Yes, Medicare Part B covers adjustable beds like hospital beds. Medicare Part B, part of Original Medicare, covers outpatient medical costs, such as doctor’s visits and durable medical equipment (DME). DME refers to medical equipment or supplies ordered by a physician for a patient to use in the home and can withstand repeated uses over time.
Since Medicare considers prescribed adjustable beds as DME, it’ll cover the cost as long as it’s deemed medically necessary by your doctor.
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The Benefits of Adjustable Beds
Adjustable beds allow you to change the position of your mattress by lifting the head or foot sections. Some medical conditions that may require the use of an adjustable bed include:
- Chronic pulmonary obstructive disease (COPD)
- Spinal cord injuries like quadriplegia or hemiplegia
- Severe cardiac conditions
- Severe arthritis or injuries
- Chronic neck, back, or spine issues
For those with the above-mentioned conditions, the customizability and flexibility of adjustable beds can drastically improve their quality of life. These beds can be adjusted to different positions, promoting better circulation, relieving pain, and enhancing breathing to better sleep quality.
Since adjustable beds offer many benefits, they often come with hefty price tags. Without financial assistance, patients may have to take out a loan to afford this medical equipment. Thankfully, Medicare Part B can shoulder a significant portion of that cost as long as you meet certain requirements and are enrolled in Original Medicare.
Understanding Medicare Coverage for Adjustable Beds
Though Original Medicare typically covers adjustable beds, you must meet the eligibility requirements to receive financial assistance from the health insurance program.
Eligibility
If you’re already enrolled in Original Medicare, you may need to satisfy the following eligibility requirements to be considered for a Medicare-covered adjustable bed:
- You have a medical condition that requires positioning of the body in ways not achievable with an ordinary bed.
- You have a prescription from your doctor detailing your medical condition and why it requires an adjustable bed.
- Your medical records support the need for an adjustable bed.
Medicare Part A Coverage
Medicare Part A, often referred to as hospital insurance, primarily covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Since DME is not included in Part A coverage, it will not help with your prescribed medical equipment bill.
Medicare Part B Coverage
Medicare Part B primarily covers outpatient medical services, including preventive care, diagnostic screenings, medical supplies, and DME. DME refers to equipment prescribed by a doctor for use in the home, such as wheelchairs, walkers, oxygen equipment, and adjustable beds.
For Medicare Part B to cover an adjustable bed, it must be deemed a medical necessity and prescribed by a Medicare-enrolled physician. Once approved, Medicare pays 80% of the DME cost after you’ve met your Part B deductible of $226 for 2023, and you’ll pay the remaining 20%.
Medigap Coverage
Medigap is a type of private health insurance policy that works in tandem with Original Medicare to help shoulder some out-of-pocket costs that Original Medicare doesn’t cover, such as deductibles, copayments, and coinsurance.
Depending on the Medigap plan, you may get 100% of your Part B coinsurance and copayment paid for. In other words, you will not have any out-of-pocket costs when renting or buying qualified DME as long as you’ve met the $226 Part B deductible.
How Does Medicare Advantage Cover Adjustable Beds?
Medicare Advantage, or Medicare Part C, is a health insurance plan offered by private companies that contract with Medicare. It provides all of Medicare Part A and Part B benefits and often includes additional coverages that Original Medicare does not offer, like vision, hearing, dental, and comprehensive wellness programs. Since Medicare Advantage plans are required to offer, at minimum, the same benefits as Original Medicare, they will also cover adjustable beds.
How Much Does an Adjustable Bed Cost With Medicare?
On average, an adjustable bed can range between $500 and $3,000, with high-end models costing even more. The supplier you choose and the additional features you need can also affect the price tag.
Assuming that the Medicare-approved amount for an adjustable bed is $2,000, Medicare Part B will typically cover $1,600 (80% of $2,000), leaving you to pay $400 plus your Part B deductible, which is $226 in 2023. So, your total out-of-pocket cost for purchasing an adjustable bed will be around $626. If you rent the adjustable bed, you’d pay 20% of the rental fee each month after meeting your Part B deductible.
Medicare Advantage Costs
Medicare Advantage plans cover everything Original Medicare covers, including durable medical equipment. However, Medicare Advantage policies may have different costs and rules, which means your copayment, deductible, and coinsurance amounts will all depend on the specifics of your plan. Check with your Medicare Advantage plan provider for more information.
What Types of Adjustable Beds Does Medicare Cover?
Medicare covers most adjustable beds, including hospital beds, though there may be some exceptions, such as beds with adjustable heights, side rails, and electrically powered beds. However, if your medical condition requires these additions to the bed, Medicare may pay for a portion of their costs as long as your doctor thinks they’re necessary and orders them for you.
Here are a few beds and bedding extras that fall into the DME category:
- Gel or gel-like pressure mattress pad
- Air-fluidized bed
- synthetic or lambswool sheepskin pad
- Air, water, or dry pressure pad for a standard mattress
- Fixed-height hospital bed
- Variable-height hospital bed
- Semi-electric hospital bed with head and foot adjustment
- Total electric hospital bed with head, foot, and height adjustment
- Heavy-duty extra-wide hospital bed
How To Get a Medicare-Covered Adjustable Bed
If you’re considering buying an adjustable bed, here’s a step-by-step guide on how to get it covered under your Medicare plan.
- Talk To Your Physician: Start by discussing your medical needs with your doctor. They must certify that the adjustable bed is necessary medical equipment for your condition.
- Get A Prescription: Medicare only helps pay for adjustable beds prescribed or ordered by a healthcare provider. If your doctor agrees that an adjustable bed is medically necessary, they’ll prescribe one for you.
- Choose A Medicare-Approved Supplier: Next, visit Medicare’s supplier directory to find a supplier approved by Medicare. Medicare may refuse coverage if your DME is not purchased or rented from a supplier enrolled in Medicare.
- Submit A Claim: Your supplier will typically submit a claim to Medicare on your behalf. If they fail to do so, call 1-800-MEDICARE (1-800-633-4227).
- Wait for Approval: Medicare will then review your documentation to determine whether to approve your DME. You have the right to appeal if your initial request is denied.
All in All
Adjustable beds can be a lifesaver for those who suffer from some medical conditions and find it impossible to get a good night’s rest on a regular bed. If you’re among the many people suffering from this issue, speak to your doctor about your eligibility for this medical equipment. While adjustable beds can be expensive, Original Medicare may help relieve some of the financial pressure by shouldering a significant portion of the cost. Just be sure to check that your doctors and DME suppliers are enrolled in Medicare to avoid issues with your claim.