- Original Medicare does cover adjustable beds, with stipulations.
- For an adjustable bed to be covered, your doctor must order it.
- The company your doctor orders the bed from must participate in Medicare.
Original Medicare (parts A and B) will cover an adjustable bed, like a hospital bed, but a number of conditions have to be met first.
Adjustable beds are covered under Medicare Part B. However, Part B may not always cover the purchase of a bed — only a rental or loan while you need it.
Read on to find out how Medicare coverage for adjustable beds works.
Medicare covers adjustable beds under Part B.
Medicare Part B pays for outpatient medical costs, such as durable medical equipment. This includes adjustable beds. Part B will cover these beds when your doctor orders one for you to use in your home.
For Part B to cover your adjustable bed, both your doctor and the company that’ll supply the bed must be enrolled as Medicare providers.
Depending on the bed you need and the supplier, you might be able to:
- rent the bed
- purchase the bed
- choose between rental or purchase
“Adjustable bed” is a general term for a bed that doesn’t remain flat or stationary. Adjustable beds allow you to move or elevate different parts of the bed to suit certain needs.
One example is a hospital bed, which may allow you to elevate the head or foot of the bed.
Medicare covers an adjustable bed when you have a specific medical need for it. You must have a face-to-face visit with your doctor or provider within 6 months of your doctor placing the order for the bed.
You must also be enrolled in Medicare Part B, which is part of original Medicare, to have an adjustable bed or any other durable medical equipment covered.
To be considered for coverage, you must have the following:
- a condition that requires special equipment or positioning not possible with a standard bed
- a prescription from your doctor for an adjustable bed that describes your medical condition and why it requires an adjustable bed
- medical records that support the need for an adjustable bed
- physician reports that detail the medical condition for which an adjustable bed is needed
Some conditions that might cause you to need an adjustable bed include:
- those that require frequent positioning of your body to address pain, contractures, or poor alignment
- some cardiac diseases
- chronic pulmonary obstructive disease (COPD)
- spinal cord injuries like quadriplegia or paraplegia
- severe arthritis or injuries
Medicare covers basic hospital beds as a rule, but your options include a number of items, exceptions, and additions if your doctor thinks they’re necessary.
For example, adjustable height features, an electric-powered bed, and side rails aren’t part of the basic coverage, but they can be added if your doctor orders them for you. There may still be coverage limitations, but Medicare does pay at least a portion if these additions are needed for your condition.
Medicare also covers a number of extras for beds or bedding items. The following is a list of what’s included on the durable medical equipment list of specific covered items:
- gel or gel-like pressure mattress pad
- synthetic sheepskin pad
- lambswool sheepskin pad
- air-fluidized bed
- air pressure pad for a standard mattress
- water pressure pad for a standard mattress
- dry pressure pad for a standard mattress
- fixed-height hospital bed — with or without side rails, with or without a mattress
- variable-height hospital bed — with or without side rails, with or without a mattress
- semi-electric hospital bed with head and foot adjustment — with or without side rails, with or without a mattress
- total electric hospital bed with head, foot, and height adjustment — with or without side rails, with or without a mattress
- heavy-duty, extra-wide hospital bed with side rails with weight capacities of 350 to 600 pounds, or greater than 600 pounds — without or without a mattress
- hospital-grade, fully enclosed pediatric crib.
The cost of an adjustable bed depends on several factors, including:
- the model
- options and extras
- which supplier you choose
- what additional insurance you may have
Generally, prices for hospital beds range from $500 to more than $30,000. Some of the most expensive models, like ICU beds, are available for rental only. You may also find suppliers that refurbish used beds and sell them or offer rentals.
If the supplier you choose accepts your Medicare assignment, Medicare will pay 80 percent of the approved amount, and you’ll pay the remaining 20 percent. You’ll also have to pay your Part B deductible.
Without Medicare, you would have to use private insurance or pay for the entire amount of the bed purchase or rental.
If you need an adjustable bed and you have Medicare, chances are you have most of the coverage you need. Medicare Part B is part of original Medicare.
Original Medicare includes Part A and Part B. You’re automatically enrolled in Part A at age 65, but you must enroll in Part B yourself. If you decide not to enroll when you first become eligible, you may have to pay a late enrollment fee.
Adjustable beds like hospital beds are included in the allowances for durable medical equipment covered under Part B, which covers outpatient care.
If you have a Medicare Advantage plan, also known as Medicare Part C, you’ll have all the basic coverage offered by original Medicare. Plus, you should have some additional coverage. This coverage may include allowances for certain services or equipment.
When Medicare covers your adjustable bed, it’ll pay 80 percent of the approved amount. You’ll pay the remaining 20 percent of the covered cost.
You’ll also have to pay your Medicare Part B deductible and any costs not eligible under your Medicare coverage, such as extra features not included in your doctor’s order.
To help manage your share of the costs, a Medicare supplement plan, also known as Medigap, can help. These plans provide help with your out-of-pocket costs after Medicare pays its share.
- Medicare Part B will cover much of the cost of an adjustable bed if your doctor orders it for a specific, permitted need.
- Extras or add-ons might not be covered under Medicare Part B; instead, you could pay out of pocket for these costs or use supplemental insurance to help pay for your share.