Medicare covers different types of durable medical equipment (DME), which may include an adjustable bed if a person meets the criteria.
For people with certain medical conditions, such as a broken hip or paraplegia, an adjustable bed can mean greater comfort and a lower risk of further injury.
This article looks at the Medicare definition of DME, the different types of adjustable bed, and Medicare coverage requirements. It also examines the costs and financial assistance.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
DME includes commode chairs, crutches, oxygen equipment, walkers, and beds.
Medicare considers prescribed adjustable beds, including hospital beds, as DME. Therefore, it will cover the cost as long as a doctor certifies that a person needs the bed for use in their home.
However, there are different types of adjustable bed, and Medicare does not cover them all. For Medicare to consider an adjustable bed as DME, the bed must:
- be durable enough to withstand repeated use
- have a medical purpose
- be for use in a person’s home
- have an expected lifetime of at least 3 years
In general, doctors do not consider an adjustable bed useful or necessary for a person who is not sick or injured. According to Medicare’s definitions, lounge beds — whether manual or electrically powered — are not DME.
Medicare is a federally funded insurance program that provides health insurance coverage to those aged 65 years and older, as well as to some people with chronic health conditions, such as end stage renal disease.
Medicare divides its coverage into parts, with each part offering coverage for different aspects of healthcare:
- Medicare Part A: Medicare Part A is the Medicare portion that covers inpatient stays, such as those at a hospital or skilled nursing facility.
- Medicare Part B: Medicare Part B pays for doctor’s visits, some medical testing, DME (including adjustable beds), and some medications, such as infusions or vaccinations.
- Medicare Part C: This portion of Medicare is also known as Medicare Advantage, and private companies provide it. Some Medicare Advantage plans may offer prescription drug plans and additional benefits, including coverage for dental, vision, and hearing care.
- Medicare Part D: This portion covers prescription drugs. Medicare requires all enrollees to have a creditable form of prescription drug coverage, which can be a Part D plan or private insurance.
Medicare costs may include deductibles, copays, and coinsurance.
Medicare will only consider an adjustable bed as DME if the bed will adjust either from the head or foot, allowing a person to elevate different body parts as necessary. The bed should also have side rails that a person can lower or raise.
Medicare may cover part of the cost for necessary modifications to a person’s adjustable bed, such as having an air-fluidized bed for reducing pressure. Other Medicare-covered adjustments may include:
- built-in weight scale
- electric power adjustments
- extra-wide hospital bed
- gel or gel-like pressure mattress pad
- lambswool or sheepskin pads
For a person to be eligible for an adjustable bed that qualifies as DME, their doctor must write a prescription stating that the bed is medically necessary. According to the eligibility requirements, the bed is a medical necessity if a person needs:
- positioning to relieve pain or promote body alignment
- positioning in a way that improves respiratory function
- special attachments, such as traction devices, that it is not possible to attach to a traditional bed
In the prescription, the doctor must describe the person’s condition and diagnosis to explain why the adjustable bed is medically necessary.
Examples of conditions for which people may need an adjustable bed include chronic obstructive pulmonary disease, paraplegia, and severe injuries to the legs.
Although Medicare helps pay for adjustable beds, a person is still responsible for paying a portion of the costs. Other factors can also affect the costs, such as the type of bed and the rental or purchase terms.
Purchased or rent
The person must rent or buy the bed from a supplier that accepts Medicare assignment. This means that the supplier agrees to the price Medicare sets for renting or purchasing the equipment.
If a person purchases or rents a bed from a supplier that does not accept Medicare, that supplier may charge more than the Medicare-approved amount, and Medicare will not cover the cost.
If the DME is rented, Medicare covers the monthly payments, and the supplier covers the cost of repairs. Medicare will cover the rental costs for 13 months of continuous use, after which, the supplier must transfer ownership to the user.
To find a supplier, a person can use this online tool or call 1-800-MEDICARE (1-800-633-4227).
Types of bed
Many different adjustable beds are available with various options for purchase or rental.
Cost factors will include:
- model of bed, including whether it is electric or manual
- inclusion of extras, such as mattresses or railings
- rental vs. purchase
After a person’s doctor certifies that a bed is medically necessary, and the person obtains it from a Medicare-approved supplier, they will pay 20% of the Medicare-approved amount. If a person has not met their Medicare Part B deductible, it will apply to the purchase or rental. For 2021, the Medicare Part B deductible is $203.
As Medicare does not fully cover the costs of an adjustable bed, a person may need financial assistance to pay for the deductible or copay related to an adjustable bed.
Some of the potential sources of help with costs include:
- Medicaid: This state and federal program can help a person with low income get financial assistance with healthcare costs. While Medicaid policies may vary by state, this program may help pay for an adjustable bed.
- Department of Veterans Affairs: Supplemental Medicare policies, such as TRICARE for Life, may help a veteran pay the Medicare copay. Other programs that may help veterans get financial assistance for adjustable beds include the Veteran-Directed Home and Community Based Services Program or the Aid and Attendance Program, which helps homebound veterans.
- Philanthropic organizations: Nonprofit organizations may help with the costs of DME. The assistance must generally be condition-specific, such as through the Muscular Dystrophy Association or National Amputation Foundation.
A person may wish to ask their doctor about potential sources of financial support in their community.
Medicare will cover a portion of the rental or purchase of adjustable beds, providing a doctor prescribes the bed as medically necessary. A person must ensure that their doctor and the bed supplier accept Medicare assignment to receive the maximum coverage.
If they need help covering the copays for the adjustable bed, the person may be able to apply for Medicaid benefits or community assistance.