Adjustable beds are often marketed as a solution for better sleep, but for Medicare beneficiaries, coverage is not based on comfort or convenience. Medicare may cover an adjustable bed only when it is classified as Durable Medical Equipment (DME) and meets strict medical necessity requirements for use in the home. This coverage is specifically for certain models that function as a “hospital bed,” not the luxury adjustable bases sold directly to consumers. Understanding the criteria for equipment, medical need, and payment rules is necessary to determine if an adjustable bed can be covered by Medicare.
Defining the Covered Equipment: Medicare’s “Hospital Bed” Classification
Medicare’s coverage for an adjustable bed is limited to equipment that fits the definition of a “Hospital Bed.” These covered beds are identified by specific Healthcare Common Procedure Coding System (HCPCS) codes, such as E0250-E0373, which denote beds with medical features beyond simple comfort adjustment. The primary function of a Medicare-covered adjustable bed must be to accommodate specific medical needs that cannot be met by an ordinary bed.
The covered equipment typically includes manual, semi-electric, or sometimes fully electric models that allow for the independent adjustment of the head and foot sections. Semi-electric beds, for example, have motorized head and foot adjustments but a manual crank for height, while fully electric beds motorize all three movements. Medicare generally covers the basic model necessary to meet the medical need, which might be a fixed-height or variable-height bed. Upgraded features, such as massage functions, luxurious mattresses, or certain advanced total electric capabilities, are usually considered comfort items and are not covered.
Hospital beds must also possess structural components like side rails, which are necessary for patient safety and to assist with movement or repositioning. The coverage extends only to the basic medical configuration, meaning that if a beneficiary chooses a model with uncovered luxury features, they are responsible for the entire cost difference.
Establishing Medical Necessity for Coverage
Obtaining coverage requires a formal prescription from a Medicare-enrolled physician and detailed documentation establishing medical necessity for the bed’s use in the beneficiary’s home. The justification must clearly state that the patient has a diagnosed medical condition for which an ordinary bed is unsafe or insufficient for their treatment. This requirement is the single most important factor for approval.
The medical necessity is demonstrated by showing the patient requires positioning that can only be achieved with an adjustable bed. For example, a common qualifying condition is the need for the head of the bed to be elevated above a 30-degree angle to manage severe respiratory conditions, such as Chronic Obstructive Pulmonary Disease (COPD), or specific cardiac conditions.
Additional Criteria for Approval
Another criterion for approval is the necessity for frequent changes in body position to prevent or treat pressure sores, also known as decubitus ulcers, or to manage severe pain that cannot be controlled in a standard flat bed. Coverage may also be approved if the patient requires special traction equipment that can only be attached to a hospital-style bed frame. The physician’s order must include a narrative explaining the diagnosis and precisely how the adjustable features of the bed will provide therapeutic benefits that cannot be achieved with a non-adjustable bed.
Understanding Medicare Payment Rules and Patient Costs
When an adjustable hospital bed is deemed medically necessary and the patient qualifies, the coverage falls under Medicare Part B as Durable Medical Equipment (DME). The equipment must be obtained from a supplier that is enrolled in Medicare and accepts assignment to ensure the patient receives the maximum benefit. If the supplier does not accept assignment, the patient may face higher out-of-pocket costs.
Medicare pays 80% of the Medicare-approved amount for the equipment after the annual Part B deductible has been met. The beneficiary is then responsible for the remaining 20% coinsurance. The supplier must also follow the “capped rental” rule for most hospital beds, meaning the bed is initially rented for a period of 13 continuous months.
During the 13-month rental period, Medicare makes monthly payments, and the patient pays their 20% coinsurance share of the rental fee. Once the 13 months are complete, the patient legally owns the bed, and Medicare will cover maintenance and servicing costs for the duration of the bed’s reasonable useful lifetime.