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.
The Spend Down Program
Spend Down programs help the program participants to qualify for Medicaid coverage.
The program participants can make deductions of certain expenses and some debts and loans depending on the method they are using to Spend Down
There are two methods
- Asset Spend Down
Should you wish to find out more, I have an article where I explain who can qualify for Spend Down, the expenses you can deduct on a Spend Down, and how you know if you qualify What is Spend Down ?
What Is Medicare Part B How Does It Relate To Hospital Beds
Medicare Part B is a standard part of the Original Medicare program which focuses on medical insurance. Medicare Part B covers services that focus on outpatient care, preventive care, and durable medical equipment.
Durable medical equipment will only be covered by your insurance plan if your healthcare provider and DME suppliers are both enrolled in the Medicare program. If they arent enrolled, Medicare will not pay for any future claims.
To gain access to a hospital bed in your home, you must meet the Medicare qualifying diagnosis and/orspecifications listed above as to why you need a DME.
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This Is The List Of Durable Medical Equipment Which Is Typically Covered By Medicare
To qualify you will need to have Original Medicare Parts A and B.
Air-Fluidized BedAlternating Pressure Pads and MattressesAudible/visible Signal Pacemaker MonitorPressure reducing beds, mattresses, and mattress overlays used to prevent bed soresBead BedBed Side RailsBed Trapeze covered if your loved one is confined to their bed and needs one to change positionBlood sugar monitorsBlood sugar test stripsCanes Commode chairsContinuous passive motion machinesContinuous Positive Pressure Airway Devices, Accessories and TherapyCrutchesVentilators WalkersWhirlpool Bath Equipment if your loved one is home bound and the pool is medically needed. If your loved one isnt home bound, Medicare will cover the cost of treatments in a hospital.
You Can Add Home Care Equipment To A Hospital Bed
Hospital beds arent purely medical these days, they are luxurious, allowing for more comfortable recoveries, better sleep, and a more at-home feel. One of the ways they do this is by accommodating a wide range of home care equipment from extensions to convenient reading lights, accessories can make the bed a piece of medical equipment that will never feel like one.
They can also hold more health and support supplies. For example, hospital bed assist rails help those with mobility issues get in and out of bed and protect them from rolling off the sides. You can add extra ones along the side of the bed frame for more coverage, and these pieces of care equipment are great reminders for people who need help in and out of bed. Clients can also attach an overhead trapeze helper bar for additional assistance when they must reposition themselves in bed.
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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 – oftentimes, nothing is wrong with your application other than the fact that its making its way through a large bureaucracy!
Will Medicare Cover Hospital Beds
If you or a loved one is struggling with the constraints of a traditional bed, there are innovative options that can make you safer and more comfortable at home. People living with congestive heart failure, chronic obstructive pulmonary disease, quadriplegia or paraplegia, among other long-term illnesses may benefit from the features of a hospital bed. If you have Medicare insurance, you may even get help paying for the equipment you need to stay safe and healthy in your own home.
The Benefits of a Hospital Bed
Modern hospital beds can be used in the home to give people living with long-term immobility or pain the opportunity to live at home where they are most comfortable. Hospital beds can provide the support and comfort you need with unique features, including:
Medicare Coverage for Hospital Beds
You dont have to be in a hospital to have access to medical equipment that can improve your health and safety. A hospital bed can be ordered for use in your home by your physician. If you are eligible for Medicare, you may get help paying for it.
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How Are Hospital Beds Covered Under Medicare
A hospital bed is considered durable medical equipment that your doctor can prescribe for use in your own home.
Medicare Part B medical insurance typically covers a medically-necessary hospital bed when it meets certain requirements, such as:
- The hospital bed is intended for use in your home
- The bed is used for specific medical reasons
- It can be used repeatedly
- The hospital bed is expected to last for 3 years or more
If the doctor that prescribes your hospital bed and the supplier that provides the bed are both enrolled in Medicare and are participating providers, it means they accept Medicare reimbursement as payment in full for the hospital bed.
If your hospital bed supplier doesnt accept Medicare assignment , they could potentially charge you any amount for the bed.
Medicaid Waivers Which Offer A Greater Chance Of Getting Free Dme
Some HCBS programs, or waivers, allow for what is called Consumer Direction/ Self Direction.
The program participant is allotted funding, or a budget, for their living needs in their home, which they spend with the help of a financial planner. Durable medical equipment can be purchased with this budget if it is part of what they need.
Equipment such as a bathtub, grab bars, a bath lift, or a shower chair, which isnt considered durable medical equipment by Medicare, if it is considered medically necessary and is within the allotted budget, may be purchased by participants on some of these programs, or waivers.
To find out more about Medicaid Self Direction click here.
There are also programs which are specifically developed to help with transitioning people from institutions back into their own homes
Money follows the person is one such Medicaidprogram for helping people to leave nursing facilities, and to relocate them back to their own homes this can include assisted living.
Any durable medical equipment which is considered to be necessary for the beneficiaries to return to, and to live in, their homes is bought by the program.
Once again, what qualifies as DME is less limited than for Medicare.
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Considering Height And Width
Most hospital beds weigh more and are wider than regular beds. Meanwhile, some can be adjusted to be higher or lower than regular beds.
A bed that can get closer to the ground is safer for people with certain diagnoses like cognitive issues, says Dodd. Having the bed lowered at night with a fall mat by the side of the bed decreases the chance of a serious injury, she adds.
Will Medicaid Pay For An Adjustable Bed
Medicaid doesnt operate in the same way as Medicare, as it is joint federal and state funded. Each state runs its Medicaid program as it wishes, within the guidelines set out by the government, and this leads to there being differences from state to state as to what can be covered by Medicaid.
