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Does Medicare Pay For Mattresses

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Hospital Beds Covered By Medicaid

Does Medicare pays for hospital beds?

The exact hospital beds covered by Medicaid vary by state, and so it is best to check locally before purchasing a bed. However, the purchase of hospital beds and other DME are unofficially viewed in a positive light because they help keep individuals outside of institutions like hospitals and other inpatient care facilitieswhich are far more costly and limited in availability.

Medicare Parts A And B

What is Medicare Part B? Part B provides outpatient/medical coverage. You would be using this type of equipment, or adjustable bed, in your own home, hence it being covered by the outpatient portion.

Lets take a look at the rates for Part B, which is really the part youll need before we learn what the other parts will do for you.

Medicare Part B Estimated Monthly Premiums, Deductibles, and Coinsurance Rates


What Is Durable Medical Equipment

Heavy-duty medical equipment that is meant for use over time is called durable medical equipment . Oxygen equipment, canes, and crutches are examples of durable medical equipment. Medicare considers beds to be DME when they are necessary. Coverage for durable medical equipment is the same, whether its a bed or a wheelchair.

Durable medical equipment must have the following qualities:

  • You can use it repeatedly
  • Serve a direct medical purpose
  • Medical provider orders their use
  • Can be used at home
  • Isnt useful to patients when their condition or disability is healed

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Supplier 2 Dmg Wellness Inc

DMG Medical Supply is a popular supplier of medical equipment in Los Angeles, California. They are a Medicare-approved mattress supplier and will cover part of the cost of your orthopedic mattress provided you comply with their regulations. DMG are committed to providing medical equipment of the highest quality and offering competitive prices. They also provide a large variety of other medical equipment.

Does Medicare Pay For Adjustable Beds For Seniors

Does Medicare Pay for Mattresses? l Adjustable Beds &  More
  • Medicare only covers some of the expense, and a secondary insurance company may partially pay, or the patient has the financial responsibility.
  • If you prefer to rent, that allows for rental payments for 13 months, at which time the bed is paid in full and there are no further payments required.

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Does Medicare Provide Coverage For Adjustable Beds

Yes! Original Medicare does offer coverage for adjustable beds as part of a beneficiarys Part B benefits. Part B offers coverage on durable medical equipment , which includes adjustable beds. Medicare will pay for 80% of the cost of an adjustable bed after you have met your Part B deductible.

This does not apply to just any bed on the market, and there are requirements that must be met. Lets talk about those next.

Reasons Medicare Will Pay For An Orthopedic Mattress

Only specific types of beds and mattresses are eligible for Medicare coverage, which is usually determined by your doctor’s prescription and diagnosis. By reducing pressure and improving spinal alignment, an orthopedic mattress can provide better comfort and reduce the risk of further complications for persons with certain medical issues. An orthopedic mattress is regarded as medically necessary if you have a medical condition that requires proper body alignment, or if you need to maintain a specific posture to ease the discomfort that isnt possible on a conventional mattress. Arthritis and sciatica are two such conditions.

Medicare covers orthopedic mattresses for people suffering from conditions such as arthritis and sciatica.

Conditions that would warrant Medicare reimbursing part of the cost of an orthopedic mattress are:

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Does Medicare Pay For Mattresses

Medicare pays for your mattress if you can satisfy three conditions. First, you must get a prescription from your doctor stating the bed is medically necessary. Next, the bed must qualify as a durable medical device . The bed itself must also meet five basic criteria. If you don’t meet these conditions, there are still great, affordable options that can help.

What Kind Of Beds Will Medicare Cover

Medicare : Will Medicare Pay for Adjustable Beds?

Medicare covers several types of beds and mattresses. If you subscribe to Medicare, it is a good idea to take a closer look at their guidelines and the criteria to ensure your new bed is covered. First, you will need to get a prescription from a doctor to state the bed is necessary for medical reasons. Second, the bed must qualify as a durable medical device, or DME. Third, the bed must match five simple criteria.

If you cannot meet all three conditions, there are other affordable options you might wish to consider.

Basically, you will have to ensure the mattress is classed as durable medical equipment, often shortened to DME. To earn a DME classification, a mattress must be a critical part of the patients life. Therefore you need a doctors prescription to say such a bed is necessary for medical reasons.

You can only get this designation from your doctor after he or she determines that you need such a bed. The physician must report to Medicare details about the medical condition for which a special bed is required.

As well as being designated as DME, the following criteria must be met:

  • For medical use only.
  • Must have a minimum 3 year life expectancy.
  • Only useful to someone injured or sick.

Summing this up, if your mattress does meet the above criteria, you can expect that Medicare will cover up to 80% of the cost of the mattress. With very few exceptions, the only types of mattresses covered by insurance are pressure-reducing ones.

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What Factors Can Affect Dme Costs

A key factor affecting DME cost is whether a supplier participates in Medicare.

