Does Medicare Cover Home Modifications?

Medicare, a federal health insurance program, provides medical coverage for millions of individuals. A common inquiry among beneficiaries concerns its coverage of home modifications, often necessary to accommodate health changes or disabilities. This article clarifies Medicare’s policies on home accessibility improvements, addressing the common misconception that such changes are broadly covered. It details what Medicare typically covers, what it does not, and explores alternative funding avenues for independent living.

Understanding Medicare’s Approach to Home-Related Needs

Medicare primarily functions as health insurance and generally does not cover permanent home modifications. Structural changes like built-in ramps, widened doorways, or permanent grab bars are typically considered home improvements rather than medical services or durable medical equipment. Medicare’s coverage is fundamentally tied to “medical necessity,” meaning services or items must be reasonable and necessary for diagnosing or treating an illness or injury, and meet accepted medical standards. Permanent home modifications usually fall outside this definition because they alter the physical structure of a residence.

The program’s design focuses on healthcare needs, not on enhancing living spaces or providing long-term care benefits that include property alterations. Medicare does not cover items deemed for comfort or convenience if they do not serve a direct medical purpose. While a doctor might recommend certain home changes for a patient’s well-being, this recommendation alone does not obligate Medicare to cover the cost of structural renovations.

Some Medicare Advantage plans, offered by private companies approved by Medicare, may offer limited coverage for certain home safety equipment or structural modifications. However, the scope of this coverage varies significantly by plan and is not a universal benefit. Beneficiaries with these plans should consult their specific plan documents to ascertain any available benefits for home modifications.

Specific Items and Services Medicare May Cover

While permanent home modifications are not typically covered, Medicare does cover specific items and services that assist individuals in their homes. Durable Medical Equipment (DME) is a major area of coverage. DME includes items that:
Can withstand repeated use.
Are used for a medical reason.
Are generally only useful to someone who is sick or injured.
Are used in the home.
Are expected to last for at least three years.

Examples of covered DME include wheelchairs, walkers, hospital beds, commode chairs, oxygen equipment, and continuous positive airway pressure (CPAP) machines. A doctor must prescribe the equipment as medically necessary for home use. The DME supplier must also accept Medicare assignment. Original Medicare Part B typically covers 80% of the approved amount for DME after the annual deductible, with the beneficiary paying the remaining 20%.

Medicare also covers certain home health services for eligible beneficiaries. These include skilled nursing care, physical therapy, occupational therapy, and speech-language pathology, provided in a home setting. To qualify, an individual must be “homebound,” meaning they have difficulty leaving home without assistance or leaving is medically inadvisable. A physician must certify medical necessity and establish a plan of care. Medicare generally covers 100% of these medically necessary home health services, though the 20% Part B coinsurance for associated DME still applies. Medicare does not cover 24-hour care, meal delivery, or personal care if these are the only services needed.

Exploring Other Options for Home Modifications

Given Medicare’s limited coverage for permanent home modifications, exploring alternative funding sources is important.

Medicaid

Medicaid, a joint federal and state program, offers Home and Community-Based Services (HCBS) waivers in many states. These waivers can cover home modifications for eligible individuals, allowing them to receive long-term care services at home instead of institutional settings. Covered modifications can include ramps, bathroom adaptations, widened doorways, and specialized electrical or plumbing systems for medical equipment. Eligibility and benefits vary significantly by state, often depending on financial status and medical need.

Department of Veterans Affairs (VA) Benefits

Veterans may access specific benefits through the VA. The Home Improvements and Structural Alterations (HISA) grant provides financial assistance for medically necessary home improvements. Eligible veterans with service-connected disabilities can receive up to $6,800 in lifetime benefits, while those with non-service-connected disabilities may receive up to $2,000. A VA physician’s prescription outlining needed modifications is required. More substantial assistance is available through the Specially Adapted Housing (SAH) and Special Housing Adaptation (SHA) grants. These help veterans with certain severe service-connected disabilities build, remodel, or purchase adapted homes. SAH grants can reach up to $117,014, and SHA grants up to $22,444, with amounts adjusted annually.

State, Local, and Non-Profit Programs

Beyond federal programs, state and local governments may offer grants, loans, or assistance for home accessibility modifications. These programs vary widely in scope and eligibility. Individuals should investigate resources through their state housing authority, local county offices, or Area Agencies on Aging. Various non-profit organizations also provide assistance or grants for home modifications, such as Rebuilding Together.

Private Funding and Tax Deductions

Private funding options for home modifications include personal savings, home equity loans, or reverse mortgages. Some private long-term care insurance policies may also offer benefits for home modifications. Certain medically necessary home improvements may be tax deductible. The Internal Revenue Service (IRS) allows deductions for improvements made primarily for medical care, such as constructing ramps or widening doorways, if they benefit the taxpayer, spouse, or a dependent. The deductible amount is typically the cost of the improvement minus any increase in the home’s value. Taxpayers must itemize deductions, and medical expenses are deductible only to the extent they exceed 7.5% of their adjusted gross income.