Are Adjustable Beds Covered by Medicare? What You Need to Know

As we age or deal with certain medical conditions, a comfortable and supportive sleeping arrangement becomes essential. Adjustable beds can significantly improve sleep quality, reduce pain, and enhance overall well-being. But since these beds can be expensive, many wonder: Does Medicare cover adjustable beds?

Quick Answer

Yes, Medicare Part B covers adjustable beds, but only under specific conditions. These beds are classified as Durable Medical Equipment (DME), meaning they must be deemed medically necessary by a doctor and prescribed for home use. However, coverage is not automatic, and there are strict eligibility criteria that beneficiaries must meet.

Our Top Picks for the Best Medicare-Covered Adjustable Beds

If you’re looking for an adjustable bed that meets Medicare’s criteria, here are our top recommendations:

1. Drive Medical Full-Electric Hospital Bed – A fully adjustable bed covered under Medicare with a user-friendly remote control, sturdy frame, and customizable height settings for maximum comfort.
2. Invacare Full-Electric Hospital Bed – Offers head, foot, and height adjustments, making it ideal for medical needs while still being easy to use at home. Durable and Medicare-approved.
3. Medline Semi-Electric Hospital Bed – A cost-effective option that provides essential adjustability while keeping expenses low. Medicare covers it under DME if prescribed by a doctor.

What Is Medicare and How Does It Work for Durable Medical Equipment?

Medicare is a federal health insurance program designed for people aged 65 and older, as well as for some younger individuals with disabilities or specific medical conditions. It is divided into several parts, each offering different types of coverage. When it comes to durable medical equipment (DME), like adjustable beds, understanding which part of Medicare covers what is essential for navigating your benefits.

Medicare Part A covers inpatient hospital stays, skilled nursing facility care, hospice care, and some home health care services. However, it does not typically cover durable medical equipment.

Medicare Part B, on the other hand, covers outpatient care, including some types of durable medical equipment. For adjustable beds to be covered under Part B, they must meet the criteria for medical necessity. In essence, Medicare will only cover an adjustable bed if it is deemed essential for the treatment of a specific health condition, such as a severe back injury or a condition that causes difficulty in positioning while sleeping.

Medicare Part C, also known as Medicare Advantage, includes all the benefits of Parts A and B and may offer additional coverage for things like vision, dental, or even certain durable medical equipment. If you’re enrolled in a Medicare Advantage plan, the specific coverage details for adjustable beds may vary, depending on your plan’s provider.

To make the most of Medicare benefits for adjustable beds, it’s crucial to know what is covered under each part and to ensure that your bed meets the medical necessity criteria.

Eligibility Requirements for Medicare Coverage of Adjustable Beds

To receive coverage for an adjustable bed under Medicare, certain eligibility requirements must be met. It’s important to understand these prerequisites to determine whether you can qualify for assistance.

Medical Necessity

One of the primary factors in determining eligibility is whether the adjustable bed is considered medically necessary. Medicare defines medical necessity as equipment that is essential for treating or managing a specific medical condition. If you are suffering from a condition such as severe arthritis, certain types of back pain, or other chronic health issues that affect your ability to get in and out of bed or require specific positioning, an adjustable bed might be deemed necessary.

Doctor’s Prescription

For Medicare to approve an adjustable bed, a doctor must provide a prescription stating that the bed is medically necessary. The doctor will need to explain why the adjustable bed is required for the treatment or management of your medical condition, rather than simply for comfort or convenience.

Documentation

Along with the prescription, you will need to provide detailed documentation of your medical condition and any related treatments. Medicare may require supporting evidence such as medical records, a history of your condition, and details of any prior treatments or therapies that you’ve undergone.

Supplier Requirements

To ensure coverage, you must purchase the adjustable bed from a supplier who is enrolled in Medicare. The supplier will help submit the necessary paperwork, including the prescription and medical records, to Medicare for approval.

By meeting these eligibility requirements, you can increase your chances of having your adjustable bed covered by Medicare, making the process smoother and more predictable.

How to Apply for Medicare Coverage for an Adjustable Bed

Navigating the process of applying for Medicare coverage for an adjustable bed can be a bit complex, but by following the right steps, you can increase your chances of a successful application. Here’s a detailed guide on how to apply for coverage:

Step 1: Obtain a Doctor’s Prescription

The first step in the process is to visit your doctor. You will need to discuss your condition and explain why you believe an adjustable bed would improve your quality of life or help manage your symptoms. If your doctor agrees, they will provide you with a prescription that details the medical necessity of the adjustable bed.

Step 2: Choose a Medicare-Approved Supplier

After you have the prescription, the next step is to find a supplier who is enrolled in Medicare. It is essential to choose a supplier that is part of the Medicare network because only these suppliers can submit claims for coverage. Ask for recommendations from your doctor or search for approved suppliers online to ensure that the bed you are considering will be covered.

Step 3: Submit Documentation to Medicare

Once you’ve selected a supplier, they will handle most of the paperwork. They will submit your doctor’s prescription, medical records, and any other required documentation to Medicare for review. It’s important to ensure all your documentation is complete and accurate to prevent delays or denials.

Step 4: Wait for Medicare’s Decision

After your paperwork is submitted, Medicare will review it to determine if the adjustable bed meets their criteria for coverage. If Medicare approves the claim, you will be notified about the next steps in receiving the bed. If the claim is denied, you have the option to appeal the decision.

Following these steps carefully ensures that you provide all the necessary information for Medicare to consider your request for an adjustable bed.

