Hospital beds come under the category called Durable Medical Equipment (DME). Medicare covers certain DME under their Part B coverage or Part C (Medicare Advantage). You must be enrolled in one of these to be considered for coverage – enrollment in Part B or C is not automatic. Also, any possible coverage can only be granted by using authorized and participating doctors and suppliers.
Medicare will not provide coverage for any kind of DME, including hospital beds, unless having such a bed is a medical necessity for the specific patient. Such a medical necessity must be prescribed and documented by a physician and such a prescription must have resulted from an in-person medical exam within six months prior to the claim to Medicare for coverage.
Per Medicare regulations, they will usually only approve a hospital bed as a covered medical necessity if one or more of the following conditions are met:
– The documented medical condition requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head/upper body less
than 30 degrees does not usually require the use of a hospital bed,
– The patient requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain,
– The patient requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary
disease, or problems with aspiration. Pillows or wedges must have been considered and ruled out,
– The patient requires medical equipment which can only be attached to a hospital bed.
Manual Hospital Beds – This is the basic type of hospital bed and can be covered by Medicare by meeting the eligibility conditions described above. They operate by hand cranks that adjust the angle of the head and the foot of the bed.
Variable Height Hospital Beds – Same as the basic manual bed but also have a hand crank to adjust the height of the bed, they can be covered if you have met the basic eligibility plus you require a bed height different than a fixed height hospital bed to permit transfer to chair, wheelchair or standing position.
Semi-electric Hospital Beds – These beds have the angle of the head and foot adjusted by an electric motor which is controlled by a hand-held device. It can be covered if you have met the basic eligibility plus require frequent changes in body position and/or has an immediate need for a change in body position.
Heavy Duty Extra Wide Hospital Beds – Covered if you have met the basic eligibility plus your weight is more than 350 pounds but does not exceed 600 pounds.
Extra Heavy Duty Hospital Beds – Can be covered if you have met the basic eligibility plus your weight is more than 600 pounds.
Total Electric Beds – Not covered as they are considered by Medicare to be a convenience feature, and thus they are denied as not being reasonable and necessary.
If Medicare approves your claim for coverage of a hospital bed, the following are the monetary details involved:
– Any deductible amount on your Medicare Part B or C will be applied before any coverage is paid.
– Medicare will cover the purchase of the bed provided you are shown to need it for long-term (at least six months). If you only need it short-term, they
will only cover a rental of the bed.
– Medicare may allow you to “rent to own”, where the bed is rented for 13 months after which you would own it.
– In either event, Medicare will pay 80% of the cost and you will pay the remaining 20%.
– Medicare will only pay a claim (their 80%) to a Medicare authorized and participating medical equipment supplier.
Usually, the hospital bed will have to be placed in your home, but it can also be allowed in a relative’s home or a nursing home if that is your actual place of residence. If you need the hospital bed on a permanent basis, Medicare may allow a replacement every five years. You must get Medicare’s approval before you make a purchase or rental of the bed.