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Beds and Medicare

Beds and Medicare

Does Medicare Cover Hospital Beds?

Medicare will cover a hospital bed when you can show a medical necessity for the bed. You must also be covered under Medicare Part B and have been assessed by your doctor. The doctor must document your need in your medical records and write you an order (prescription) for the equipment. Only your doctor can prescribe the equipment for you.

The supplier must receive the order before Medicare is billed and it must be kept on file by the supplier.

How Do I Qualify For a Hospital Bed?

To qualify for a hospital bed you must show that you:

• Change positions in ways not possible on a normal bed
• Lay or sleep in positions not possible with a normal bed in order to relieve pain
• Have to sleep with the head of the bed higher than 30 degrees because of conditions such as congestive heart failure, breathing problems, or other types of problems
• Use traction equipment that must be attached to a hospital bed
• Have a Certificate of Medical Necessity that is completed, signed and dated by the treating doctor

The above is the basic criteria for coverage for hospital beds. There are a number of different kinds of beds, such as an adjustable hospital bed. Each will have additional requirements for coverage. Your treating doctor and/or your supplier will know what needs to be documented in order for you to qualify for the bed and equipment that is right for you. Adjustable beds, full-electric beds and electric hi-lo beds are considered convenience devices, and are not covered by Medicare.

How Much Does It Cost to Rent or Buy a Hospital Bed?

After you have paid your annual deductible, you will pay 20% of the Medicare-approved amount for the hospital bed purchase or rental and maintenance. If you have Supplemental insurance you may have little to no out-of-pocket cost for a manual crank, or a semi-electric Hospital bed.

Those costs may be higher if the supplier doesn't accept assignment. Hospital beds are in the Capped Rental category, which means you may choose to rent or purchase the bed. Once Medicare has made 10 monthly rental payments you will be given an opportunity to purchase the bed. The supplier will send you a "Purchase Option" letter in the ninth month of the rental. You will have 30 days to reply.

If you reply and want to buy the bed:

• Medicare will make three more payments and the bed is yours.
• You will be responsible for maintenance (Medicare may cover some of the maintenance cost).

If you do not answer or choose to continue renting:

• Medicare will make a total of 15 rental payments and the bed is yours to use as long as you need it.
• The supplier keeps ownership of the bed and is responsible for maintaining it.
• You may be charged a maintenance and service fee every six months.

Where Do I Purchase or Rent Hospital Beds?

You will save money if you order your items from a Medicare-approved provider that accepts the assignment. You may also buy your hospital bed from any store that sells them. However, if the supplier from which you order your bed is not enrolled in Medicare, Medicare will not pay for the equipment.

Things to review before you choose a supplier:

• There are two types of Medicare suppliers: participating suppliers, and those who are enrolled but have chosen not to participate.
• Participating suppliers will not charge more than the Medicare allowed amount.
• A Medicare approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15% above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the bed. In this situation, Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple of months to receive payment.
• If you receive your Medicare coverage through a Medicare Advantage Plan (like an HMO or PPO), it is likely that the plan will have its own steps for the purchase. In addition, the plan may have restrictions on which suppliers you can use.

Will Medicare Pay for Electric Hospital Beds?

Medicare does not cover full electric hospital beds. They are considered a convenience device. However, you can apply the cost of the manual lift towards the purchase price of an full electric model by using an Advance Beneficiary Notice (ABN). You will have to pay the difference between the two items. In some cases it may be cheaper to purchase an electric bed directly from the medical equipment store.

When medically necessary, Medicare will cover hospital beds to use at home. You&#;ll need a doctor&#;s order stating that your condition requires one. Medicare Part B will pay 80% of the cost. Medigap or Medicare Advantage plans may pay more.

Your doctor might order a hospital bed for you to use at home for many reasons, such as if you&#;re in severe pain, having trouble breathing, or experiencing swelling in your legs and feet.

Medicare will cover the hospital bed as long it&#;s medically necessary to help your condition. Your doctor will need to order the bed and show how it will help your condition.

Medicare pays for all medical equipment, including hospital beds, under Medicare Part B. Part B will pay 80% of the cost of your hospital bed.

You might be able to get more coverage if you have a Medigap or Medicare Advantage plan.

When does Medicare cover hospital beds for home use?

Hospital beds for home use are considered durable medical equipment (DME). Medicare covers DME under Part B. Your hospital bed will need to meet a few conditions in order to be covered.

Medicare will pay for your hospital bed if:

• You have a documented medical condition that requires a home hospital bed.
• You&#;re under the care of a doctor for your condition and being seen at least once every 6 months.
• Your doctor orders the bed for home use.
• Your doctor&#;s order includes your condition and why a hospital bed will help you.
• Your doctor participates in Medicare.
• The equipment provider participates in Medicare.