Coverage Limitations and Costs of Adjustable Beds under Medicare

While Medicare can cover adjustable beds under specific conditions, it’s essential to understand the limitations and out-of-pocket costs that may be involved. Even if you qualify for coverage, it may not cover the entire cost of the bed.

Limited Coverage

Medicare Part B typically covers adjustable beds if they are deemed medically necessary, but coverage is not unlimited. Medicare will cover only the portion of the bed’s cost that meets their criteria. In some cases, this may mean that only the basic components of the bed, such as the motor and adjustable features, are covered. Additional features, such as enhanced comfort options or luxury mattresses, may not be covered under Medicare.

Deductibles and Co-pays

Even when an adjustable bed is covered, you may still be required to pay a deductible and co-pays. Medicare Part B has an annual deductible, which you must meet before Medicare begins to pay its share. After the deductible is met, you typically pay 20% of the Medicare-approved amount for durable medical equipment like an adjustable bed. This 20% can add up, especially for higher-end models.

Medicare Advantage Plans

If you are enrolled in a Medicare Advantage plan, the coverage may vary. Some Medicare Advantage plans offer more extensive coverage for durable medical equipment, while others may have more restrictions. Always check with your plan provider to understand how they handle adjustable bed coverage and what additional costs you may incur.

Additional Out-of-Pocket Costs

If Medicare does not cover the full cost, you may need to pay out-of-pocket for the balance. Some suppliers may offer payment plans or financing options to help manage these costs. It’s also a good idea to explore any available supplemental insurance that may assist with covering the remaining costs.

Understanding these limitations and costs is key to preparing for any out-of-pocket expenses and planning your purchase of an adjustable bed.

Alternative Coverage Options for Adjustable Beds

If you find that Medicare doesn’t fully cover the cost of an adjustable bed, there are alternative coverage options that might help reduce your out-of-pocket expenses. Exploring these options can ensure that you get the support you need without financial strain.

Medicaid

In some cases, Medicaid may provide additional coverage for adjustable beds if you meet the eligibility requirements. Medicaid is a joint federal and state program, so the coverage specifics can vary by state. If you are eligible for both Medicare and Medicaid, known as being “dual-eligible,” you may receive more extensive coverage for durable medical equipment, including adjustable beds. Check with your state Medicaid office to see if they offer such coverage.

Veterans Affairs (VA) Benefits

If you are a veteran, the Department of Veterans Affairs may cover the cost of an adjustable bed, particularly if it is required for a service-related injury or condition. The VA provides benefits for veterans with disabilities, and this can extend to durable medical equipment, including adjustable beds. Reach out to your local VA office or your VA healthcare provider to explore available options.

Private Insurance

If you have private health insurance, either through your employer or a personal plan, it may provide coverage for adjustable beds. Private insurance plans often vary widely in terms of what they cover, so it’s important to review your policy or contact your insurer directly to find out if adjustable beds are included under your plan’s durable medical equipment benefits.

Financing Options

Some adjustable bed suppliers offer financing options to make the bed more affordable. These plans allow you to pay for the bed in instalments over time. While this doesn’t reduce the overall cost, it can help manage payments if you’re unable to pay the full amount upfront.

By considering these alternative coverage options, you may be able to reduce the financial burden of purchasing an adjustable bed.

Conclusion

Adjustable beds can be covered by Medicare under certain conditions, primarily when they are deemed medically necessary. To qualify, you must have a doctor’s prescription and meet specific eligibility criteria, including medical documentation.

However, even with Medicare coverage, you may still encounter out-of-pocket costs like deductibles and co-pays, and coverage limitations may apply. If Medicare coverage isn’t sufficient, alternative options like Medicaid, VA benefits, or private insurance could help. Additionally, financing options may be available to ease the payment process.

Ultimately, understanding the ins and outs of Medicare coverage for adjustable beds and exploring other avenues for financial assistance will ensure you make an informed decision. If you believe an adjustable bed could improve your health and comfort, it’s worth investigating all available coverage options to find the best solution for you.

FAQs

Does Medicare cover adjustable beds for everyone?

No, Medicare does not automatically cover adjustable beds for all individuals. For coverage, the bed must be considered medically necessary for the treatment of a specific health condition. A doctor’s prescription and supporting medical documentation are required to prove this necessity.

How do I know if an adjustable bed is medically necessary?

An adjustable bed is deemed medically necessary if it helps manage a condition such as severe back pain, arthritis, or other health issues that affect your ability to sleep or reposition yourself in bed. Your doctor must confirm this necessity and provide a prescription outlining the medical need.

What is the difference between Medicare Part B and Part C regarding adjustable beds?

Medicare Part B covers adjustable beds if they meet medical necessity criteria and are prescribed by a doctor. Medicare Part C (Medicare Advantage) may provide additional coverage for durable medical equipment, including adjustable beds, but this varies by plan. It’s essential to check with your plan provider for details.

Can I use my private insurance to help cover the cost of an adjustable bed?

Yes, private insurance may provide coverage for an adjustable bed, especially if it’s considered durable medical equipment. Coverage depends on your plan, so it’s essential to review your policy or speak with your insurance provider to understand the details.

What if my Medicare claim for an adjustable bed is denied?

If your Medicare claim is denied, you have the option to appeal the decision. You can request a reconsideration by providing additional medical documentation or clarification from your doctor. The appeal process involves several steps, and it’s essential to follow the required guidelines to increase your chances of approval.