A state will have a Medicaid State Plan, and usually Home Community Based Services , or waivers , each with their own eligibility, criteria and goals, and resulting in hundreds of programs and waivers for Medicaid across the US.
With these hundreds of HCBS waivers and state plans, what can be considered durable medical equipment can vary from program to program, let alone from state to state.
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When Does Medicare Cover Hospital Beds For Home Use
Hospital beds for home use are considered durable medical equipment . 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.
Youre 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 doctors 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.
Based On Where You Reside
Medicaid will provide coverage ONLY for the following places that include the following:
- Your home
Generally, most of us have a policy on insurance companies such as Medicaid however, there are still some people who are not covered for this kind of service or medical equipment. Therefore, you might be wondering about other options to get medical equipment without any insurance. Well, no worries, since I have some helpful tips for you that you can look for when the time comes.
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No Prescription Or Doctors Order
As a rule of thumb, Medicaid will not cover anything UNLESS you will present a prescription issued by your doctor that shows you really need the medical equipment. The doctors order or the prescription must include the following important information:
- Date of the prescription
- Signature of the doctor
- Doctors license number
Aside from your doctor, here are other qualified personnel that can issue you a prescription for your needed medical equipment:
- Physicians assistant
- Advanced registered nurse
In some other cases, wherein, for example, you are staying in a home health agency, the process might be a bit different, yet almost the same principle. For you to qualify for durable medical equipment, you must talk to your agency so that they can create a plan of care. Once you have prepared the plan of care have it signed to any of the following qualified personnel mentioned above.
Medicare Approved Hospital Bed Suppliers
Hospital bed suppliers are also often known as DME suppliers. In order to receive financial assistance with the purchase or rental of a hospital bed, the supplier must participate in Medicare, and they must accept assignment. Medicare assigns a cap on how much a piece of equipment, such as a hospital bed, can cost the supplier must accept this Medicare assignment.
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Medicare Guidelines For Semi Electric Hospital Bed
The Medicare guidelines for a semi-electric hospital bed are the same as for a manual-lift hospital bed, except for one special provision. The prescribing doctor must specify that the individual needs frequent and/or immediate changes in their body position, which would make a semi-electric hospital bed a medical necessity. Remember, Medicare will cover equipment as long as it is a medical necessity.
New Vs Used Vs Rented
When attempting to find a hospital bed for your home, remember that there are plenty of options to choose from. You can purchase a bed thats new or used, and you can even look to rent. Each option comes with its pros and cons. Finding the right bed can be tricky, especially when taking into account the costs. How vastly different are the three options?
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Medicare To Cease Reimbursement For Bed Sores Pressure Sores And Decubitus Ulcers
Last year, the Centers for Medicare and Medicaid Services announced that it will cease reimbursement for hospital care of eight reasonably preventable conditions including pressure ulcers, bed sore aka decubitus ulcers in October 2008.
Which is understandable, since the number of hospital patients develop pressure ulcers, bed sores and decubitus ulcers year increased by 63% over the last 10 and nearly 60,000 deaths annually from hospital-acquired bed sores, pressure sores and decubitus ulcers.
But this is not the only victim. According to the Agency for Healthcare Research and Quality, the average length of stay for patients hospitalized for treatment of Hospital-acquired pressure ulcers, bed sores and decubitus ulcers was 13 days, each with an average cost of $ 37,500 U.S. dollars stay.
If a patient is immobile bedridden or has difficulty moving after surgery or procedures, the minimum friction burns with blankets, wheelchairs or other areas can quickly become established in pressure ulcers. One problem is that pressure ulcers, bed sores and decubitus ulcers can be initially difficult to see that look sometimes seen as nothing more than a pink or red spot on inaccessible areas such as skin creases or bony.
So what can we do? We need to put the medicine in a proactive way to work through the transformation of our core protocols in prevention programs for pressure sores, bed sores and decubitus ulcers.
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State Financial Assistance Programs
A large number of states will have non-Medicaid programs designed to assist the elderly, and the disabled, in maintaining a more, or less, independent lifestyle in their own homes these are usually known as State Financial Assistance Programs.
State Financial Assistance Programs will pay for a wide variety of assistive and safety equipment, and even home modifications.
The durable medical equipment and remodeling are paid for with grants or loans, or sometimes a combination of both.
To find out about your State Financial Assistance Programs ask at your local Area Agency on Aging.
You can find your local Area Agency on Aging here.
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What Kind Of Mattresses And Beds Are Covered
There are a few types of mattresses and beds covered by Medicare. If you are a Medicare subscriber, then it’s important to understand the guidelines and what qualifies to be covered. Essentially, you’ll need to make sure the mattress is classified as durable medical equipmentâsometimes referred to as “DME.”
For a mattress to be given a designation as durable medical equipment, it must be an essential part of a patient’s normal life. This designation can only be obtained from a doctor after they determine your bed is medically necessary. In addition to a DME classification, it must also meet 5 additional criteria.
These 5 criteria are:
To summarize, if your mattress meets the following three criteria, Medicare covers the cost of up to 80% of the mattress price.
- DME Classification
Typically, the only types of mattresses that meet these specifications are pressure-reducing mattresses.
When Does Medicare Cover Adjustable Beds
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
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Renting Home Hospital Beds
Renting a home hospital bed is a great option for those who will only need it for a limited period of time. This is a much more cost efficient option for short-term use. On average, it costs one $200 $500 / month to rent a home hospital bed. One can also find mattresses for rent. Some companies that rent home hospital beds may charge an initial fee for set-up. If this is the case, one should expect to pay an additional $50 to $100.
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