Paying for Walk-in Tubs: Medicare’s Benefits and Other Financial Help
Medicare’s Policy on Paying for Walk-In Tubs
Unfortunately, paying for walk-in tubs or their installation, by original Medicare is not a possibility, as they are not considered to be durable medical equipment.
There may be rare situations in which original Medicare does provide financial assistance. When this occurs, the support comes as reimbursement, rather than in advance of the purchase. The tub would have to be considered an absolute medical necessity. The beneficiary would need a medical diagnosis that proves his/her need. In addition, a written prescription that outlines the reasons for which a walk-in tub is necessary, as well as any features specific to a brand is required. Even with all this support, there is no guarantee of original Medicare’s assistance. When it comes to original Medicare, it is best to think of the tub as an out-of-pocket purchase, submit one’s claim, and hope for the best. However, one should be financially prepared to pay the full cost, including installation, or look for other sources of assistance.
Medicare Advantage (regulated by Medicare, but run by private insurance companies) may be a different story. In April of 2018, the Centers for Medicare and Medicaid Services (CMS) announced the expansion of health related supplemental benefits through Medicare Advantage (MA) plans. Services or items which should be utilized to prevent, diagnose, or treat a disease or injury, make up for physical injuries/weaknesses, better the functional and/or psychological effect of physical/heath issues, or assist in reducing the need for emergency care, could mean that some MA plans will pay for the cost of walk in tubs.
Supplemental health benefits will vary based on the state in which one resides, as well as one’s specific Medicare Advantage plan.
Medicaid’s Policy on Walk-In Tubs
Even with Medicare Advantage plans offering new supplemental healthcare benefits in 2019, Medicaid is more likely to provide financial assistance for the purchase and installation of a walk in tub. Medicaid is not a single federal program. Instead each state has several different Medicaid programs. Therefore, there are possibly hundreds of different sets of rules governing Medicaid’s policy on the purchase of a walk in tub or “low threshold shower”. For example, Medicaid in California (Medi-Cal) has a Medicaid program called Community Transitions that helps nursing home residents move back to private homes. This program very likely would cover the cost of a walk in tub.
There are also Medicaid programs for Home and Community Based Services (HCBS). For example, Colorado has an Elderly, Blind and Disabled Persons Waiver, which will pay for “specialized medical equipment” and “environmental accessibility modifications”. Under these guidelines, when medically necessary to help an individual remain living in their home, Medicaid will pay the purchase price and installation costs for a walk in tub.
Each state has different Medicaid HCBS waivers. To determine if your state will pay for a walk in tub, you should examine the benefits of your state’s Medicaid waivers to see if they will pay for durable medical equipment, assistive technology, home modifications or environmental accessibility adaptations. A complete list of Medicaid waivers relevant to the elderly can be found here.
Veterans Benefits and Walk In Tubs
TRICARE and CHAMPVA – with these insurance programs, it would be difficult to receive assistance for a walk in tub as they do not consider them to be durable medical equipment.
Home Modification Grants – On a more positive note, there are several VA programs that provide assistance which can be used for the purchase and installation of walk-in tubs or roll in showers. The VA offers 3 different grants for disabled veterans: these are the Specially Adapted Housing (SAH) Grant, the Special Home Adaptation (SHA) Grant and the Home Improvements and Structural Alterations (HISA) Grant. Of these, the HISA Grant is the most applicable to aging veterans as their disability need not be connected to their military service. In other words, veterans who require a walk in tub simply because of aging challenges may qualify under the HISA Grant.Walk-in Tubs and Spas
Veterans Directed Home and Community Based Services (VD-HCBS) – this is a program modeled after Medicaid’s Consumer Directed HCBS. With VD-HCBS, participants are provided with a set budget for their care requirements and given a certain amount of flexibility to spend that budget on the services and supplies they determine as necessary. Under this program, a veteran may choose to allocate a portion of the allowance toward the purchase and installation of a walk in bathtub or shower. Learn more about VD-HCBS.
VA Aid and Attendance, Housebound and other Pensions – these pensions have no specific limitations as long as they are used for the care of the beneficiary. Therefore, these benefits can be used for walk in tub purchases and installations. Moreover, persons receiving these pensions can receive assistance above and beyond their current benefit specifically to pay for the cost of a walk-in tub or roll-in shower. A walk-in tub can be considered an unreimbursed medical expense for VA income calculating purposes. This means the cost of the walk-in tub, is deducted from one’s income, and the veteran will receive an increased pension benefit in the amount of the deduction which will cover the cost of the tub. Learn more about how the VA calculated income here.
Other Financial Assistance Paying for Walk-In Tubs
Several other options which can help paying for walk-in tubs are not necessarily available to everyone.
A grant from the U.S. Department of Agriculture helps elderly, low income, residents of rural areas make home modifications to enable aging in place. These grants can be used for home and safety improvements including the addition of a walk in tub to one’s bathroom. Learn more here.
Some states have non-Medicaid financial assistance programs for the elderly which can be used for home modifications such as paying for walk-in tubs. Unfortunately, only a handful of states have these programs at present. A list is available here.
On occasion, non-profit organizations have community initiatives which can offset the installation costs of a walk-in tub. It should be noted that these organizations typically do not pay for the cost of materials (i.e. the cost of the walk in tub). One such program with a national footprint is called Rebuilding Together.
Finally, some manufacturers of walk in tubs offer financing which can convert a large upfront payment into a monthly bill. Monthly payments of between $80 and $150 can be expected.
Tax Deductibility of Walk In Tubs
If a walk in tub is purchased for medical safety reasons, it can be considered a medical expense. Therefore, the materials and the installation costs are tax deductible as a Medical and Dental Expense.
If one is caring for an elderly parent in their home and they make a home modification which includes the addition of a walk in tub, the homeowner can claim the expense under the Dependent Care Tax Credit. Some states have their own version of this credit; click here to learn more.
Alternatives to Walk-in Tubs
Walk-In Tubs vs. Roll-In Showers
The most common alternative to a walk in tub is a roll in shower, also called a low threshold shower. Most showers have a 3-6 inch step at the base designed to contain the water as it drains. These ridges can be higher if the shower doubles as a normal tub. These thresholds prevent wheelchair bound persons from entering the shower. A roll in shower has no threshold so a wheelchair can roll directly into the showering space or to a transfer bench. An additional benefit is the bather does not have to wait for the water to fill and drain during usage.
Funding options and financial assistance for roll in showers are the same as for walk in tubs. Original Medicare only pays in very rare occasions, but beginning in 2019, some Medicare Advantage plans may fund roll in showers. That said, Medicaid and VA benefits are more likely to help with the costs. Roll in showers can be less expensive than walk in tubs. However, the total cost depends more on the bathroom design and installation and less so on equipment costs. Most trained contractors are proficient in either tub or shower installations. Quotes for roll in showers are also available free of charge and without obligations.
Finally, there are portable roll in showers as well. These are meant as temporary solutions and require considerable effort to set up and take down. Surely more effort than could be put forth by the individual desiring to use such a product. A friend or family member would be needed to set up and take down the shower. As they require considerable room space as well, they are unlikely to be left standing between uses.
SOURCE: Paying for Senior Care