The Medicare Advantage Home Safety benefit is one of the least understood supplemental benefits in the program. Most members have it. Most have never used it. And most have no idea it covers real modifications to their home, not just a pamphlet about fall prevention.
Here is how it works and how to use it.
What Is the Home Safety Benefit?
The Home Safety benefit (sometimes called the Home Modification benefit) is a supplemental benefit included in most Medicare Advantage plans. Original Medicare does not offer it. It gives you an annual dollar allowance to spend on modifications that reduce fall risk and improve safety in your home.
The benefit exists because falls are one of the leading causes of injury, hospitalization, and decline for older adults. Plans offer this benefit because preventing a fall is far cheaper for the plan than paying for a hip fracture, surgery, and rehabilitation.
What Does the Home Safety Benefit Cover?
Covered items typically include:
- Grab bar installation in bathrooms and hallways
- Raised toilet seats and toilet safety rails
- Shower chairs and bath benches
- Non-slip bath mats and tub mats
- Threshold ramps for doorways and entries
- Handrails and stair rails
- Motion-sensor night lights
- Portable wheelchair ramps
- Suction-cup grab bars (for renters)
Some plans also cover doorway widening for wheelchair access, lever-style door handles, and roll-in shower modifications. The specific covered items vary by plan and by market.
How Much Does the Benefit Cover?
Most plans offer $200 to $500 per year. Some plans in competitive markets offer up to $1,500 per year. The exact amount is in your plan's Summary of Benefits document, which you can find on your plan's website or request by calling Member Services.
The allowance resets annually on January 1. Unused balances do not roll over.
How to Use Your Home Safety Benefit: 4 Steps
Step 1: Find your allowance amount. Call Member Services or check your Summary of Benefits. Ask for your Home Safety or Home Modification benefit amount and how the claiming process works for your specific plan.
Step 2: Get a list of approved vendors. Your plan will have a network of approved contractors and vendors. Using an out-of-network vendor may mean the cost is not covered. Ask for the list before hiring anyone.
Step 3: Schedule an assessment if required. Some plans require a brief home safety assessment before approving modifications. This is usually a short visit from an occupational therapist or contractor who identifies what your home needs. The assessment is typically covered at no additional cost.
Step 4: Get the work done. Most plans pay the approved vendor directly. Others allow you to pay out of pocket and submit a receipt for reimbursement up to your allowance amount. Ask Member Services which method your plan uses before scheduling work.
Does the Benefit Cover the Full Cost?
Up to the benefit limit, yes. If your total modification costs exceed the annual allowance, you pay the difference. For most standard modifications (two grab bars, a shower chair, a threshold ramp), the typical $200 to $500 allowance is often sufficient to cover everything.
What Happens If You Don't Use It?
The allowance resets on January 1 and unused funds do not carry over. If you have the benefit and your home has any fall risks at all (and most homes do), this is money worth using. The modifications that fall prevention specialists consistently recommend first are also the least expensive: grab bars, a shower chair, and better bathroom lighting.
Can You Use Both Home Safety and DME Benefits Together?
Yes. The Home Safety benefit covers modifications to your home. The DME benefit covers equipment like walkers, commodes, and wheelchairs. Both can be used at the same time. If you are setting up your home after a hospital stay or for a family member moving in, you may be able to claim both benefits simultaneously.
