How Does Medicare Cover In-home Hospital Beds?

Medicare does cover in-home hospital beds in certain situations. If you meet the eligibility requirements and your doctor prescribes a hospital bed as medically necessary, Medicare Part B categorizes the bed as durable medical equipment (DME) and covers a percentage of the cost. This can reduce the financial burden of medically necessary hospital beds and help enable Medicare recipients to receive safe, comfortable care in their homes.

In-Home Hospital Beds Can Benefit Patients and Caregivers

Hospital beds in the home play a crucial role in patient care and caregiver support. For patients with medical conditions such as arthritis, chronic obstructive pulmonary disease (COPD), certain heart diseases, or mobility issues, a home hospital bed can drastically improve the quality of life. Hospital beds can aid in repositioning, help reduce pain, and make daily activities like eating, reading, or watching television more manageable.

Adjustable hospital beds can also help prevent caregiver injuries that could occur while assisting a patient with mobility issues. Caregivers can easily adjust the bed height or angle, reducing the risk of straining their backs or arms. Hospital beds with side railings can also offer extra security to prevent patient falls.

Medicare coverage for hospital beds can be a critical part of a patient’s care plan, potentially allowing them to receive in home care rather than having to move to a nursing facility or other care arrangement. By categorizing hospital beds as DME and covering them under Part B, Medicare prioritizes patients’ health and independence and helps ensure that beneficiaries can access the care they need in their homes.

Types of Hospital Beds

There are several different types of hospital beds approved by Medicare, including:

Manual hospital beds: These are hand-operated beds that use a crank to adjust overall bed height, as well as the head and foot of the bed
Semi-electric hospital beds: These are beds that operate using a combination of manual and electric controls — the head and foot positions are adjusted electronically, while a hand crank manages the overall bed height
Bariatric hospital beds: This bed is designed specifically to provide comfort and safety for larger individuals, sturdy, with wider dimensions and higher weight capacities

Understanding Medicare Coverage for Hospital Beds

Medicare Part B covers hospital beds under the category of durable medical equipment. DME is medical equipment that is ordered by a doctor for use in the home. To qualify as DME, items must be reusable, long-lasting, and used for medical purposes. They must also be used in the home and not useful to someone who is not sick or injured. For hospital beds to qualify as DME and therefore be covered by Medicare, they typically need features not found in a regular bed, like adjustable heights or side rails.

Medicare Part B may cover either rental or purchase of a hospital bed for home use, depending on the circumstances. Whether you buy or rent, the Part B deductible applies, and you’re typically responsible for paying 20% of the Medicare-approved amount.

To get a hospital bed through Medicare, you first need a written prescription from your doctor stating that the hospital bed is medically necessary due to your specific health condition. Once you have this prescription, you take it to a supplier enrolled in Medicare and approved by Medicare to provide DMEs.

Eligibility

To receive a Medicare-covered hospital bed, you must meet the following requirements:

You’re under the care of a doctor who is a participant in the Medicare program.
You have a documented medical condition that requires you to have a home hospital bed.
The doctor has provided a prescription for a hospital bed for home use.
The doctor’s orders clearly describe your condition and why a hospital bed is medically necessary.
You are under a doctor’s care for your condition and see the doctor at least once every six months.
You purchase the bed from a DME provider that participates in Medicare.

Getting Coverage: Your Doctor and Bed Supplier Must Accept Assignment

When buying or renting hospital beds approved by Medicare, choosing a doctor and DME supplier who accept Medicare assignment can significantly lower your out-of-pocket costs.

Accepting assignment means that the providers have agreed to accept the Medicare-approved amount as the total cost for their services or products. When providers accept assignment, they bill Medicare directly, and you’re responsible for paying the remaining 20% after Medicare pays its share. Providers that do not accept assignment may charge more than the Medicare-approved amount, leaving you to pay the excess cost out of pocket.

How Does Medicare Advantage Cover Hospital Beds?

