A hospital bed in the home is a piece of Durable Medical Equipment (DME) that provides specialized positioning and support beyond what a standard mattress can offer. This equipment is often necessary for individuals managing chronic conditions, recovering from serious injury, or needing comprehensive care at home. Acquiring one involves a structured process that moves from medical justification to logistical preparation. The following steps outline how to secure a hospital bed and integrate it safely into a home environment.
Establishing Medical Necessity
The process begins with a physician establishing the medical necessity for the bed, as this is the primary requirement for any insurance or government coverage. A hospital bed is deemed necessary when a patient’s condition requires specific body positioning that is not feasible with an ordinary bed. This requirement is often met if a patient needs to elevate their head more than 30 degrees due to conditions like congestive heart failure, chronic pulmonary disease, or aspiration risk.
The need for positioning to alleviate pain, prevent contractures, or maintain proper body alignment can also establish medical necessity. Additionally, if the patient requires traction equipment that can only be attached to a hospital bed frame, this justifies the need. The treating physician must document the patient’s specific condition and explain how the hospital bed will directly benefit their health outcome.
The physician must complete a specific form, often referred to as a Certificate of Medical Necessity (CMN), to formally justify the request. This documentation must include the patient’s medical information and a description of the equipment being ordered. Without this official certification, coverage from most payers, including Medicare, will not be possible.
Navigating Coverage and Costs
Since a hospital bed is classified as Durable Medical Equipment (DME), coverage is handled under the medical benefit portion of an insurance plan. For individuals covered by Original Medicare, the bed is covered under Part B, which pays 80% of the Medicare-approved amount after the annual Part B deductible is met. The remaining 20% is the patient’s responsibility, which may be covered by a supplemental Medigap policy or a Medicare Advantage Plan.
Medicare follows a “capped rental” rule for hospital beds, meaning the bed is rented for a period, typically 13 months, after which ownership transfers to the patient. To ensure the 80% coverage applies, both the prescribing physician and the DME supplier must be enrolled in Medicare and accept assignment. If a supplier does not accept assignment, the patient may be responsible for a higher out-of-pocket cost.
Private insurance and Medicaid plans operate on similar principles but often require a formal Prior Authorization (PA) before the bed is delivered. This process involves the DME supplier submitting the physician’s CMN and medical records to the payer for approval before the rental or purchase is finalized.
Out-of-pocket costs can range significantly depending on the type of bed and whether the supplier accepts the insurance-approved amount. The patient’s 20% co-insurance can be substantial, as hospital beds can cost from around $500 up to thousands of dollars, with rental fees typically ranging from $200 to $500 per month. It is important to confirm all potential costs and the exact terms of coverage with the insurance provider before signing any agreement.
Choosing the Right Equipment and Vendor
Once medical necessity and financial coverage are established, the next step is selecting the appropriate physical equipment. Home hospital beds generally fall into three categories: manual, semi-electric, and full-electric.
A manual bed uses a hand crank to adjust the head, foot, and overall height, making it the most affordable but requiring physical effort from a caregiver. A semi-electric bed offers electric controls for the head and foot sections, but the overall height adjustment still requires a manual hand crank. A full-electric bed provides motorized adjustment for all three functions—head, foot, and overall height—offering maximum independence and ease of use.
Medicare may only cover the least expensive option that meets the patient’s medical needs, often a semi-electric model. Essential accessories, such as trapeze bars to assist with repositioning and specialized mattresses to prevent pressure ulcers, should be included in the physician’s order to ensure coverage. The chosen equipment must be sourced from a Durable Medical Equipment (DME) supplier who is a Medicare-approved provider.
Delivery, Installation, and Home Preparation
The final stage involves preparing the home for the bed’s arrival and coordinating the logistics of delivery and setup. Prior to delivery, the designated room needs to be cleared, ensuring sufficient space for the bed’s footprint and ample room for caregivers to maneuver. It is essential to check that the bed, which is delivered in disassembled parts, can fit through all doorways, hallways, and stairwells.
The delivery team from the DME supplier is responsible for bringing the components inside, safely assembling the bed, and testing all its functions. This installation includes attaching any ordered accessories, such as side rails or trapeze bars, and ensuring the bed is level and secure. Preparing the floor with a protective mat is advisable, as the bed’s weight can damage flooring.
The technicians should provide comprehensive training to the patient and caregivers on the safe and proper operation of the bed, including the use of the remote control and safety mechanisms. This instruction ensures users understand how to adjust the bed for optimal therapeutic positioning and how to perform basic maintenance.