Commode Chairs and Medicare

What Is the Purpose of a Commode Chair?

Commode chairs provide bathroom assistance. Some Medicare beneficiaries may require it for the following reasons:

• Illness has left the body unstable and weak, making trips to the bathroom difficult and dangerous. (For example, the bathroom is a common place for individuals to fall.)
  
• Surgery has temporarily left a person too weak to walk the distance to the bathroom.
  
• Joint problems and aging have weakened the legs, making it difficult for an individual to get on and off the toilet.
  
• Balance problems that make it difficult for an individual to safely travel to and get on/off the toilet.

How Does the Commode Chair Help?

Many falls happen in the bathroom for two good reasons: one, water and moisture in the air can make bathroom surfaces slippery; and two, weakened muscles and balance problems can affect a beneficiary’s ability to travel to the bathroom and use the toilet. Commodes reduce the risk of falling by making it easier to get on and off the toilet. Some function as a portable toilet, reducing trips to the bathroom.

What Types of Commode Chairs Are Available?

Commodes come in many styles and sizes. They include:

• Stand-alone toilets for use at the bedside or in the bathroom. These come in three basic styles:
  
• Standard commode chairs (basic unit)
  
• Extra-wide commode chairs (for people over 250 pounds)
  
• Drop-arm commode chairs (arms fold down)
  
• Commodes with wheels
  
• Tall, toilet-covering commodes
  
• Multi-function commodes (toilet, shower chair, bedside chair or wheelchair)
  
• Commodes that attach to the toilet seat, making the toilet taller and easier to use

It is important to pick the right seat for your needs. Your supplier will work with you to ensure your commode meets your needs, is comfortable to sit on, and is safe and easy to use.

What Does Medicare Pay For?

Medicare covers medically necessary commode chairs.

How Do I Qualify for a Commode Chair?

In order to qualify, the doctor must write a prescription and document your need in your medical records. Medicare requirements are 

different for each type of commode chair. For example, Medicare will cover a bedside commode under the following situations:

• Illness keeps you confined to one room
  
• Disability makes it difficult to use the toilet
  
• Beneficiaries confined to a home level with no bathroom
  
• Beneficiaries living in a home with no bathroom

If you receive your Medicare benefit through a Medicare Advantage or MediGap/Medicare Supplemental plan, call and ask how to qualify for a commode chair. Regardless of your coverage, a supplier may be able to answer questions about qualifying for the equipment.

How Much Does It Cost?

You may rent or purchase commode chairs. Your cost will depend on which type of Medicare coverage you receive. For example:

• Medicare covers 80% of their approved amount; you are responsible for the remaining amount.
  
• If you have a MediGap/Medicare Supplemental Plan, call and ask what is covered by the plan. Many times with MediGap plans you will be responsible for little or no cost.
  
• If you have a Medicare Advantage Plan, call your plan and ask what is covered and what your share of cost is. Remember the plan must cover at least what Medicare does; many cover more.

How Do I Find a Medicare Supplier?

Ask your doctor, friends and family for recommendations. When choosing a supplier, do your homework. Before you purchase/rent the commode chair ask the supplier:

• If they are participating suppliers
  
• If they accept assignment
  
• To write down what they will charge and how much of it you will have to pay
  
• If your supplier does not accept assignment, you may:
  
• Be charged more than the Medicare-approved amount
  
• Have to pay the entire cost of your supplies when you get them
  
• Have to bill Medicare yourself and wait several weeks before you will be reimbursed

Other important things to know:

• If the supplier is not enrolled in Medicare, Medicare will not pay the claim.
  
• You must have paid your annual deductible for services and supplies before Medicare will begin to pay its share.
  
• An order (prescription) must be on file with the supplier and must be signed and dated by your doctor.
  
• If you get your coverage through a MediGap/Medicare Supplemental or Medicare Advantage plan, you may have to use one of the suppliers they have on contract.