Medicare Advantage plans, also known as Medicare Part C, typically offer additional benefits beyond what Original Medicare covers (Medicare Part A and Part B). While Medicare Part B has strict eligibility requirements for hospital bed coverage, Medicare Advantage plans may have more lenient requirements or offer additional coverage.

Medicare Advantage plans are required to cover, at a minimum, the same benefits as Original Medicare. Therefore, if a home hospital bed is covered by Original Medicare, it is also covered by Medicare Advantage.

However, the cost-sharing structure might vary. While Original Medicare typically covers 80% of the cost, leaving 20% as your responsibility, a Medicare Advantage plan might offer a different ratio, potentially reducing your out-of-pocket expenses. Some Medicare Advantage plans also have a network of approved providers, requiring you to buy or rent the hospital bed from an in-network supplier to receive full coverage.

How Much Do Medicare Approved Hospital Beds Cost?

Since they are categorized as DME, hospital beds are covered by Medicare at a rate of 80%. This means that after you’ve met your Part B deductible for the year ($226 in 2023), you’re responsible for 20% of the Medicare-approved amount.

The cost to purchase a hospital bed for home use can range from less than $500 to more than $5,000, depending on the type of bed. With Medicare coverage, individuals are responsible for 20%, reducing the cost to between $100 and $1,000. Renting a bed without Medicare coverage typically costs from $200 to $500 per month. Medicare coverage can reduce this to $40 to $100 a month.

Medicare Advantage Costs

When receiving medical services or purchasing DME under a Medicare Advantage plan, you may be responsible for various costs, including premiums, copayments, coinsurance, and, in some cases, costs incurred from using out-of-network suppliers.

Premiums for Medicare Advantage plans vary greatly. Some offer zero dollar premiums, meaning you are not responsible for additional monthly premiums beyond your Medicare Part B premium. Other plans come with a premium in addition to what you pay for Medicare Part B.

Deductibles, copayments, and coinsurance are all ways you may have to share in the cost of your Medicare-covered hospital bed. The exact amount can differ depending on the specific plan you’ve selected.

If your plan has a network and you choose a bed supplier that is not included, you may face higher costs or even full responsibility for the payment. Medicare Advantage plans also have an annual out-of-pocket maximum, which puts a cap on what you pay for covered services and DME. Once you reach this limit, you pay nothing out of pocket for the rest of the year.

Putting It All Together

For Medicare beneficiaries dealing with certain health conditions, acquiring a hospital bed for home use can significantly improve the quality of life. Original Medicare and Medicare Advantage plans both categorize home hospital beds as durable medical equipment, offering coverage to Medicare participants. To ensure coverage, it’s important to meet the eligibility requirements, including working with a doctor and equipment provider that both participate in Medicare.

Medicare does not have a set schedule for replacing home hospital beds. Replacement typically depends on the individual’s medical needs and whether the equipment is no longer functional or safe. If there’s a change in your condition that warrants a different type of bed, your doctor can provide a new prescription.

Yes, Medicare Part B covers both renting and buying a hospital bed. The choice between renting and buying generally depends on your doctor’s prescription, how long you’re expected to need the bed and your supplier’s policies.

There’s no standard timeframe for Medicare approval. It depends on various factors, including the complexity of the case, the completeness of the documentation, and Medicare’s processing times. You may be able to expedite the process by ensuring that the doctor’s prescription clearly states the medical need for the bed and that all required paperwork is submitted promptly.

Medicare typically does cover the cost of bed accessories as long as they are deemed medically necessary by your doctor. Medicare categorizes accessories like bed rails as durable medical equipment, so the coverage rules and cost-sharing are similar to the rules and costs for the bed itself.

The cost of delivering and assembling the bed is generally included in the Medicare-approved amount. As long as you’re using a supplier that accepts Medicare assignment, you’re responsible for 20% of the cost after the Part B deductible has been met.

Does Medicare Cover Hospital Beds?