A participating supplier is one that accepts assignment, which means the company can charge a person only the coinsurance and deductible for the Medicare-approved amount.

However, if a company is not a participating supplier, there is no limit to what it can charge.

Other factors affecting the cost include whether an individual has other insurance and whether a person buys or rents the equipment.

This online search tool can help people search for a DME supplier in their area.

As an alternative, a person can call 800-MEDICARE . A person who is deaf may call 877-486-2048.

Questions to ask a supplier may include:

  • Do you accept Medicare assignment? In not, what is your non-assignment charge?
  • Are you a Medicare-enrolled supplier?
  • Do you bill Medicare directly?

What Parts Of Medicare Cover Dme

Original Medicare is composed of Part A, hospitalization insurance, and Part B, medical insurance. If a person has original Medicare, Part B covers a hospital bed and other DME. The out-of-pocket cost is 20%, and the annual deductible applies, which is $203 in 2021.

Medicare Advantage, Part C, is the alternative to original Medicare, and also covers parts A and B benefits. If a person enrolled in an Advantage plan needs a hospital bed or other DME, they can check with their plan provider to determine if they cover the item. Out-of-pocket costs of Advantage plans vary.

Medicare has two main criteria for DME coverage. One requirement is that a healthcare provider prescribes the item for use in a persons home. The provider may be one of the following:

  • doctor
  • nurse practitioner
  • clinical nurse specialist

A persons supplier must also be enrolled in Medicare. This means Medicare has approved the supplier and assigned it a supplier number. A company must meet strict standards before it receives Medicare approval as a supplier.

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This Is How Medicare Can Cover The Cost Of Your New Mattress

Health insurance can be confusing, but taking the time to learn about it could save you a lot of money. There are some really helpful things you can qualify for depending on your healthcare plan, especially if youre a Medicare subscriber.

Your health coverage might be able to cover the cost of your next mattress but you cant just walk into any furniture store and send Medicare the receipt later. If youre a Medicare subscriber and want to know if you qualify for a new bed, heres what you need to know.

Does Medicare Cover Hospital Beds For Home Use

Is a Medical Bed Covered by Medicare?

Medicare DOES cover hospital beds for home use. In fact, individuals can choose to buy or rent the hospital bed.

If an individual has the appropriate medical documentation and purchases a hospital bed from a supplier who is enrolled in Medicare, they will receive coverage. A supplier is a vendor who sells hospital beds, although usually they also sell other forms of medical equipment, too.

An individual then only pays 20% of the Medicare-approved cost of the bed. This value, which is the amount of covered costs that the individual has to pay out of pocket, is known as “coinsurance”. And so, for every medical expense covered by Medicare, an individual is expected to pay 20% of the cost before Medicare pays for the other 80%.

There is an additional annual Medicare Part B “deductible” requirement, which boils down to a certain amount of money that an individual must spend each year before Medicare coverage kicks in.

And so, with a Medicare-covered purchase of a hospital bed, the maximum that an individual will pay is their annual deductible plus 20% of the cost of the hospital bed.

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Do Medicare Advantage Plans Cover Adjustable Beds

In conclusion, Medicare Advantage plans may cover some of the costs of adjustable beds. Remember, MA plans are not standardized, which means each carrier determines how much coverage they will offer. Contact us to see which MA plans cover adjustable beds. Get an instant Medicare Advantage plan quote here.

Related Articles:
  • Medigap FAQ Medicare is a good start but has gaps in its coverage. These gaps could cost a lot of money should you have certain medical needs or conditions. Additionally, Medicare requires that you first pay deductibles before benefits begin. That is where Medicare Supplemental Insurance comes into plan.
  • Medigap Overview You may already know that Medicare covers you up to 80%. A Medigap plan will take care of the remaining 20%. This means that whatever Medicare covers, Medigap will cover too.
  • New to Medicare: Everything you need to know. Medicare is the United States federal health insurance program for Americans 65 and older, as well as people with certain disabilities or End Stage Renal Disease .

Obtain The Mattress From A Medicare Approved Supplier

The final step in receiving a Medicare reimbursement for an orthopedic mattress is to purchase it from a Medicare-approved mattress retailer. Check the list of Medicare-approved suppliers with this search function on their website, because Medicare will only cover mattresses purchased from suppliers on this list. Below we provide more information on Medicare-approved suppliers.

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Mattresses For Seniors That May Be Covered By Medicare

You spend a lot of time on your mattress its where you sleep each night and where you rest and relax. And while a comfortable, supportive mattress is crucial at any age, its especially important as you get older. You can experience all kinds of aches, pains, and health woes, and your mattress needs to be able to meet your comfort needs.

Thats why many older adults choose special mattresses that reduce pressure and relieve pain. But these types of mattresses can be incredibly expensive. Fortunately, there may be a way to reduce the cost you pay out of pocket.

