Medicare does not typically cover the cost of walk-in showers. However, other options may help pay for this modification.
A walk-in shower is a shower without doors or curtains and is free from barriers. It may help people with accessibility needs and reduce the risk of falls in the bathroom. However, the cost sometimes prohibits someone from making the modification.
Sometimes, an individual may turn to an insurance provider such as Medicare to cover the costs. Medicare may pay for durable medical equipment, but walk-in showers do not usually qualify as medical equipment. However, there are some exceptions.
Glossary of Medicare terms
We may use a few terms in this article that can be helpful to understand when selecting the best insurance plan:
- Out-of-pocket costs: An out-of-pocket cost is the amount a person must pay for medical care when Medicare does not pay the total cost or offer coverage. These costs can include deductibles, coinsurance, copayments, and premiums.
- Deductible: This is an annual amount a person must spend out of pocket within a certain period before an insurer starts to fund their treatments.
- Coinsurance: This is the percentage of treatment costs that a person must self-fund. For Medicare Part B, this is 20%.
- Copayment: This is a fixed dollar amount a person with insurance pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare does not usually cover the costs of a walk-in shower. Although a walk-in shower is often easier to navigate than a traditional shower or bathtub, Medicare does not cover it as medically necessary durable medical equipment (DME).
Medicare typically considers a walk-in shower a home modification, not DME.
Medicare Part B does cover some types of DME when the plan deems it medically necessary and a doctor prescribes it, including:
- wheelchairs
- walkers
- hospital beds
However, Medicare has rules for what it considers DME. Usually, it defines DME as equipment that it deems medically necessary and that a doctor prescribes for use by an individual with physical injuries or a medical condition. That said, although a walk-in shower is helpful to some people with mobility issues, many insurance providers, including Medicare, do not consider it medically necessary.
Learn more about Medicare and medical equipment coverage.
Roll-in showers
A roll-in shower is also a type of shower with no barriers. It has no raised lips and is flush to the floor. It may differ in height from a walk-in shower, which usually has a low threshold of 3 to 7 inches.
A roll-in shower allows someone in a wheelchair to get into and out of the shower easily. Some roll-in showers also include a grab bar and a chair to make showering more accessible and safe for people in wheelchairs.
In most cases, Medicare also does not cover the cost of a roll-in shower.
The cost of walk-in showers can vary depending on style, size, region, and additional features. For instance, adding jets to make the tub a whirlpool will increase the cost.
The costs include materials, the shower itself, and installation, though all these costs may vary. Generally, walk-in shower prices, including installation, range from $2,000 to $20,000.
There may be some exceptions to Medicare coverage for walk-in showers. For people with Original Medicare (parts A and B), if their doctor prescribes a walk-in shower and provides specific details, Medicare may cover the costs. The details must include the medical condition the enrollee has and exactly how a walk-in shower would help.
Additional exceptions may also include Medicare Advantage (Part C) plans. Medicare Advantage plans may provide coverage for a walk-in shower when a doctor prescribes it and the plan deems it medically necessary.
Medicare Advantage plans are an alternative to Original Medicare. People who select a Medicare Advantage plan choose a private insurance company that Medicare contracts to provide benefits.
Medicare Advantage plans must adhere to certain federal Medicare regulations. However, some plans may offer additional benefits beyond original Medicare. Depending on the plan, the benefits may include coverage of a walk-in tub.
Since Medicare Advantage plans are subject to regional and company guidelines and rules, exact coverage may vary. An individual can contact their Medicare Advantage company to ask about potential coverage.
Read about Original Medicare versus Medicare Advantage.
There are other options besides Medicare that may help pay for a walk-in shower.
Medicaid
Medicaid is a federal and state-funded program that provides medical benefits for some people with limited resources and income.
The federal government has certain rules for all Medicaid programs. However, each state runs its own program, and covered services may vary. Some state Medicaid programs may cover specialized medical equipment, such as walk-in showers. Individuals on Medicaid should contact their state Medicaid office.
State assistance programs
Many states have financial assistance programs to help make a home more accessible. State assistance programs may vary in rules and guidelines for helping with home modifications such as walk-in showers.
Individuals interested in applying for state assistance programs can contact their state Department of Health and Human Services Regional Office for more information.
USDA Rural Repair and Rehabilitation Grants
The USDA Rural Development Loans and Grants program provides loans or grants to low income adults living in rural areas to remove safety and health hazards.
Certain rules apply, such as:
- having a household income that does not exceed the low income limits of the county
- being age 62 or older for grants
- being the homeowner and occupying the home
- being unable to obtain affordable credit elsewhere
Rebuilding Together
Rebuilding Together is a nonprofit organization that provides repairs and accessibility modifications for people in need. It has 120 independent affiliates across the United States. The organization may help cover the costs of modifying and installing a walk-in shower.
Medicare resources
For more resources to help guide you through the complex world of medical insurance, visit our Medicare hub.
A walk-in shower does not have barriers, such as a door or curtain. It typically has a low threshold, of a few inches, which can reduce the risk of falling in the bathroom.
Although it can provide benefits to someone with mobility issues, insurance providers, such as Medicare, do not typically cover the costs. However, there are instances where Medicare Advantage plans may offer coverage for home modifications that they deem medically necessary.