021/feb/medicare-advantage-plans-supplemental-benefits
8. Stevens, J. A., Hass, E. N., & Haileyesus, T. (2011, June 10). Nonfatal bathroom injuries among persons aged ≥15 years --- United States, 2008. Centers for Disease Control and Prevention. Retrieved January 27, 2023, from https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6022a1.htm
(Hey, did you know we have an awesome online course for people who have a hard time wiping after using the toilet? It’s an awkward topic that you can learn how to solve in the comfort and privacy of your own home! Learn more about the course HERE!)