Medicare will cover most of the cost for certain mattresses. So, if youre a senior whos in need of a special mattress for your health, heres how you may be able to get that purchase covered under Medicare.

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Will My Medicare Cover Adjustable Beds

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Adjustable beds are covered by your Medicare. Medicare Part B, under the DME section explicitly allows cover for adjustable beds. But, as with any other insurance, there are certain requirements that must be met to qualify. First and foremost, the physician must prescribe the hospital bed for use at your home for your medical needs.

The moment a prescription is obtained, the bed must be sourced from an accredited Medicare supplier. Once all requirements have been met, the system will only cover a part of the expense. It is the role of the patient or the second medical insurance company to partially pay for the DME, which in this case is an adjustable hospital bed.

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Would A Sleep Number Adjustable Bed Be Covered By Medicare

It is unlikely that Medicare will cover the latest and greatest beds, which includes Sleep Number beds. Of course, individuals have the option to purchase an adjustable bed outside of Medicares coverage.

Whether you need an adjustable bed to help with a temporary injury or require one for long-term use, there is a good chance that youll be able to utilize your Medicare benefits. Consult with your doctor to find out if you qualify.

How Do I Qualify For A Hospital Bed

When recovering from surgery or an illness at home, your regular bed wont always suffice. You might need a hospital bed, which provides more support, safety and comfort.

But as with any major purchase medical or otherwise youre left with the big question: How do I pay for this? Medicare can help, but youll need to qualify.

Whether youre looking to buy a new bed or searching for hospital beds for rent in Philadelphia, heres what you need to know about qualifying for one under Medicare.

Also Check: How To Check Medicare Payments

Determine If This Type Of Mattress Is Best For You

Not every patient finds a pressure-reducing mattress to be the best option. As you might expect, there are specific guidelines to determine whether a pressure-reducing mattress is a good fit for a patient.

If you can answer yes to at least one of these questions, a pressure-reducing mattress is probably the best option for you. If you cannot answer yes to any of them then it is more likely you should consider other affordable options:

  • Do you need positioning to reduce pain which is not possible with a conventional bed?
  • Do you have a medical condition which needs body position not possible with a conventional bed?
  • Does your head need to be elevated more than 30 degrees because of a medical condition and a regular wedge or pillow would not work?

If you answer yes to one of the above questions, Medicare should approve you for a bed or mattress covered by your insurance. The first step is to schedule a visit with your doctor to discuss your medical requirements.

Severe arthritis, chronic pulmonary obstructive disease, specific cardiac diseases, and spinal cord injuries are some examples of conditions where Medicare might cover a special bed.

Not all features are covered by insurance. An electric-powered bed, adjustable height features and side rails are not included in basic coverage but one or more of these options might be included if your doctor believes they are necessary.

Can I Rent A Hospital Bed

Are Adjustable Beds Covered by Medicare?

For more expensive equipment, such as a hospital bed, Medicare pays a rental fee for 13 months of a persons continuous use. After the 13th month, the supplier transfers ownership of the bed to the individual. If the bed needs repairs or replacement parts during the rental period, the supplier assumes responsibility for the costs.

A person who needs less expensive DMEs can choose to rent or buy the equipment.

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How To Find Mattresses Covered By Medicare

If youre in need of a new mattress but cant afford the cost, Medicare may be able to help. Youll need to make sure that the mattresses you need or are considering qualify as durable medical equipment. Then, youll need to check your specific Medicare coverage to determine how much Medicare will pay, and how much youll be responsible for.

To make your search for a Medicare-approved mattress easier, youll want to search online. You can view mattresses from many different providers, and youll be able to narrow down your search for specific types. Plenty of Medicare-approved mattresses and beds are available online.

While shopping for a new mattress online, you can also compare prices and check to see whats covered by Medicare. This makes the process easier, and you dont even have to leave home to find a better mattress for your comfort and health.

Dmitrii Pridannikov / Shutterstock

Be Patient When Waiting

This is less of a tip on how to be approved and more advice on how to survive the waiting process. It can take weeks for this process to go from start to finish, frustrating some Medicaid patients and worrying others. Thats why its important to remain patient â oftentimes, nothing is wrong with your application other than the fact that its making its way through a large bureaucracy!

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Does Medicare Cover Hospital Beds

by Christian Worstell | Published March 30, 2021 | Reviewed by John Krahnert

Medicare will pay for a hospital bed purchase or rental if it’s considered medically necessary and prescribed by a doctor, and provided by a medical equipment provider approved by Medicare.

Medicare classifies hospital beds as durable medical equipment , which is covered by Medicare Part B. However, there are some requirements you must meet for Medicare hospital bed coverage.

Additionally, even if Medicare does cover your hospital bed, there are some out-of-pocket costs you’ll likely face. Learn more about your coverage.

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