If you are currently enrolled in Medicare or eligible to enroll soon, and are in the market for a walk-in tub, you may have done some research to see if the cost of purchasing and installing one is covered under your plan. As a general rule, walk-in tubs are unfortunately not typically covered by Medicare. However, in some cases you may qualify for a partial reimbursement or for financing through alternative programs.

To understand how the process works, it’s helpful to clarify some of the most common Medicare terminology and how certain medical treatments and expenses are classified. Medicare Part B – a part of the original Medicare plan funded by the government – is designed to cover a variety of medically necessary and preventive care services. Within the “medically necessary” portion of coverage, Medicare will pay for what is referred to as durable medical equipment (DME). DME is medically necessary equipment prescribed by a healthcare provider for your use in managing your medical condition at home or outside of a medical facility. Depending on the situation, the equipment may be purchased or rented. A few examples of DME include canes, walkers, hospital beds, crutches, blood sugar devices, wheelchairs and scooters, and patient lifts. Currently, walk-in tubs are not considered medically necessary by Medicare. Additionally, the installation a walk-in tub requires falls outside of the parameters of DME expenses covered by Medicare.

However, as mentioned earlier, there may be situations in which you could receive partial reimbursement for the cost of your walk-in tub. While there is no guarantee, there are steps you can take to submit a claim for consideration. To do this, several conditions must be met:

-          The walk-in tub must be prescribed by a doctor

-          The prescription must include details about your medical condition and the specific ways in which the               tub would help to improve it

-          The tub must be purchased from a Medicare-enrolled supplier with a Medicare participant number

If you are enrolled in the optional Part C plan, known as Medicare Advantage, you may also be eligible for coverage of your walk-in tub. Medicare Advantage plans are offered through private insurance companies – unlike original Medicare, which is a government-funded program – and therefore vary in coverage depending on a variety of factors, including the insurance company’s regional location and Medicare rules. Medicare Advantage was created to provide additional benefits not typically covered by original Medicare, such as transportation to medical appointments, dental, vision, and hearing care, and other services that are considered routine healthcare that you use every day. In some cases, this may extend to include coverage on a walk-in tub. Because Medicare Advantage plans vary so greatly, it’s best to contact your insurance provider directly to inquire about possible coverage and the steps required to submit a claim.

If you are enrolled in Medicaid, you may have a greater chance of receiving financial assistance for the purchase and installation of a walk-in tub. But unlike original Medicare, in which the same general coverage rules apply from state to state, Medicaid programs offer different benefits in every state, sometimes with multiple programs available within one state alone. What that means to you, the consumer, is the process will likely be more complicated, and you will need to do your research on the programs available in your state and the coverage included in each one. Additionally, within each state’s Medicaid programs, there are waivers available for home- and community-based services (HCBS). These waivers are available to help qualified individuals pay for items that Medicaid considers “specialized medical equipment” and “environmental accessibility modifications”. For those within waiver guidelines who require a walk-in tub to enable them to remain living in their home, tub and installation costs are usually covered. Additionally, if you are a veteran, there are programs designed to work much like the HCBS program, but specifically for veterans (VA-HCBS). If you’d like to find out more about your state’s Medicaid programs and available waivers, the Medicaid website is a great place to start. If you are a veteran, find out more about VA-HCBS and other programs that may help with walk-in tub expenses here.

For individuals enrolled in private health insurance plans, it may be worth having a conversation with your healthcare provider to discuss whether or not he or she feels a walk-in tub is medically necessary for you. If so, you and your provider can work together to provide information and medical records to your insurance company, who may have special policies or riders available to cover expenses such as walk-in tubs.

Lastly, talk to your tax advisor about the possibility of a tax deduction on the purchase of your walk-in tub or look into your state’s participation in the USDA’s Section 504 Home Repair program. You may qualify for a loan or grant if a walk-in tub helps to remove a safety hazard in your home.