Are Adjustable Beds Covered by Medicare?

An adjustable bed is a specialized bed base featuring a multi-hinged lying surface that can be positioned into various angles. This allows for independent elevation of the upper body and lower body, offering customized comfort and support. These beds operate using an electric motor system, enabling users to adjust sections via remote control for different postures.

Medicare’s Coverage of Durable Medical Equipment

Medicare generally covers durable medical equipment (DME) under Medicare Part B, which addresses outpatient medical costs. Durable medical equipment refers to items that are reusable, serve a medical purpose, are typically not useful to someone without illness or injury, are suitable for use in the home, and are expected to last for at least three years.

For Medicare to cover DME, a physician or other authorized healthcare provider, like a nurse practitioner or physician assistant, must prescribe it as medically necessary. The equipment must be for use in a beneficiary’s home, though a long-term care facility can qualify as a home for this purpose.

Medicare Part B covers medically necessary DME when prescribed for home use, provided it is obtained from a Medicare-enrolled supplier. If a supplier participates in Medicare, they must accept assignment, meaning they agree to the payment amount Medicare approves for the service.

Specific Criteria for Adjustable Bed Coverage

Adjustable beds are considered a type of durable medical equipment (DME) by Medicare, specifically falling under the category of hospital beds. For an adjustable bed to be covered, it must be prescribed by a doctor as medically necessary for a specific medical condition that necessitates special positioning or equipment not achievable with a standard bed. This includes conditions such as severe arthritis, immobility due to certain diseases, or the need for positioning to relieve pain, promote proper body alignment, or improve respiratory function.

The bed must also be capable of adjusting at either the head or foot, allowing for elevation of different body parts. Certain modifications, such as side rails, electric power adjustments, or specialized pressure-reducing mattress pads, may also be covered if deemed medically necessary. Medicare typically covers basic hospital-style adjustable beds, not consumer-brand adjustable beds advertised for general comfort.

A physician’s prescription, along with supporting medical records that detail the condition and why an adjustable bed is required, must be provided. A face-to-face visit with the doctor or provider within six months of the bed order is typically required to determine medical necessity.

Steps to Obtain a Medicare-Covered Adjustable Bed

The process begins with securing a prescription or order from your doctor or healthcare provider. This prescription must clearly state the medical necessity of the adjustable bed for your condition.

Next, you need to find a supplier that is enrolled in Medicare and accepts Medicare assignment. You can find Medicare-approved suppliers through Medicare’s official website or by calling 1-800-MEDICARE. It is important to confirm that both your prescribing doctor and the chosen supplier are Medicare-enrolled to ensure coverage.

Once you have the prescription and have identified a Medicare-approved supplier, the supplier will typically submit the claim to Medicare. Medicare may require that you rent certain items, or it may offer the option to purchase, depending on the specific equipment. The supplier manages the billing and insurance paperwork, but beneficiaries should monitor the claim’s progress and provide any additional information Medicare may request.

Understanding Your Costs for a Covered Adjustable Bed

When Medicare covers an adjustable bed as durable medical equipment, the financial responsibility is shared. Medicare Part B typically pays 80% of the Medicare-approved amount for the equipment. This payment occurs after you have met your annual Part B deductible.

For 2025, the annual deductible for all Medicare Part B beneficiaries is $257. After this deductible is met, you are generally responsible for the remaining 20% coinsurance of the Medicare-approved amount. Your monthly Part B premium, which is $185.00 in 2025 for most beneficiaries, is a separate cost.

For individuals seeking to minimize out-of-pocket expenses, supplemental insurance options like Medigap plans can provide additional coverage. Medigap plans may help cover the Part B deductible and the 20% coinsurance, potentially reducing your financial burden for Medicare-approved durable medical equipment.