Letter of Medical Necessity for Paying for Walk-In Tubs: How It Works & Ways to Help Pay
Short summary: If you or a loved one needs safer bathing, a letter of medical necessity can be the key to getting some costs covered—or at least reducing taxes—when buying walk-in tubs for seniors. This guide explains what the letter is, when insurers or programs use it, how to get one, and the smartest options for paying for walk-in tubs without blowing your budget.
Article roadmap
What is a letter of medical necessity for walk-in tubs?
Who needs the letter and how do you get it?
Will Medicare or Medicaid help pay?
What a Medicare Advantage plan may cover
Are walk-in tubs tax deductible medical expenses?
Veterans benefits (HISA, Aid & Attendance) and how they apply
Private insurance and supplemental insurance options
Medicaid programs & HCBS waivers by state
Realistic costs: tub, installation costs, and what to expect to pay
Safer alternatives and home modifications if a tub isn’t approved
Documentation & reimbursement: your step-by-step checklist
Sources of assistance you can contact today
1. What is a letter of medical necessity for paying for walk-in tubs?
A letter of medical necessity is a short statement from your clinician (MD, DO, NP, or PT) that explains why a specific device or home modification is required for your health and safety. For bathing, it typically outlines your medical condition, fall risk, and why a standard bathtub or high tub edge is unsafe. The provider states the equipment is medically necessary for daily living, hygiene, and to reduce the risk of injury.
Insurers use the letter to decide whether a device is medical equipment or simply a convenience upgrade. Many carriers don’t treat tubs as durable medical equipment, but the letter still matters: it can support tax deductibility, VA or state program reviews, and some health insurance appeals.
2. Who needs the letter—and how do you get it?
You usually need the letter when you’ll submit claims, apply for benefits, or ask for reimbursement from an assistance program. Ask the prescriber for a written prescription and the letter together. It should describe how the installation of a walk-in tub would improve safety, what features are required (low entry, grab bars, seat), and why a roll-in shower or other option isn’t adequate.
Keep a copy for your records, and verify each funding source’s formatting requirements. Some ask the clinician to include ICD codes; others accept plain language. If your evaluation is offered by a hospital-based therapist, it may even be free of charge.
3. Will Medicare or Medicaid help pay?
Original Medicare generally does not treat walk-in tubs as durable medical equipment, so Medicare covers the fixtures only in rare, case-by-case situations. That said, Medicare coverage policies intersect with home safety in a few ways:
Medicare and Medicaid coordination: Certain state Medicaid waivers can layer onto Medicare, and Medicare covers related medical equipment (for example, transfer benches) when justified.
Clinical documentation: A strong letter of medical necessity plus photos of hazards can help demonstrate the need for accessibility improvements, even if the tub itself isn’t approved.
Medicaid is different. States run their own Medicaid programs and programs offered under waivers. Some program may fund accessibility changes under home and community based services—or a blind and disabled persons waiver—when modifications are necessary for safety. Coverage rules vary based on state and diagnosis, and some medicaid will pay contractors directly rather than reimbursing you.
4. What a Medicare Advantage plan may cover
A Medicare Advantage plan (Part C) sometimes offer additional supplemental benefits that Original Medicare doesn’t. In recent years, some plans offer additional benefits focused on fall prevention and home modifications, and a few may provide allowances for bathroom changes including walk-in tubs or low threshold shower entries. Because these policies differ, check your specific Medicare Advantage plan booklet for “home support” or “special supplemental benefits.”
Plans provide coverage only under their written rules; always call the number on your card.
Medicare Advantage plans may give a cash allowance or vetted-contractor pathway and offer additional in-home support visits.
Ask whether your plan will help cover grab bars or bathroom safety products, even if a tub itself isn’t covered.
5. Are walk-in bathtubs tax deductible medical expenses?
The IRS lets taxpayers deduct medical expenses as a medical and dental expense when they exceed the threshold for the year and are ordered to make home safer due to a medical need. If your clinician has deemed medically necessary changes to prevent falls, portions of the project that don’t increase property value can be tax deductible as part of home modifications.
