Adjustable beds are often marketed for home comfort, but Medicare does not provide coverage for items solely intended for convenience or a lifestyle enhancement. Medicare will only cover equipment that is deemed medically necessary for treating an illness or injury.
Defining the Covered Equipment
Medicare classifies covered adjustable beds as Durable Medical Equipment (DME), which falls under Medicare Part B. To qualify as DME, the equipment must withstand repeated use, serve a medical purpose, be appropriate for home use, and have an expected lifespan of at least three years.
The covered item is specifically a DME Hospital Bed, not a commercial adjustable base. These beds possess features that directly address clinical needs, such as the ability to elevate the head and foot sections to specific angles and, in some cases, adjust the overall height.
The basic covered model includes a manual or semi-electric bed, often with side rails. More advanced features, like fully motorized height adjustments or specialty mattresses, may be covered if a physician documents a specific medical need. Luxury features, such as built-in massage or heat therapy, are excluded from coverage as they are considered convenience items.
Establishing Medical Necessity for Coverage
To obtain coverage for a DME Hospital Bed, a beneficiary must establish medical necessity. This requires a detailed prescription and supporting documentation from a Medicare-enrolled physician. The documentation must clearly explain why a standard bed cannot meet the patient’s medical requirements.
A primary qualifying criterion is a medical condition requiring body positioning not feasible with an ordinary bed. This includes the need for frequent changes in position to alleviate pain, promote proper body alignment, or prevent pressure sores. For instance, elevating the head of the bed more than 30 degrees is often required for conditions like severe cardiac conditions, chronic pulmonary disease, or aspiration issues.
Specific conditions that may qualify a patient include severe arthritis, bone fractures, or respiratory impairments that necessitate therapeutic positioning. The variable height feature may be covered if the patient has severe lower extremity injuries, such as a fractured hip, and needs to place their feet on the floor while sitting on the edge of the bed. Comprehensive physician documentation is essential, as insufficient medical records are a common reason for claim denials.
Patient Costs and Payment Structure
Once medical necessity is established, the financial responsibility for the DME Hospital Bed is handled through Medicare Part B. The beneficiary must first meet the annual Part B deductible. After the deductible is satisfied, Medicare typically covers 80% of the approved amount for the equipment, leaving the patient responsible for the remaining 20% coinsurance.
If the supplier accepts Medicare assignment, they agree to charge only the approved amount, limiting the patient’s out-of-pocket expenses. Suppliers who do not accept assignment may charge the patient more than the Medicare-approved amount.
Hospital beds are obtained through either rental or purchase, often mandated by Medicare based on the expected duration of need. If the bed is rented, ownership transfers to the beneficiary after 13 continuous months of rental.
If a beneficiary has supplemental insurance, such as a Medigap policy or a Medicare Advantage plan, these plans may cover the remaining 20% coinsurance. Patients should confirm that both their prescribing physician and the equipment supplier are enrolled in Medicare to ensure maximum coverage and avoid unexpected costs.