Medicare and Walk-In Tubs
If your doctor has advised you to buy a walk-in tub, I am sure you would like to check out if it is covered by your Medicare policy or not. Also, it is not just the cost of the equipment but even the expenses you need to bear for installation are a bit on a higher side. Hence, it is best to find out whether Medicare covers it or not.
It is a bit difficult to answer your concerns simply in ‘yes’ or ‘no,’ because Medicare has certain criteria under which a walk-in tub may or may not be covered. Let us have a look at whether or not Medicare covers walk-in tubs.
The basic rules
Unfortunately, walk-in tubs are not categorized as durable medical equipment by the original Medicare. Hence, the cost of purchase and installation will not be covered by it.
Having said that, there could be some rare situations in which original Medicare may provide financial assistance. The support could be in the forms of reimbursement and not as an advance for the purchase.
To be covered under Medicare, the equipment must be an absolute medical necessity. Hence, Medicare may cover the cost of a walk-in tub only when it has been recommended by a doctor.
The beneficiary would also need a medical diagnosis to prove he or she needs the walk-in tub. A written prescription stating the reasons why a walk-in tub would be necessary is also one of the requirements you need to fulfill for the coverage.
It may require your doctor to specify the particular features of any brand of a walk-in tub and stress on the absolute need of the particular equipment. However, in spite of all this support, Medicare may deny assistance to cover the costs of the equipment and installation.
Hence, it is best to think of a walk-in tub as your out-of-pocket expense, submit the claim, and hope for the best. Since there is no guarantee your walk-in tub would be covered by Medicare, it is advisable to be financially prepared to manage the entire cost, including installation.
What are other alternatives?
You may look for assistance from other sources to cover the cost of the walk-in tubs. Medicare Advantage, which is regulated by Medicare and run by private insurance companies, may cover the costs.
In April of 2018, the CMC (The Centers for Medicare and Medicaid Services) announced that the cost of healthcare service or equipment could be covered by Medicare Advantage if it helps to prevent any health issues.
It also stated that the equipment should be utilized to provide physical support to the patient in the case of physical injuries or weakness and assist to reduce the need for emergency care.
Walk-in tubs are designed to help minimize the risk of fall or slip thereby minimizing the chances of injuries, and fractures. This use of walk-in tubs fits loosely into the criteria specified by the CMC. The guidance by the CMC could be interpreted with an understanding that some Medicare Advantage plans can cover the cost of a walk-in tub.
Medicare may reimburse the costs of a walk-in tub fully or partially. You can submit your doctor’s prescription with the paid invoice to Medicare. At the same time, it is also advisable to make alternative financial arrangements or opt for Medicare Advantage for managing the expenses.