Keep receipts for the costs associated with the project and the cost of a walk-in tub unit.
Ask your tax professional whether you can count labor tied to installation costs.
Caregivers may also explore the dependent care tax credit for certain support services, though it’s not designed for fixtures.
Always consult a tax pro; we’re simply explaining how the IRS treats categories, not giving tax advice. Good documentation and a letter of medical necessity help when claiming the deduction.
6. Veterans benefits (HISA, Aid & Attendance) and how they apply
Several veterans benefits may help with accessibility:
HISA grant (Home Improvements and Structural Alterations), offered by the VA, can fund modifications toward the purchase and installation of safety items when needed for treatment.
Aid and Attendance increases a veteran’s pension when the person is housebound or needs help with activities of daily living; these funds can be used out-of-pocket for safer bathing.
Some VA clinical teams approve home modifications—such as tub or shower conversions—when they are necessary for safety.
Ask your VA clinician whether the modification is deemed medically necessary, and whether your station has a program may provide an allowance. TRICARE-related programs (TRICARE and CHAMPVA) can review needs too; benefits differ, so check with your case manager.
7. Private insurance and supplemental insurance options
Most insurance companies do not list tubs as covered medical equipment, but there are exceptions. A few private insurance companies and employer health insurance plans consider bathing access under catastrophic injury riders and may provide partial reimbursement when a fall hazard is documented. Some supplemental insurance riders also offer additional benefits for home safety upgrades.
If your insurer allows claims, they’ll ask for: the letter of medical necessity, a written prescription, photos, and itemized quotes. Ask the provider whether you must give consent to receive texts or emails about approvals and whether they’ll pay vendors directly. Insurance programs can be slow—keep copies and follow up.
8. Medicaid programs & HCBS waivers by state
State Medicaid programs can provide financial assistance through home and community based services waivers, disability waivers, or a blind and disabled persons waiver. Benefits vary based on income, age, and need. The program’s goal is to keep an older adult at home rather than moving to assisted living.
Look for “environmental accessibility adaptations” language.
Many states fund grab bars and home modifications for safer entries, and some may provide funds toward the purchase and installation of a tub or a roll-in shower conversion.
Contact your local Area Agency on Aging to learn about sources of assistance and programs offered in your county.
9. Realistic costs: tub, installation costs, and what to expect to pay
The cost of a walk-in varies widely. Nationally, the cost of a walk-in tub plus installation costs often lands between mid-four figures and low five figures, depending on plumbing, electrical, and wall modification work. You should expect to pay part of the project out-of-pocket even with benefits.
Get at least two quotes from licensed contractors and well-rated tub manufacturers.
Ask how the tub installed will be supported, which upgrades are optional, and how warranties work.
If you’re comparing a tub or shower, consider a low threshold shower conversion. For some layouts it’s less expensive and easier to navigate with a wheelchair.
If you apply to programs, request that quotes separate labor and material line items; many reviewers want to see the amount allocated toward the purchase and installation.
10. Safer alternatives and home modifications if a tub isn’t approved
Not every situation calls for a tub. For narrow spaces, a roll-in shower with grab bars and a secure seat may be the fastest way to restore hygiene and independence. Many families install a handheld shower, slip-resistant flooring, and doorway ramps as fast home modifications while funding decisions are pending.
Community nonprofits such as Rebuilding Together sometimes assist with simple accessibility projects for qualifying households. If climbing is tough, ask about wheelchair-friendly layouts and accessibility upgrades that still meet code.
11. Documentation & reimbursement: your step-by-step checklist
Get the paperwork. Ask your clinician for a letter of medical necessity and written prescription. Clearly state why the change is necessary for safety and list features required for walk-in tubs.
Collect quotes. Include model numbers, delivery, and installation costs broken out.
Submit benefits. File with your Medicare Advantage plan, state waiver, or other payer, and keep copies. Some programs ask you to consent to receive texts or emails about your case.
Know what plans cover. Even when a tub isn’t approved, some payers cover the cost of grab bars or related medical equipment.
If approved, follow instructions. Some programs pay contractors directly; others use reimbursement after you submit receipts.
