Medicare Coverage for Home Modifications

There are few instances when an accessibility item falls under Medicare’s classification of durable medical equipment (DME). Meaning that you will probably have to pay for most other items.

DME is largely focused on equipment that is medically necessary, not convenience or comfort based. This means that items such as grab bars, bathtub seats and stairway elevators are unlikely to be covered.

Since there are many items that simply are not specified by Medicare, there is a chance that exceptions could be made on some equipment under certain conditions and needs.

While the accessibility items that Medicare will help pay for are very limited, commode chairs are covered if you can’t use a normal toilet and the item is deemed medically necessary. Unlike regular toilet seats, commode chairs can be mobile and are designed to help people who are immobilized or injured.

Medicare will cover 80% of the cost of a commode chair, leaving you with 20% after you meet the Part B deductible. The cost itself can vary due to certain circumstances, such as if Medicare requires you to rent instead of purchase it. Your doctor and supplier must be enrolled in Medicare.

Medicare typically does not cover modifications to the home of any kind.

Home modifications can span a wide range of areas, from simple equipment additions to large construction projects. They are usually added to reduce risk of injuries and falls by increasing accessibility.

Many of these changes can improve or ease your living situation and may even be recommended by a health care provider. But since none of them are typically considered a medical necessity, Medicare will not cover them under DME.

Medicare provides little coverage for home modifications, but there are some alternatives to paying for these updates.

Medicaid is more likely than Medicare to help thanks to home and community-based service waivers. The point of these waivers is to help you get long-term care at home instead of living in a facility, so some home modifications could be covered under this.

In past years, more than half of Medicaid’s long-term care spending has gone toward home and community services. HCBS waivers vary by state.

Modifications to your home can also be covered under a Medicare Advantage plan, which is an alternative to Original Medicare provided by private insurance companies.

Medicare Advantage also provides — at minimum — the same level of coverage as Medicare Part A and Part B.