A shower chair is a common safety device designed to provide a stable, seated surface for individuals who have difficulty standing while bathing. For people with mobility issues, balance concerns, or general weakness, using a shower chair significantly reduces the risk of dangerous slips and falls in a wet environment. Securing this equipment through Medicare can be challenging, as the program has specific rules about what items are eligible for coverage. Navigating this process requires understanding how Medicare classifies medical equipment and exploring all available avenues for financial assistance.
Defining Durable Medical Equipment and Coverage Rules
Original Medicare Part B covers durable medical equipment (DME), which includes items used in the home that are medically necessary to treat a condition or injury. To be covered, an item must be durable, able to withstand repeated use, and primarily serve a medical purpose, not merely a convenience or comfort function. It must also be intended for use in the home and generally not useful to someone who is not sick or injured.
Shower chairs are typically not covered under Part B because they are categorized as “personal comfort items” or assistive devices, failing to meet the strict definition of necessary DME. Medicare does not consider a shower chair as directly diagnostic or therapeutic, even though it provides significant fall prevention. This classification is why most claims for standard shower chairs (often coded as E0170 or E0175) are denied by Original Medicare.
A key distinction exists with commode chairs, which Medicare does cover because they are medically necessary for toileting and classified under the DME benefit. Since many commode chairs are waterproof and can be used over a toilet or in a shower, they may serve as a covered alternative if the physician documents medical necessity for the commode function. Beneficiaries are responsible for a 20% coinsurance of the Medicare-approved amount after meeting the Part B deductible for a covered commode chair.
Required Documentation and Physician Orders
Even though a standard shower chair is generally excluded from coverage, a beneficiary must still follow a structured process involving their healthcare provider to submit any claim. The provider must first write a detailed prescription for the equipment, certifying that it is medically necessary due to the patient’s physical limitations or medical diagnoses. This prescription is the first step required for any DME claim submission.
The physician must document in the patient’s medical record the reasons why the equipment is needed, such as diagnoses like severe arthritis or a recent hip fracture, which prohibit safe standing during bathing. Although the formal Certificate of Medical Necessity (CMN) form has been discontinued, the supplier still relies on this detailed clinical documentation to support the claim. The documentation must clearly link the patient’s inability to safely bathe without assistance to the prescribed equipment.
The supplier uses this documentation to submit a claim to Medicare, which usually results in a denial for a standard shower chair due to the “personal comfort item” exclusion. This expected denial is a necessary administrative step that allows the beneficiary to explore formal appeal rights or transition to alternative coverage options, such as using a covered commode chair.
Exploring Coverage Alternatives
Since Original Medicare rarely covers shower chairs, beneficiaries must look toward other coverage programs that offer supplemental benefits for home safety equipment. Medicare Advantage (Part C) plans, offered by private insurance companies, represent the most common alternative. Many Part C plans offer expanded supplemental benefits, which can include an allowance for non-DME items like shower chairs or other bathroom safety devices.
Coverage varies widely between individual Medicare Advantage plans, so a beneficiary must check their specific plan’s Evidence of Coverage or contact the plan directly to confirm eligibility and any required steps. Some plans offer a flexible spending card or an over-the-counter (OTC) benefit that can be used to purchase these items.
Medicaid, the joint federal and state program for low-income individuals, often has broader coverage for home and community-based services and equipment than Medicare Part B. State Medicaid programs may cover a shower chair if it is deemed medically necessary and prescribed by a physician. Veterans enrolled in the Department of Veterans Affairs (VA) healthcare system may also be eligible for coverage through specific VA programs that provide adaptive aids. Local aging agencies and certain non-profit organizations sometimes run equipment loan closets or grant programs that provide shower chairs at no or low cost.
Working with Suppliers and Understanding Costs
When attempting to obtain a shower chair, it is important to work with a supplier who is enrolled in Medicare, even if the item is not covered. Medicare-enrolled suppliers are categorized as either participating or non-participating, and this distinction affects billing. A participating supplier accepts “assignment,” meaning they agree to accept the Medicare-approved amount as full payment for covered services and will bill the patient only for the deductible and coinsurance.
If the item is denied coverage, as is likely for a standard shower chair, the beneficiary will be responsible for the full retail cost of the equipment. For covered DME, such as a commode chair, Medicare Part B pays 80% of the approved amount after the annual deductible is met, leaving the beneficiary responsible for the remaining 20% coinsurance.
Because the denial rate for a standard shower chair is high, many individuals choose to purchase the item directly from a retailer. Retail prices for basic shower chairs are often lower than the out-of-pocket costs associated with a lengthy and unsuccessful claim process through Medicare. Direct purchase allows for immediate use of the equipment without the administrative delays of prescription writing and claim submission.