Medicare and Medicaid are both regulated by state laws that determine if a new product on the market can be covered by them.
Since walk-in tubs are fairly new commodities, it will take some time before they’re fully regulated by Medicare and Medicaid.
Although mobility scooters are used by bariatric users who most definitely need them, there’s a mobility scooter “plague” currently underway whose owners don’t actually need them, and even these stigmatized vehicles are covered by Medicare Plan B.
By following the steps below, you may have a chance to receive coverage from medical insurers but there are no guarantees.
- Sign Up with the Medicare Advantage Plan
As of yet, the best shot a senior has for receiving some aid from insurers is Medicare’s Advantage Plan. There are ten Medicare plans in total: A, B, C, D, F, G, K, L, M, and N – the one of interest to us being Plan C. Known as the Medicare Advantage Plan, Plan C entails that private insurance companies who are approved by Medicare can offer to cover the cost of a walk-in tub. Even if your application for financial assistance is approved, assistance will most likely be in the form of a reimbursement. The chances that your unit will be paid for in advance is highly unlikely.
You can ask Medicare for an “advance coverage decision”. It will detail what will and won’t be covered.
You will need to ask around and search for an insurance company willing to cover a unit since there are no clear-cut rules across the board for the entire nation as regulations differ from state to state.
Like the Medicare Advantage Plan, Medicaid is regulated on a state-by-state level, and so how successful your attempt will be to cover the cost of a walk-in tub or “low threshold shower” – as they refer to it – will hinge upon your state’s laws.
Medicaid’s language on what counts as durable medical equipment can be vague at times, which is understandable since the ambiguity allows for current and future developments to be incorporated. But in a nutshell, any “environmental accessibility modifications” applied to the home after a subscription and diagnosis has been demonstrated by a patient’s certified physician will be considered by Medicaid but won’t necessarily be followed by an approval.
Medicaid’s Community Transitions program is dedicated to helping seniors move from nursing homes to private homes. This usually involves providing seniors with mobility assistance equipment that render a nursing home obsolete for a particular applicant. The program can be found in 27 states including California, Arizona, Montana, and most states of the West Coast.
Other options are the programs Home and Community Based Services (HCBS) sponsored by Medicaid. Again, these don’t guarantee coverage of a walk-in tub purchase or cost of installation, but their guidelines are such that it’s possible to receive approval. If your unit is seen to be an “environmental accessibility modification”, you may receive aid after all.
- Ensure That You’ll Be Insured
Absolutely and without exception, always make sure that your insurance company will cover the price of a walk-in tub or its installation costs before you put all your eggs in one basket. Don’t go into this blindly and assume that you won’t pay the price. Think responsibly and reap the rewards.