Does Medicaid cover bathroom equipment?

Medicare is a federal program that provides health insurance to seniors when they reach the age of 65. Eligibility is not tied to financial assets. Disabled individuals and dialysis patients may be eligible for Medicare benefits even if they are under age 65. The program is administered nationwide by the Centers for Medicare & Medicaid Services (CMS).

Medicare Benefits Solutions

Nov 2, 2020

 3 minutes read

Medicaid is a program that serves people with limited financial resources regardless of age. Those qualified typically incur no medical expenses, possibly with the exception of small copayments. Though the federal government establishes guidelines for the program, it is administered at the state and local levels. Therefore, covered benefits and costs vary from one state to the next.

Dual-eligibles

Many benefits covered under Medicare are covered by Medicaid too. In that case, Medicare pays first. When the Medicaid agency issues payment, the disbursement is sent directly to the health care practitioners. Recipients of both Medicaid and Medicare benefits are referred to as dual-eligible beneficiaries, sometimes known as dual-eligibles or duals. These beneficiaries have Medicare Part A and/or Part B in addition to full benefits from Medicaid. The recipient’s income and assets determine the level of Medicaid coverage. 

Durable Medical Equipment (DME)

Medicare benefits that fall under Part B include durable medical equipment and home health services in addition to doctor visits, outpatient care and mental health services. A commode chair is considered a type of DME and is covered if your doctor orders it for home use based on an incapacity to use a regular toilet. 

Additionally, home health services, covered under Part A and/or Part B, may include durable medical equipment and medical supplies for home application. Being homebound is a prerequisite for these services, which means leaving home is either difficult without help or not recommended based on your medical condition.

It is important that you check if your doctors and DME vendors are enrolled in Medicare and accept assignment, meaning that the provider agrees not to bill you for more than the Medicare deductible and coinsurance. The medicare.gov website provides a supplier directory where you can conduct a search for Medicare-approved suppliers.

Other bathroom equipment

There are a variety of bathroom items on the market not specifically mentioned in the Medicare handbook. Dual-eligibles may want to inquire if their Medicaid benefits include additional bathroom equipment designed for safety. These include a grab bar, a shower chair with arms, and a set of tub treads. Even if not covered, purchasing safety aids may be a worthwhile investment for your protection and comfort.  

Resources

To learn more about the Medicaid program and who should apply, browse the Medicaid site at medicaid.gov or the Health & Human Services site at hhs.gov. There is no special enrollment period for Medicaid, so you can apply anytime throughout the year. Apply to the Medicaid and Children’s Health Insurance Program (CHIP) through your state’s health insurance marketplace or Medicaid agency. On healthcare.gov/medicaid-chip/, you can find step-by-step enrollment instructions.

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