Medicare can provide coverage for you to either rent or buy a bed.

Whether you rent or buy will depend on the type of bed your doctor orders and the policies of the company you use. You might also rent a bed at first, then purchase it if you still need it later on.

Which Medicare plans may be best for you if you know you need a hospital bed at home?

You can get coverage for hospital beds through a few different parts of Medicare.

If you use Medicare parts A and B, together called original Medicare, your coverage will be through Medicare Part B. That&#;s because Medicare Part A covers inpatient stays and care you receive in hospitals and skilled nursing facilities.

Medicare Part B covers your other healthcare needs, including:

• doctor&#;s office visits
• emergency room care
• medical equipment

Part B will cover 80% of the Medicare-approved amount of your hospital bed. You&#;ll pay the remaining 20%.

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You can also get coverage through a Medicare Part C plan. Part C plans, also known as Medicare Advantage plans, are offered by private companies that contract with Medicare.

They&#;re required to provide the same coverage as original Medicare. Plus, many Advantage plans go beyond the coverage of original Medicare to offer additional covered services.

So, since original Medicare covers hospital beds, all Advantage plans will also cover hospital beds. Your cost might be more or less than with original Medicare, depending on your plan.

Medicare Part D is prescription drug coverage. It won&#;t help you pay for any DME, including hospital beds.

Medigap, however, can help you pay for a hospital bed. This is Medicare supplement insurance. It covers some of the out-of-pocket costs of using original Medicare, like copayments and coinsurance amounts.

So, if you use Medicare Part B to get a hospital bed, a Medigap plan could cover the 20% coinsurance amount you&#;d normally need to pay.

What is a home hospital bed?

A hospital bed is a bed that has extra features, such as side rails, gel cushioning, or the ability to raise your head or feet. Your doctor might order a hospital bed for home use if you have:

• arthritis, osteoporosis, or another chronic pain condition
• heart conditions that require you to keep your head, heart, or limbs elevated
• a condition that requires you to be repositioned for pain or pressure relief
• a spinal cord condition or injury
• chronic obstructive pulmonary disease that&#;s affected by your sleeping position

Which hospital beds are covered?

Medicare covers several types of hospital beds. This includes:

• adjustable beds
• semielectric beds with adjustable heads and feet
• beds with side rails
• extra-wide bariatric beds that can hold weights of 350 to 600 pounds
• extra-wide bariatric beds that can hold weights of more than 600 pounds

Bed types are all available with a mattress or without one. Medicare also covers mattresses pads, including:

• lambswool sheepskin pads
• synthetic sheepskin pads
• gel pressure pads
• dry pressure pads
• water pressure pads
• air pressure pads

Hospital bed accessories

Medicare will also cover some additional features if they&#;re medically necessary. However, it won&#;t cover things that are considered convenience features.

For example, Medicare will cover accessories like trapeze pull bars that help you sit up in bed but won&#;t cover things like over-the-bed tables, which are considered a convenience and not a necessity.

Any bed you order needs to be considered medically necessary for your condition. For example, to get approved for a bariatric bed, you&#;ll need to send a medically documented recent weight.

It&#;s also important to note that while Medicare covers semielectric beds with adjustable heads and feet, it doesn&#;t cover fully electric beds.

Fully electric beds have adjustable height in addition to the adjustable head and feet. Medicare considers adjustable height a convenience feature, and won&#;t pay for it.

How much does the average hospital bed for home use cost?

The cost of a hospital bed depends on the type of bed your doctor orders.

According to Consumer Affairs, hospital bed costs start at around $500 and can often reach thousands of dollars. When you rent a hospital bed, Consumer Affairs reports, you can spend between $200 and $500 per month depending on the bed type.

Medicare can help you reduce this cost. Medicare Part B will pay 80% of your costs when you use original Medicare.

So, let&#;s say your doctor orders a bed with a cost of $1,000. In this case, Medicare would pay $800 and you&#;d pay $200. If you decide to rent a bed instead for $300 per month, Medicare would pay $240 and you&#;d pay $60.

If you have a Medigap plan, it can pick up those remaining costs, meaning you wouldn&#;t need to pay anything for your hospital bed.

Your costs with a Medicare Advantage plan will depend on the plan. Each Part C plan has its own copayment or coinsurance amounts. You can call your Advantage plan if you&#;re not sure.

The bottom line

Medicare will pay for a hospital bed for home use if it&#;s medically necessary and ordered by your doctor.

Medicare covers a variety of hospital beds to help with different conditions. Your doctor will need to specify your condition and why a hospital bed will help it.

Medicare will pay for you to buy or rent a bed. Original Medicare will pay 80% of the costs. A Medicare Advantage or Medigap plan might cover more.

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