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Medicare helps pay for some types of adjustable beds, such as an adjustable hospital bed, as durable medical equipment (DME).
Certain eligibility criteria must be met for both the beneficiary and the home medical equipment itself in order for Medicare to help pay.
Medicare Part B is the portion of Medicare that handles durable medical equipment rental and/or purchase.
Adjustable beds are a type of durable medical equipment that can be prescribed by a doctor for home use. But does Medicare pay for it? Are only certain types of adjustable beds covered?
If the use of an adjustable bed is deemed medically necessary, Medicare covers some of the cost. That said, there are specifics in place for what is deemed to be a medical necessity as well as the specific type of adjustable bed needed.
Learn more about Medicare and adjustable beds coverage in this comprehensive guide.
What is Durable Medical Equipment?
The Federal Medicare Program defines durable medical equipment (DME) as medically necessary equipment and supplies, which a doctor prescribes for a patient’s home use. DME is used to improve a patient’s quality of life.
How Does Medicare Coverage Work For DME?
As a reminder, Original Medicare only consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Medicare Part A covers inpatient services, such as those received at a skilled nursing facility. Medicare Part B covers outpatient services, such as a doctor’s visit, some vaccinations, etc. Original Medicare does not include prescription drug coverage (Medicare Part D).
Medicare Part B is the portion of Original Medicare that handles DME coverage. Medicare Part B will cover DME if the following criteria are met:
It can tolerate repeated use
It is medically necessary
The equipment is only useful in cases of sickness or injury
It is for home use
It has an expected lifetime of at least three years
It’s important to note that a parovider must indicate the narrative as to why DME is medically necessary in order for Medicare to cover it. For example, they need to indicate that the patient has had spinal cord injuries and requires frequent repositioning in order to address pain in order for the patient to get coverage for a hospital bed.
Furthermore, Medicare pays for DME in different ways, as it will all depend on the specific item involved. Some examples of durable medical equipment covered by Medicare Part B include:
Raised toilet seats
Medicare Costs for DME
In most cases, if the DME supplier accepts assignment, as well as the prescribing doctor, Part B covers 80 percent of the Medicare-approved amount for DME, leaving Medicare beneficiaries responsible for the remaining 20 percent of costs. The Medicare-approved amount refers to the amount a doctor or supplier can be paid.
The Medicare Part B deducible also applies for DME coverage.
Note: Learn more about durable medical equipment and Medicare coverage at this resource.
There are a number of factors that may impact the overall DME cost including:
Secondary insurance a beneficiary may have
How much a doctor or medical supplier charge
Whether the doctor or supplier accepts Medicare assignment
Beneficiaries should always consult a healthcare provider or their insurance company to confirm coverage.
Renting vs. Buying Durable Medical Equipment
In addition to the type of DME, whether the medical equipment is being rented or purchased will also factor into how Medicare coverage works. In most cases, Medicare pays for DME on a rental basis. Medicare only buys inexpensive or routinely-bought items including walkers, canes, etc.
For more expensive equipment, such as wheelchairs or hospital beds, Medicare will pay monthly rental payments for the DME for 13 months of continuous use. If the rental period surpasses that 13-month period, the Medicare supplier must transfer ownership of the DME to the beneficiary.
Note: Learn more about renting versus purchasing DME on page 12 of this resource.
How to Find a DME Supplier
Medicare will help pay DME only in the event that both the prescribing physician and the medical supplier are enrolled in Medicare. If they are not, Medicare will not cover the claims submitted. Doctors and medical suppliers must meet strict sourcing standards in order to stay enrolled in the Medicare program.
Note: Find participating suppliers here.
What Is An Adjustable Bed?
An adjustable bed is a type of bed that can be reclined, risen, or lowered in order to find the best positioning for the patient based on their medical needs.
An adjustable bed typically consists of both head and foot sections that can be reclined or propped up. Adjustable beds also usually have side rails that can be raised or lowered.
