Most people don’t think about bathroom safety equipment until the need arises. Then, your doctor or therapist suggests getting a set of toilet safety rails to help you get up and down from the toilet more safely.
Once you or your loved one has agreed, the next thought is, “Will Medicare pay for toilet safety rails?”
Unfortunately, the answer is usually no. But, sometimes, other insurance plans will.
Here’s how to know if your insurance will cover and pay for toilet safety rails.
The Medicare Conundrum: Why They Don’t Cover Bathroom Equipment Like Toilet Safety Rails
When I worked at a durable medical equipment company, this was the hardest thing to explain to people. But, it stems from Medicare’s definition of “medically necessary.”
The Centers for Medicare and Medicaid Services define medical necessity as:
“needed for the diagnosis or treatment of your medical condition, are provided for the diagnosis, direct care, and treatment of your medical condition, meet the standards of good medical practice in the local area, and aren’t mainly for the convenience of you or your doctor.”
So, because bathroom equipment doesn’t diagnose or treat a medical condition, these items are not covered services. Instead, they help you manage disease symptoms, so items like toilet safety frames and rails are considered convenience items.
Please, don’t shoot the messenger!
However, Medicare does cover bedside commodes used for toileting for people confined to their bedrooms. Because toileting is a necessary function and the beneficiary cannot perform it if they are confined to bed, Medicare has decided they are medically necessary.
So, the bottom line is that most equipment used in the bathroom is considered a convenience by Medicare and is not covered.
Medicare Advantage Plans Might Cover Toilet Safety Frames
However, some Medicare beneficiaries with Advantage Plans through third-party providers may have coverage for bathroom equipment.
This potential coverage is one of the main advantages of these plans – they often add coverages that Medicare doesn’t provide with lower deductibles. But, of course, you have to pay monthly for these plans. And the coverage may be subject to a deductible.
To know for sure if your Medicare Advantage plan covers toilet safety rails, call the number on the back of your card and ask. Ask the representative to send you the coverage criteria in writing via email or mail.
Medicaid Is Sometimes An Option
Some Medicaid plans do cover bathroom equipment like toilet safety items, but every state has its own coverage rules and criteria. So, you will need to call your local Medicaid office and ask.
You could also contact a local DME (Durable Medical Equipment) store and ask. They usually know what your local Medicaid office will cover and won’t cover.
Private Insurance Plans Will Be Hit Or Miss
If you have a private or employer-sponsored insurance plan, you need to call the number on the back of your card and ask.
While many private insurance plans will cover bathroom safety equipment like toilet safety frames, others are starting to follow and use Medicare criteria for their coverage policies.
What Are Your Options Then?
If your insurance will not pay for toilet safety rails and you need them, you will have to find a way to pay for them yourself.
Fortunately, they aren’t expensive, and most people can afford them. If you or your loved one cannot afford to buy a toilet safety frame outright, here are a few options:
- Shop online and in local stores for discounts
- Ask a family member to buy it
- Buy a used one – look at yard sales, flea markets, and Goodwill stores
- Use a credit card to purchase it
- Call local senior services or charity groups
- Ask your church or a local congregation for assistance
Medicare will not pay for toilet safety rails directly, but some Medicare Advantage Plans will. If you have Medicaid, chances are pretty good that they will pay for toileting aids.
With private insurance, you have a 50/50 chance of coverage. Because these plans differ wildly from company to company, you’ll have to call and ask.
Most people end up buying this type of equipment themselves. Use the options in this guide to help you pay for this needed equipment. Check out my installation guide for toilet safety rails here to learn more about that.