A hospital bed is a piece of Durable Medical Equipment (DME) designed to accommodate specific physical needs that cannot be met by a standard mattress and frame. These specialized beds offer features like adjustable head and foot sections, as well as variable height, intended to provide therapeutic positioning and safety. Coverage for this equipment is not automatic and is strictly determined by documented medical necessity, requiring a clear connection between the bed’s features and the patient’s condition.
Understanding Medicare Part B Coverage for Equipment
Hospital beds for use in the home are classified as Durable Medical Equipment (DME) and are covered under Medicare Part B, which is Medical Insurance. For coverage to be approved, the equipment must be necessary and reasonable for treating an illness or injury and must be used within the patient’s home. The bed must be prescribed by a physician who participates with Medicare, and it must be obtained from a supplier also enrolled in Medicare.
Medicare Part B generally covers 80% of the Medicare-approved cost for the hospital bed after the annual Part B deductible has been met. The remaining 20% is the patient’s coinsurance responsibility, unless they have supplemental insurance, such as Medigap or a Medicare Advantage plan, to cover that portion.
Required Medical Justification for Coverage
Medicare does not cover a home hospital bed for convenience or comfort; coverage is tied to a functional impairment or specific clinical need. The core justification is that the patient has a medical condition that requires positioning of the body in ways not feasible with an ordinary bed. This often relates to the need to alleviate pain or promote proper body alignment for recovery or chronic symptom management.
A common qualifying condition involves the need for the head of the bed to be elevated more than 30 degrees most of the time due to respiratory or cardiac issues. This includes diagnoses like severe Chronic Obstructive Pulmonary Disease (COPD), Congestive Heart Failure, or conditions that present a high risk of aspiration. Furthermore, a hospital bed is covered if the patient requires traction equipment that can only be affixed to a hospital-grade frame.
Other qualifying circumstances include severe immobility, such as that caused by a spinal cord injury, severe arthritis, or multiple limb amputations, where the patient requires frequent changes in body position. The documentation must clearly show that an ordinary bed would endanger the patient or prevent effective treatment, for instance, by making safe transfers impossible.
Covered Types and Features of Hospital Beds
Medicare typically covers the most basic type of hospital bed that meets the documented medical necessity, which often includes manual or semi-electric models. A manual bed requires a hand crank to adjust the head, foot, and height sections. A semi-electric bed uses a motor for head and foot adjustments but retains a manual crank for height variation. Fully electric beds, which use electric motors for all adjustments including height, are usually considered a convenience item and may not be fully covered unless specific medical justification for the powered height adjustment is provided.
If a fully electric model is desired, the beneficiary may have to pay the difference in cost between the covered semi-electric model and the fully electric one. Coverage also extends to certain accessories when they are medically necessary and an integral part of the covered bed. This includes side rails, which may be needed for patient safety, and specialized mattresses, such as pressure-reducing types, required to prevent or treat pressure ulcers.
Extra-wide or bariatric hospital beds are also covered, but only if the patient’s body weight exceeds 350 pounds and is specifically documented by the physician as a medical necessity. Any accessory must be prescribed by the doctor and justified as necessary for the treatment of the patient’s medical condition. Items considered solely for comfort or convenience, such as over-the-bed tables, are not covered.
The Necessary Steps for Securing Coverage
Securing Medicare coverage begins with the treating physician, who must document the specific medical necessity in the patient’s official medical record. The physician must then provide a Detailed Written Order (DWO) for the hospital bed before the equipment is delivered. This order must specify the patient’s diagnosis and explain exactly why the specialized features of a hospital bed are required, not just for general comfort.
Medicare determines whether the bed should be rented or purchased based on the expected length of the patient’s need for the equipment. Hospital beds fall under a “capped rental” category, meaning the patient typically rents the bed for a maximum of 13 months, after which ownership transfers to the beneficiary. If the physician can document that the need for the bed is permanent or long-term, direct purchase may be an option from the start.
For certain high-cost or specialized equipment, the supplier may need to obtain prior authorization from Medicare before delivery. The supplier is also responsible for ensuring all documentation, including the DWO and the medical necessity justification, is on file before billing Medicare. Failure to follow these precise administrative steps can result in the claim being denied, leaving the patient responsible for the full cost.