If You Need a Hospital Bed, What Does Medicare Cover?
Article originally featured on Healthline
Medicare will cover hospital beds to use at home when they’re medically necessary.
To get coverage, you’ll need a doctor’s order stating that your condition requires a hospital bed.
Medicare Part B will pay 80 percent of the cost of your home hospital bed.
If you have a Medicare Advantage plan, it may pay more.
Your doctor might order a hospital bed for you to use at home for many reasons, such as if you’re in severe pain, having trouble breathing, or experiencing swelling in your legs and feet.
Medicare will cover the hospital bed as long it’s medically necessary to help your condition. Your doctor will need to order the bed and show how it will help your condition.
Medicare pays for all medical equipment, including hospital beds, under Medicare Part B. Part B will pay 80 percent of the cost of your hospital bed.
You might be able to get more coverage if you have a Medigap or Medicare Advantage plan.
When Does Medicare Cover Hospital Beds for Home Use?
Hospital beds for home use are considered durable medical equipment (DME). Medicare covers DME under Part B. Your hospital bed will need to meet a few conditions in order to be covered.
Medicare will pay for your hospital bed if:
You have a documented medical condition that requires a home hospital bed.
You’re under the care of a doctor for your condition and being seen at least once every 6 months.
Your doctor orders the bed for home use.
Your doctor’s order includes your condition and why a hospital bed will help you.
Your doctor participates in Medicare.
The equipment provider participates in Medicare.
Medicare can provide coverage for you to either rent or buy a bed.
Whether you rent or buy will depend on the type of bed your doctor orders and the policies of the company you use. You might also rent a bed at first, then purchase it if you still need it later on.
Which Medicare Plans May Be Best for You if You Know You Need a Hospital Bed at Home?
You can get coverage for hospital beds through a few different parts of Medicare.
If you use Medicare parts A and B, together called original Medicare, your coverage will be through Medicare Part B. That’s because Medicare Part A covers inpatient stays and care you receive in hospitals and skilled nursing facilities.
Medicare Part B covers your other healthcare needs, including:
Doctor’s office visits
Emergency room care
Part B will cover 80 percent of the Medicare-approved amount of your hospital bed. You’ll pay the remaining 20 percent.
You can also get coverage through a Medicare Part C plan. Part C plans, also known as Medicare Advantage plans, are offered by private companies that contract with Medicare.
They’re required to provide the same coverage as original Medicare. Plus, many Advantage plans go beyond the coverage of original Medicare to offer additional covered services.
So, since original Medicare covers hospital beds, all Advantage plans will also cover hospital beds. Your cost might be more or less than with original Medicare, depending on your plan.
Medicare Part D is prescription drug coverage. It won’t help you pay for any DME, including hospital beds.
Medigap, however, can help you pay for a hospital bed. This is Medicare supplement insurance. It covers some of the out-of-pocket costs of using original Medicare, like copayments and coinsurance amounts.
So, if you use Medicare Part B to get a hospital bed, a Medigap plan could cover the 20 percent coinsurance amount you’d normally need to pay.
What is A Home Hospital Bed?
A hospital bed is a bed that has extra features, such as side rails, gel cushioning, or the ability to raise your head or feet. Your doctor might order a hospital bed for home use if you have:
Arthritis, osteoporosis, or another chronic pain condition
Heart conditions that require you to keep your head, heart, or limbs elevated
A condition that requires you to be repositioned for pain or pressure relief
A spinal cord condition or injury
Chronic obstructive pulmonary disease that’s affected by your sleeping position
What Hospital Beds Are Covered?
Medicare covers several types of hospital beds. This includes:
Beds with side rails
Extra-wide bariatric beds that can hold weights of 350 to 600 pounds
Extra-wide bariatric beds that can hold weights of more than 600 pounds
Bed types are all available with a mattress or without one. Medicare also covers mattress pads, including:
Lambswool sheepskin pads
Synthetic sheepskin pads
Dry pressure pads
Water pressure pads
Air pressure pads
Medicare will also cover some additional features if they’re medically necessary. However, it won’t cover things that are considered convenience features.
So, Medicare will cover features like trapeze pull bars that help you sit up in bed but won’t cover things like over-the-bed tables, which are considered a convenience and not a necessity.
Any bed you order needs to be considered medically necessary for your condition. For example, to get approved for a bariatric bed, you’ll need to send a medically documented recent weight.
It’s also important to note that while Medicare covers semielectric beds with adjustable heads and feet, it doesn’t cover fully electric beds.
Fully electric beds have adjustable height in addition to the adjustable head and feet. Medicare considers adjustable height a convenience feature, and won’t pay for it.
How Much Does the Average Hospital Bed for Home Use Cost?
The cost of a hospital bed depends on the type of bed your doctor orders.
According to Consumer Affairs, hospital bed costs start at around $500 and can often reach thousands of dollars. When you rent a hospital bed, Consumer Affairs reports, you can spend between $200 and $500 per month depending on the bed type.
Medicare can help you reduce this cost. Medicare Part B will pay 80 percent of your costs when you use original Medicare.
So, let’s say your doctor orders a bed with a cost of $1,000. In this case, Medicare would pay $800 and you’d pay $200. If you decide to rent a bed instead for $300 per month, Medicare would pay $240 and you’d pay $60.
If you have a Medigap plan, it can pick up those remaining costs, meaning you wouldn’t need to pay anything for your hospital bed.
Your costs with a Medicare Advantage plan will depend on the plan. Each Part C plan has its own copayment or coinsurance amounts. You can call your Advantage plan if you’re not sure.
The Bottom Line
Medicare will pay for a hospital bed for home use if it’s medically necessary and ordered by your doctor.
Medicare covers a variety of hospital beds to help with different conditions. Your doctor will need to specify your condition and why a hospital bed will help it.
Medicare will pay for you to buy or rent a bed. Original Medicare will pay 80 percent of the costs. A Medicare Advantage or Medigap plan might cover more.