Does Medicare or Insurance Pay for a Walk-In Tub?
Walk-in tubs can be a major relief to people with a wide variety of medical conditions. No, medicare does not typically pay for a walk in tub. They are not considered to be Durable Medical Equipment (DME). However, whether they are covered by health insurance can be a tricky question. It’s a poor combination of vague language and often intangible health benefits.
However, that doesn’t mean that you can’t get these items covered. Instead, this guide will discuss how you can have the best chance of getting some or all of the cost of a walk-in tub covered.
Cost
of a Walk-in Tub
If you do need to install a walk-in tub, then you may be looking at a large bill. Naturally, it depends on what model you choose and where you are in the country. However, you’ll likely pay somewhere between $1,500 and $20,000.
For pricing of some specific brands, see these pages:
One of the biggest determinants of cost is whether you choose a model with hydrotherapy. Buy one without this option, and you’ll usually be able to keep the cost under $5,000. However, in most cases, hydrotherapy is an important medical benefit (indeed, sometimes the whole point of buying a walk-in tub), meaning you’ll be paying a higher rate. Walk-in tubs usually cost between $700 and $3,000 to install, again, depending on what model you choose.
Overall, these costs can be out of reach for many. However, all is not lost. There are some options that will either offset the cost or cover it totally. Keep reading below to see if you are able to cover some or all of the costs involved in a walk-in tub.
Generally, however, the best place to start (aside from reading this guide) is to talk to your primary care doctor. They will be able to advise on the type of tub you need and perhaps suggest whether it will be covered under your insurance.
What Does
Medicare Cover?
For those on Medicare, there is little likelihood of getting a walk-in tub paid for. Ultimately, the reasoning behind this boils down to money – Medicare doesn’t have the resources or the willingness to cover walk-in tubs. However, there is a little more to it than that.
1
Part B Coverage
Part B of your Medicare coverage is what covers ancillary services, such as outpatient visits, medical supplies, and the like. However, when it comes to medical equipment, Medicare tends only to fund items that can be used for a short period of time or at least can be returned and reused. Unfortunately, a walk-in tub does not fall into that category as they are installed into the fixtures and fittings of your home. Instead, the key phrase for Medicare Part B is ‘Durable Medical Equipment.’
2
Durable Medical Equipment
Durable Medical Equipment has to meet the criteria of being:
Durable (i.e., can be used multiple times)
Medically required and someone who is not ill or injured in some way would not find it useful
For home use
Has a minimum lifespan of three years
DME covers only items that are medically necessary and have been prescribed by a doctor for use in your home. If you have a prescription, Medicare will cover some of the cost of the items for the duration of the time recommended by your doctor (this may be an ongoing thing). Some of the items covered under the term DME are the following:
Blood Sugar Meters
Canes
Continuous Positive Airway Pressure (CPAP) devices
Hospital Beds
Infusion Pumps and Supplies
Nebulizers and Nebulizer Medications
Oxygen Equipment and Accessories
Patient Lifts
Traction Equipment
Walkers
Wheelchairs and Scooters
If you meet your Part B deductible, you will pay 20% of the Medicare-Approved Amount. In some cases, you will need to rent the equipment. In others, you may need to buy it. Sometimes you are given an option of whether to rent or buy.
To put it another way, you’re unlikely to get any help from Medicare. However, it is always worth reviewing the list of approved DMEs, as items on the list may change from time to time.
Medicare Advantage Coverage
As stated above, therefore, it’s unlikely that a basic medicare plan will cover a walk-in tub. All hope is not lost, however. Medicare Advantage – a plan that is regulated by Medicare, but run by private companies – may actually be able to help out.
Since April 2018, Medicare Advantage has had greatly expanded supplemental benefits (including equipment) under the umbrella term “health-related supplemental developments.” There is a little bit of guesswork involved in what exactly falls under those labels, although it should include items designed to:
Prevent, diagnose, or treat a problem
Compensate for any weaknesses
Better the function (or psychological) effect of physical or health issues
Minimize the need for emergency care
In addition, in 2019, Medicare Advantage plans also expanded to include items for chronic illnesses. For many people with chronic illnesses, a walk-in tub is a necessity, and as such, it is likely that Medicare Advantage will cover some or all of the costs of the setup and installation of a walk-in tub.
A key piece of language in the Medicare Advantage is that it will cover things that provide “a reasonable expectation of improving or maintaining the health or overall function” of an individual. Again, you’ll need to speak to your primary care physician to ensure that a walk-in tub meets that definition – and that they will write you a prescription to testify to the fact.
However, because of Medicare Advantage’s breadth of offerings and the ongoing widening of services, there is a chance that a walk-in tub will be covered. That’s not to say that it definitely will – there is a great deal of variance within Medicare Advantage plans. However, it’s a strong possibility that you’ll receive some recompense for a walk-in tub.
Private Insurance
In some ways, private insurance is the most likely way to pay for the costs of a walk-in tub. In others, however, they may be the hardest to get to actually pay up. As anyone who has ever had to deal with insurance companies can testify, getting money from them is not easy. The best way to approach your insurance company is with as much information as possible. Think about it like preparing a case.
The best way to start is by speaking with your primary care physician. They will most likely be able to speak directly to the insurance company, which will greatly improve your chances of getting coverage. You should also do your research on the specific type of walk-in tub you think is best. Again, this is best done in conjunction with your doctor, who will make recommendations about key features and the like. Any further research you do must absolutely be credible. Do not lie or exaggerate to your insurance company – this may result in your entire claim being denied.
Once you have all your information, you can contact your insurance company. If the doctor has done their work and made a case for coverage, your meeting will involve simply going over different models and confirming what the insurance company will cover. Be sure to ask direct questions – never make assumptions.
After your call, send an email to the insurance company with the summary of your call. Assuming they respond in the affirmative, you will be good to go (since you will have their answer in writing). Most likely, you will need to pay the upfront cost of the purchase and then send the receipts to the insurance company to cover. They will usually take a while to pay (sometimes weeks, sometimes months), but you will get your payment.
Is it a Deductible Expense?
One final thing to consider if you’re struggling to get funding for a walk-in tub is that it may be a tax-deductible medical expense. While this doesn’t cover the total cost of the purchase, it can help to mitigate the out-of-pocket expense by using it as a means to cover taxes.
The IRS allows for...
the purchase of ‘medical supplies, devices, and equipment needed to treat, or prevent physical and mental diseases or disabilities.’ It gets a little complicated, but if you are over 65, you can deduct your Schedule A expenses that are greater than 7.5% of your adjusted gross income (AGI). Anyone under 65 can deduct if the cost is greater than 10% of their AGI.
In some cases, state taxes allow for these deductions on state returns. You should always speak to a CPA before making any tax-based financial decisions.
ultimately,
it can be extremely difficult to determine whether a walk-in tub will be covered under your health insurance plan. The language is often extremely vague, and the health benefits of walk-in tubs seem somewhat intangible, particularly compared with items like CPAP machines or crutches. However, that doesn’t mean that all hope is lost.
Instead, speak to your health insurance provider and your doctor, and you’ll have a much clearer sense of a) whether a walk-in tub truly is a medical necessity and b) whether your insurance company will pay for it.