Medicare covers a hospital bed and many other durable medical equipment (DME) items if they are medically necessary.
Requirements for coverage include a prescription for the beneficiary’s home use, as well as Medicare enrollment of both the doctor and the DME supplier.
Original Medicare covers 80% of the cost under Part B, while Medicare Advantage covers a percentage that varies with the plan.
This article defines DME and discusses Medicare coverage and criteria. It then examines the Medicare policy of renting hospital beds, as well as factors that affect DME cost. Lastly, it tells how to find suppliers.
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.
Medicare puts a hospital bed in the category of durable medical equipment, which means it can withstand repeated use. Other DME includes:
- patient lifts
- traction equipment
- commode chairs
In addition, the DME category includes smaller items, such as:
- nebulizers and nebulizer medications
- blood sugar test strips
- blood sugar monitors
- infusion pumps and supplies
- oxygen equipment and accessories
Aside from all the above items, DME also includes orthotics and prosthetics, such as:
- artificial limbs
- urological supplies
- breast prosthesis
- ostomy bags
- therapeutic shoes or inserts
Every DME item must meet the following criteria:
- A person needs it for a medical reason.
- Someone uses it in their home.
- It is not usually useful to an individual who is not injured or sick.
- It has an expected lifetime of 3 years.
Original Medicare is composed of Part A, hospitalization insurance, and Part B, medical insurance. If a person has original Medicare, Part B covers a hospital bed and other DME. The out-of-pocket cost is 20%, and the annual deductible applies, which is $203 in 2021.
Medicare Advantage, Part C, is the alternative to original Medicare, and also covers parts A and B benefits. If a person enrolled in an Advantage plan needs a hospital bed or other DME, they can check with their plan provider to determine if they cover the item. Out-of-pocket costs of Advantage plans vary.
Medigap is Medicare supplement insurance, which pays 50–100% of original Medicare (parts A and B) out-of-pocket costs, including those for DME.
Part D is Medicare prescription drug coverage. It does not provide any coverage of DME.
Medicare has two main criteria for DME coverage. One requirement is that a healthcare provider prescribes the item for use in a person’s home. The provider may be one of the following:
- physician’s assistant
- nurse practitioner
- clinical nurse specialist
A person’s supplier must also be enrolled in Medicare. This means Medicare has approved the supplier and assigned it a supplier number. A company must meet strict standards before it receives Medicare approval as a supplier.
Can I rent a hospital bed?
For more expensive equipment, such as a hospital bed, Medicare pays a rental fee for 13 months of a person’s continuous use. After the 13th month, the supplier transfers ownership of the bed to the individual. If the bed needs repairs or replacement parts during the rental period, the supplier assumes responsibility for the costs.
A person who needs less expensive DMEs can choose to rent or buy the equipment.
A key factor affecting DME cost is whether a supplier participates in Medicare.
A participating supplier is one that accepts assignment, which means the company can charge a person only the coinsurance and deductible for the Medicare-approved amount.
However, if a company is not a participating supplier, there is no limit to what it can charge.
Other factors affecting the cost include whether an individual has other insurance and whether a person buys or rents the equipment.
This online search tool can help people search for a DME supplier in their area.
As an alternative, a person can call 800-MEDICARE (800-633-4227). A person who is deaf may call 877-486-2048.
Questions to ask a supplier may include:
- Do you accept Medicare assignment? In not, what is your non-assignment charge?
- Are you a Medicare-enrolled supplier?
- Do you bill Medicare directly?
Both original Medicare and Medicare Advantage provide coverage for a hospital bed. There are conditions relating to coverage and costs.
Because a hospital bed is a large piece of DME, Medicare prefers to pay a monthly rental fee for 13 months for a person, at the end of which time the individual owns the bed.
When looking for a supplier, the main things to find out are whether the company is Medicare enrolled and whether it accepts Medicare assignment.