Does Medicare Cover Tub to Shower Conversion?
Is your tub-to-shower conversion covered by Medicare? Explore the complex rules, what Medicare *does* cover for home safety, and other financial pathways.
A tub-to-shower conversion involves modifying a bathroom to improve accessibility and safety, often by removing a bathtub and installing a shower that may feature a low or no-threshold entry. This type of renovation can significantly enhance independence for individuals with mobility challenges.
Medicare Coverage Overview
Original Medicare (Parts A and B) generally does not cover home modifications like tub-to-shower conversions. These structural changes are typically considered home improvements rather than direct medical services or durable medical equipment (DME). Medicare’s coverage is primarily for medically necessary services and supplies required to diagnose or treat an illness, injury, condition, or its symptoms, meeting accepted medical standards. Medicare Part D, which focuses on prescription drug coverage, is also not relevant to home modifications.
Medicare Advantage Plan Considerations
Medicare Advantage Plans (Part C) are offered by private companies approved by Medicare and are required to cover all services that Original Medicare covers. Beyond this, these plans can offer additional benefits not covered by Original Medicare, including some supplemental benefits related to health and safety. These might encompass certain home health aids or minor home modifications that directly contribute to health outcomes.
Coverage for a full tub-to-shower conversion through a Medicare Advantage plan is rare and highly dependent on the specific plan’s offerings. While some plans may offer limited support for home modifications, such as grab bars or handheld showers, comprehensive structural changes are less commonly covered. Individuals must directly contact their specific Medicare Advantage plan provider to determine if any coverage is available for such modifications.
Related Medicare-Covered Items
While the tub-to-shower conversion itself is generally not covered, Medicare Part B does cover certain Durable Medical Equipment (DME) if it is medically necessary and prescribed by a doctor for use in the home. DME is defined as equipment that can withstand repeated use, is primarily medical in nature, is typically only useful to someone who is sick or injured, is used in the home, and is expected to last at least three years. The equipment must be obtained from a Medicare-enrolled supplier who accepts assignment.
Examples of DME that could be covered and are relevant to bathroom safety include commode chairs, especially if a patient cannot use a regular toilet, or walkers and wheelchairs that aid mobility. Shower chairs, while beneficial for safety, are generally not covered as DME by Original Medicare because they are often considered convenience items, though some Medicare Advantage plans may offer them as an over-the-counter benefit. Grab bars are also typically not covered by Original Medicare because they are considered safety devices rather than DME. For covered DME, Medicare typically pays 80% of the Medicare-approved amount after the Part B deductible is met, with the beneficiary paying the remaining 20% coinsurance.
Alternative Funding Options
Since Medicare generally does not cover tub-to-shower conversions, other avenues for financial assistance exist. Medicaid, a joint federal and state program for individuals with limited income and resources, may offer home modification benefits through state-specific waivers or programs if medically necessary to prevent institutionalization. These waivers can sometimes cover modifications like walk-in showers or widening doorways.
Eligible veterans may access grants or programs for home modifications through the Department of Veterans Affairs (VA). Programs such as the Specially Adapted Housing (SAH) grant, Special Home Adaptation (SHA) grant, or Home Improvements and Structural Alterations (HISA) grant can provide financial assistance for extensive home accessibility modifications, including bathroom adaptations. The amounts for these grants vary, with the SAH grant offering up to $117,014 and the SHA grant up to $23,444 in fiscal year 2024 for eligible veterans.
State and local programs, often through housing departments or community development block grants, may also offer grants or low-interest loans for home accessibility modifications for seniors or individuals with disabilities. Non-profit organizations like Rebuilding Together or Habitat for Humanity sometimes provide home repair and modification services for low-income families, seniors, and individuals with disabilities. Additionally, some private long-term care insurance policies or comprehensive health plans might offer limited coverage or benefits for home modifications, though this is highly variable.