There are various types of adjustable beds available but the two main types are hospital beds and air-fluidized beds.
What Is A Hospital Bed?
Hospital beds are beds specifically created for those in need of healthcare. Some types of hospital beds include:
Basic hospital beds
Manual hospital bed
Adjustable hospital bed
Semi-electric hospital bed
What Is An Air-Fluidized Bed?
An air-fluidized bed is a type of adjustable bed used to aid in healing an ulcer or other wounds. These types of adjustable beds reduce pressure on the body to give the patient a sensation of “floating.”
Does Medicare Cover Adjustable Beds?
Medicare covers adjustable beds as DME if the following are true:
The bed can adjust from the head or foot for proper elevation and positioning
Side rails that can lower and raise
It is medically necessary
Exactly how Medicare coverage functions for adjustable beds will depend on the type of adjustable bed in question.
How Does Medicare Coverage Work For Hospital Beds?
Medicare covers hospital beds for at-home use if it is medically necessary for the patient and if the supplier and doctor accept Medicare assignment.
Like most DME, 80 percent of the Medicare-approved cost of an air-fluidized bed is covered by Medicare Part B, leaving patients responsible for the remaining 20 percent.
Note: Hospital beds must meet a number of qualifying criteria in order to be considered medically necessary. Review its National Coverage Determination (NCD), found on the Centers for Medicare and Medicaid Services official website.
How Does Medicare Coverage Work For Air-Fluidized Beds?
Medicare covers air-fluidized beds for at-home use if it is medically necessary. Like most DME, 80 percent of the Medicare-approved cost of an air-fluidized bed is covered by Medicare Part B, leaving patients responsible for the remaining 20 percent.
Note: Air-fluidized beds must meet a number of qualifying criteria in order to be considered medically necessary. Review its NCD on the CMS website.
Does Medicare Advantage Cover Adjustable Beds?
Medicare Advantage plans, also known as Medicare Part C or MA plans, are a type of supplemental insurance offered by private insurance companies that are Medicare-approved. Medicare Advantage plans consist of both Medicare Part A and Medicare Part B. Many Medicare Advantage plans also include additional benefits such as hearing, dental, vision, and prescription drugs.
Because a Medicare Advantage plan includes Medicare Part B, coverage for adjustable beds will, at the very least, handle coverage the same way. That said, specifics in regards to costs will vary based on the specific plan chosen.
Medicare Advantage beneficiaries should always contact their plan’s insurance provider to confirm coverage.
Do Medigap Plans Cover Adjustable Beds?
Medigap, or MedSupp, are supplemental insurance plans that intend to “fill in the gaps” of Original Medicare. Medigap policies are sold by private insurance companies and help pay some out-of-pocket costs such as deductibles, coinsurance, and copays. This may include the Medicare Part B deductible, which, in turn, would help pay more of the adjustable bed cost.
Financial Assistance for Adjustable Beds
Medicare does not cover all the costs associated with adjustable beds, such as hospital beds. As such, financial assistance may be necessary. There are multiple options beneficiaries can pursue to receive financial assistance for renting or buying adjustable beds.
Medicaid is a joint federal and state health insurance program for various eligible Americans, including those with financial limitations, children, pregnant women, elderly adults, and people with disabilities. Medicaid policies will vary by state but some may states may offer Medicaid coverage that helps pay the adjustable bed out-of-pocket costs.
It is possible to be eligible for both Medicare and Medicaid. This is known as the Medicare-Medicaid Dual Eligibles program. Those who are eligible for Dual Eligibles are entitled to both Medicare and Medicaid benefits.
Many non-profit organizations accept lightly-used hospital bed donations to provide to those in need. Some examples of non-profits that do so include:
Navigating Medicare Coverage Issues: DME
If a Medicare beneficiary experiences problems with a Medicare supplier or physician, there are a few steps they can take:
Why are adjustable beds good for seniors?
Adjustable beds are great options for seniors as they help those with low mobility, chronic pain, sleep apnea, and more.