FAQ: What Kinds of Home Equipment and Modifications Are Covered by Medicare, Medicaid, or the VA?
What kinds of home equipment and modifications are covered by Medicare, Medicaid, or the VA?
In general, both Medicare and Medicaid cover medical equipment for use at home but don't cover actual physical modifications to the home. The VA, on the other hand, offers some coverage for both: medical equipment through its medical care program, and home modifications through separate grant programs.
Medicare Part B
Medicare Part B covers a wide variety of what's called "durable medical equipment" for use in a patient's home. Some equipment must be rented, some purchased, and sometimes the patient has a choice. Equipment must be medically necessary and prescribed by a doctor. Covered equipment can include hospital beds, patient lifts, commode chairs, crutches, walkers, both manual and electric wheelchairs and scooters, oxygen equipment, traction equipment, infusion and suction pumps, nebulizers, blood sugar monitors, home dialysis machines, and many other types of equipment. However, Medicare Part B does not cover equipment that's permanently installed in a patient's home, such as a wheelchair ramp, stair lift, special shower stall or walk-in tub, bars, or railings.
The types of equipment that Medicare Part B covers -- along with information about whether they're to be rented or purchased with Medicare Part B paying most of the bills -- is described in detail in the official online Medicare booklet called Medicare Coverage of Durable Medical Equipment and Other Devices.
Medicare Part B pays 80 percent of the Medicare-approved amount for the rental or purchase of covered equipment. There are special rules, however, for wheelchairs and scooters. It's important to rent or purchase your equipment from what's called a Medicare "participating supplier," who is prohibited by Medicare rules from charging any more than the Medicare-approved amount for the item. However, a supplier who's enrolled in Medicare but isn't an official "participating supplier" may charge more than the amount that Medicare Part B approves for the equipment. In that case, you'd personally have to pay the difference between the Medicare-approved amount and the amount the supplier actually charges (on top of the 20 percent of the Medicare-approved amount that Medicare Part B doesn't pay).
Medicare's official website provides a geographic directory of equipment suppliers to help you find a Medicare-certified supplier near you who has the specific equipment you need. "Participating suppliers" -- the ones who can't charge more than the Medicare-approved amount -- are noted in the directory with a special icon.
Medicare Advantage (Part C) Plans
If you have a Medicare Part C Medicare Advantage plan, that plan must cover everything that's included in original Medicare Part B coverage, including durable medical equipment. But sometimes a Medicare Advantage plan covers more, with lower co-payments for medical equipment. To find out whether your plan provides extra coverage or requires different co-payments for medical equipment, contact the plan directly.
If you're enrolled in your state's Medicaid program, it will cover the same types of durable medical equipment covered by Medicare Part B. If you have Medicaid but not Medicare, you'll be charged a small co-payment for use of the equipment. If you have both Medicaid and Medicare, Medicaid will pay all of the 20 percent that Medicare doesn't pay, except for a small co-payment. Like Medicare, Medicaid doesn't cover physical modifications to the home. However, some state Medicaid programs have special pilot programs that can help with home modifications. If you need home modification, check with the Medicaid worker who handles your file and ask if there might be special coverage that can help you.
Department of Veterans Affairs (VA)
Like Medicare, the Department of Veterans Affairs (VA) program of medical benefits includes coverage of durable medical equipment for use in the home. In addition, the VA has three programs that offer home-modification grants to certain veterans who have severe service-connected disabilities. These are:
Specially Adapted Housing (SAH) grants. An SAH grant is to help modify a home to make it wheelchair accessible or otherwise "barrier free" for certain veterans whose severe service-connected disabilities make it impossible for them to live independently without such modifications. An SAH grant can be as much as $63,780.
Special Home Adaptation (SHA) grants. An SHA grant helps pay to modify a home -- the veteran's or a family member's where the veteran lives -- to meet the needs of certain disabled veterans who need assistance with mobility around the house. An SHA grant can be as much as $12,756.
Home Improvement and Structural Alteration (HISA) grants. A HISA grant provides funds for home improvements necessary for a disabled veteran to have access around the house and for essential lavatory and sanitary facilities. A HISA grant is available to a disabled veteran even if the disability isn't service-connected. HISA grants are up to $4,100 for a veteran whose disability is service-connected and up to $1,200 for a veteran whose disability isn't service-connected.
For more detailed information on these home modification grant programs and how to apply for them, see Home Modification for Veterans with a Service-Connected Disability.
Excellent information on paying for medical equipment and home modifications. I would add that the limits for HISA grants have been raised to $6,800 for service connected disabilities and $2,000 for non service connected disabilities.
With the increase in the HISA grant, a client can typically receive a bathroom remodel to meet their needs without any out-of-pocket money. Its like getting a bathroom remodel FREE.