If denied, appeal. Cite specific policy language and include photos showing hazards.
Tax prep. Save all receipts for medical expenses—your CPA can advise on the deduction under IRS rules.
12. Sources of assistance you can contact today
Area Agency on Aging: local navigator for waivers and sources of assistance.
State Medicaid office: explains HCBS waivers and how benefits may qualify.
VA Medical Center: ask about HISA grant, Aid and Attendance, and benefits offered by the VA.
Nonprofits: Rebuilding Together and local charities may fund simple safety upgrades.
Manufacturers & lenders: Some tub manufacturers and dealers offer payment plans that spread costs associated with installation.
City housing departments: look for accessibility programs offered to lower-income homeowners.
Details that matter to reviewers (and how to frame them)
Explain why you need a letter: a history of falls, limited mobility, and why a tub or shower with a high edge is unsafe.
Make the link to function explicit: the new tub helps with transfers, hygiene, and caregiver support.
State if you use a wheelchair or scooter or have limited knee flexion.
If a clinician believes the change is necessary for safety, ask them to say so in the letter.
When you contact programs, ask whether benefits are provide coverage as cash, vouchers, or a contractor network.
If your plan says medicare covers nothing for tubs, ask whether they cover the cost of related medical equipment while you pursue other options.
Quick answers to common questions
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Original Medicare rarely pays for tubs as durable medical equipment, but some Medicare Advantage plans cover limited home supports or a small allowance when safety is at risk. Always check the plan’s booklet and call member services.
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Medicaid programs vary, but some states approve home modifications through waivers. Benefits can include grab bars, ramps, and—in select cases—tub conversions. Your state’s rules vary based on diagnosis and income.
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Yes. City rehabs, utility safety grants, nonprofit projects, and employer EAPs are all sources of assistance. If you’re a veteran, ask about the HISA grant and Aid and Attendance.
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Most do. Provide a template and ask them to specify features and why the change is needed. The evaluation may be free of charge during a clinic visit.
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Some health insurance plans and riders offer additional benefits for fall prevention. It’s uncommon, but it never hurts to ask.
Terminology at a glance (so you can speak the reviewer’s language)
Durable medical equipment: gear used at home to treat a condition. Tubs are usually not classified as DME, but letters still help.
Medical equipment: broader term that sometimes includes transfer benches and seats tied to bathing.
Medicare coverage: umbrella term for what Original Medicare or a Medicare Advantage plan will pay.
Reimbursement: money paid back to you after submitting receipts.
Accessibility: design that allows safe entry and use—critical for older adult safety.
Final checklist (so nothing gets missed)
Obtain your letter of medical necessity and written prescription.
Gather itemized quotes for walk-in tubs and labor (separate parts/labor).
Submit to your Medicare Advantage plan, VA, or state waiver and track responses.If denied, request a supervisor review; cite policy sections; resubmit photos.
Talk with your CPA about tax deductible medical expenses and documentation.
If caregivers pay for support services, ask about the dependent care tax credit.
If you’re a veteran, apply for veterans benefits like Aid and Attendance and HISA.
For private plans, ask if they’ll help cover related gear or give an allowance.
Bullet-point summary to remember
A strong letter of medical necessity explains risks, why a standard bathtub is unsafe, and how a new unit will reduce the risk of falls.
Medicaid waivers and Medicare Advantage plan extras may provide help; Original Medicare seldom pays for tubs as durable medical equipment.
Veterans can leverage HISA grant, Aid and Attendance, and other programs offered by the VA.
For taxes, the IRS may allow deduction of qualified medical expenses tied to home modifications when ordered by a clinician.
Keep quotes and receipts; some benefits use reimbursement, while others pay contractors directly.
If funding is limited, consider a roll-in shower, grab bars, and other home modifications to improve accessibility and hygiene now.
Nonprofits (like Rebuilding Together) and local housing programs can be crucial sources of assistance.
Always verify rules, because benefits vary based on state and plan.
Plain-English bottom line: With the right paperwork and a smart mix of programs, you can help pay for safer bathing—whether through benefits, tax relief, or step-by-step budgeting—so the project gets approved and the tub installed the right way.
