Does Medicare Pay for a Shower Chair?

Medicare provides health coverage for millions of Americans, including medical equipment that supports various health needs. Understanding the specifics of what Medicare covers, particularly for items used in the home, can be complex for beneficiaries. The program has distinct criteria for coverage, aiming to ensure that necessary medical supplies and equipment are accessible.

Medicare’s General Coverage for Durable Medical Equipment

Medicare Part B provides coverage for Durable Medical Equipment (DME) that is medically necessary and prescribed by a healthcare provider. DME includes items designed to withstand repeated use, primarily serving a medical purpose, and typically not useful to someone without an illness or injury. These items must be for use in the home and are expected to last for at least three years.

For an item to qualify as DME, a Medicare-enrolled doctor or other authorized healthcare provider, such as a nurse practitioner or physician assistant, must prescribe it. The prescription must document the medical necessity for the equipment, confirming it is part of a treatment plan for a specific condition or injury. This documentation ensures the equipment directly supports a medical need rather than serving as a convenience.

Common examples of covered DME include walkers, wheelchairs, hospital beds, oxygen equipment, and nebulizers. Medicare pays for different kinds of DME in various ways, sometimes requiring rental and sometimes allowing purchase. This coverage supports beneficiaries in managing health conditions at home.

Specific Coverage Requirements for Shower Chairs

Original Medicare does not cover shower chairs because they do not meet the definition of Durable Medical Equipment. Medicare considers shower chairs “personal comfort items” or “convenience items,” rather than equipment that directly treats an illness or injury.

While a shower chair can enhance safety and assist individuals with mobility challenges during bathing, Medicare views it as a non-medical aid for daily living. This distinguishes them from items like wheelchairs or oxygen equipment, which are essential for managing a specific medical condition. Shower chairs do not qualify for coverage under Medicare Part B.

In rare instances, a shower chair that also functions as a commode chair might be considered for coverage if a doctor deems it medically necessary for a specific medical condition. This is an exception and depends on the item’s primary medical function. Medicare focuses on equipment directly related to treatment, not general personal care.

The Process for Obtaining Covered Durable Medical Equipment

To obtain Durable Medical Equipment covered by Medicare, a healthcare provider must first determine medical necessity. A doctor or other authorized professional must issue a prescription or order for the specific equipment. This document confirms medical necessity.

Beneficiaries must acquire the equipment from a Medicare-enrolled supplier. It is important to confirm the supplier participates in Medicare and accepts assignment. Accepting assignment means the supplier agrees to accept the Medicare-approved amount as full payment, billing the beneficiary only for the deductible and coinsurance.

After the annual Medicare Part B deductible is met, Medicare pays 80% of the Medicare-approved amount for the DME. The beneficiary is responsible for the remaining 20% coinsurance. Some items may be rented, while others can be purchased, with the payment structure varying by equipment type.

Options When Medicare Does Not Cover a Shower Chair

Since Original Medicare does not cover shower chairs, beneficiaries may need to explore alternative payment options. One common approach is to pay for the shower chair out-of-pocket. These items are widely available at various retailers and price points.

Medicare Advantage Plans (Medicare Part C), offered by private insurance companies, are another avenue for potential coverage. These plans must provide at least the same coverage as Original Medicare but often include additional benefits. Some Medicare Advantage plans may cover shower chairs or provide allowances for such items, though this varies significantly by plan.

Medicaid programs, which are state-administered, may also cover shower chairs if deemed medically necessary and the individual meets income eligibility. Additionally, community programs, non-profit organizations, and local charities may offer assistance or provide low-cost or free shower chairs through equipment loan closets or donation programs. Examples include Area Agencies on Aging and Lions Clubs.