Yes, Medicare does cover mattresses, given a doctor prescribes one as medically necessary and you purchase it through a Medicare-approved bed supplier. Medicare classifies mattresses as durable medical equipment (DME), so Part B usually reimburses most of the purchase price. However, depending on the cost and available suppliers, patients occasionally have to rent their prescribed model.
Your mattress must present a clear medical reason to warrant a prescription from a Medicare-approved doctor. For example, Medicare will cover an air-fluidized bed that minimizes pressure on bony areas of the body. Other mattresses that alleviate bed sores, ulcers, or chronic pain may also see coverage.
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Understanding Medicare Coverage for Mattresses
Medicare mattress coverage hinges on your medical condition and your Medicare policy details.
Eligibility
For Medicare to cover a mattress or any other DME, a doctor must prescribe it as medically necessary in treating or managing a chronic condition. Ailments that require specialized bedding include:
- Stage II pressure ulcers
- Arthritis
- Sciatica
- Chronic pain
- Back problems or other injuries that make it difficult to get in and out of bed
Your doctor and DME provider must have already enrolled in Medicare to receive coverage. Likewise, Medicare mattresses for seniors must prove reliable enough to withstand repeated use within their homes and last for at least three years. Medicare will not authorize coverage for support surfaces that do not have explicit physical health benefits.
Part A Coverage
Part A will rarely cover a take-home mattress. Still, it will pay for your bedding expenses and other equipment you require while registered as an inpatient resident at a hospital, skilled nursing facility (SNF), or nursing home. In exceptional cases, Part A will pay for temporary in-home hospital beds required of recently discharged hospital or SNF patients receiving home health care services that meet specific criteria.
Part B Coverage
Medicare classifies mattresses as DME, so they usually see coverage under Medicare Part B. To activate these benefits, a doctor who accepts Medicare assignment must prescribe a specific mattress as medically necessary to treat or manage a chronic condition. You must purchase this support surface through a Medicare-approved bed supplier in your area.
Part B pays for 80% of all covered doctor’s services and Medicare-compliant DME, leaving patients with a 20% coinsurance and their 2023 Part B deductible of $226. For example, if a medically necessary orthopedic mattress costs $600, you will owe at least $120. You will only have to pay your deductible if you have not fulfilled it as part of other medical expenses earlier in the year.
How Does Medicare Advantage Cover Mattresses?
Medicare Advantage must legally provide equal or greater benefits to Original Medicare. Therefore, all Medicare Advantage Plans will pay for some or all of the cost of a medically necessary mattress ordered by a Medicare-approved doctor. However, since private companies govern these policies independently, they may charge varying <a class=”wpil_keyword_link” href=”https://assurance.com/health-insurance/copays-deductibles-and-coinsurance, copayment, or deductible rates.
What Kind of Beds Does Medicare Cover?
Medicare most commonly covers orthopedic beds designed to alleviate back pain and pressure-reducing mattresses that distribute weight away from sensitive body parts. 5 types of support surfaces specifically require patients to get advance approval from Medicare, also known as prior authorization. These include:
- Powered air floatation beds
- Powered pressure-reducing air mattresses
- Non-powered, advanced pressure-reducing mattress overlays
- Powered air overlays
- Non-powered advanced pressure-reducing mattresses
Among these, popular models covered by Medicare include:
- Joerns PrevaMatt Pressure Relief Series Mattress: Prevents and treats stage II pressure ulcers.
- Drive Medical Therapeutic 5-Zone Support Mattress: Redistributes pressure over 5 areas and reduces friction.
- Solace Resolution Glissando Heavy Duty Mattress: Reduces friction and incorporates sidewalls to help patients get in and out of bed.
Does Medicare Cover Hospital Beds?
Yes. As with other specialized mattresses, Medicare Part B covers in-home hospital beds as DME. After meeting your deductible, you would owe 20% of the Medicare-approved amount for a medically necessary hospital bed rented or purchased through a Medicare-enrolled supplier. In exceptional cases, a hospital bed may see total coverage under Medicare Part A for eligible home health care patients.
Does Medicare Cover Adjustable Beds?
Yes. If you have trouble getting in and out of bed or have chronic pain from arthritis, cardiac disease, or injuries, Medicare Part B will likely cover a take-home adjustable bed as medically necessary DME. Due to their high prices, Medicare often requires patients to rent these beds rather than permanently purchase one. Similarly, Medicare might not cover all adjustable mattresses or upgrades, such as electrically powered models or side rails.
How Much Do Mattresses Cost With Medicare?
Your out-of-pocket share of a Medicare-covered mattress depends on numerous factors, including:
- The type of mattress
- Whether Medicare requires you to rent or own the prescribed model
- Medicare-approved mattress suppliers in your area
- Whether you have Original Medicare or Medicare Advantage
Without insurance, medically-specialized support surfaces can cost anywhere from $200 to $30,000. In most cases, Medicare Part B will cover 80% of your medically necessary mattress, leaving you to pay the remaining 20%. An example of your out-of-pocket costs may look like the following:
Pressure Relief Mattress Total Cost | Medicare Part B Coverage | Your Coinsurance | Your Deductible | Your Total Cost |
|---|---|---|---|---|
$2,289 | 80% of the mattress cost: $1,831 | 20% of the mattress cost: $458 | $226 | $684 |
How Much Does It Cost With Medicare Advantage?
Medicare Advantage costs for a covered mattress depend on the same criteria listed above and the specific details of your plan. Because Medicare Advantage policies operate independently of Original Medicare, some might charge a higher coinsurance and deductible. However, other benefit packages may pay up to 100% of a prescribed support surface or impose less stringent coverage requirements.
How To Get Coverage For Mattresses
Follow these steps to secure a Medicare-covered mattress:
- Receive a Certificate of Medical Necessity (CMN). Discuss your health needs with your doctor, allowing them to determine your options and write a prescription illustrating why you require a specialized mattress.
- Contact Medicare. A Medicare agent can help clarify your coverage details, help you find a compliant DME supplier, and initiate preauthorization.
- Submit documentation. Fill out any required paperwork from your supplier and submit these forms along with your CMN for Medicare to review. Many times, the DME supplier will handle this process on your behalf.
- Purchase or rent your bed or mattress. Once approved, Medicare will pay the majority of the cost, leaving you to cover your coinsurance and deductible.
Putting It All Together
You may need a specialized mattress if you experience trouble getting in and out of bed, suffer from chronic pain, or have persisting ulcers or bed sores. In most cases, your Medicare plan will cover most of the cost of a medically necessary support surface prescribed by a doctor and purchased through a compliant DME provider.
Your share of expenses will ultimately depend on the type of mattress you require, DME suppliers in your area, and whether you have Original Medicare or Medicare Advantage. If you have any questions about how to proceed, simply schedule an appointment with your doctor or call 1-800-MEDICARE to determine your health needs and discuss your coverage options.