Are Hospital Beds Covered by Medicare?

Medicare helps individuals manage healthcare costs, especially when specialized equipment is needed for home use. For those requiring a hospital bed, Medicare can provide coverage under specific conditions, ensuring patients receive the support needed within their home environment.

Understanding Medicare Part B and Durable Medical Equipment

Medicare categorizes certain medical equipment used in the home as Durable Medical Equipment (DME). This broad category includes items designed for repeated use, serving a medical purpose, and expected to last at least three years, such as wheelchairs, oxygen equipment, and hospital beds. These items must be suitable for use in the home, although they can also be used outside the home.

Medicare Part B is the specific component of Medicare that covers DME. For coverage, the equipment must be medically necessary, meaning it is required for the diagnosis or treatment of an illness or injury, or to improve the functioning of a malformed body part. A doctor or other qualified healthcare provider must prescribe the DME, and it must be obtained from a supplier enrolled in Medicare.

Beneficiaries typically cover 20% of the Medicare-approved amount for DME after meeting the annual Part B deductible. Medicare pays the remaining 80% of the approved amount. For hospital beds, Medicare pays for rental for 13 months of continuous use, after which ownership transfers to the patient.

Specific Coverage Requirements for Hospital Beds

Medicare has detailed criteria that must be met for a hospital bed to be considered medically necessary for home use. The patient’s medical condition must necessitate body positioning that is not feasible with an ordinary bed, such as to alleviate pain, promote proper body alignment, prevent contractures, or avoid respiratory infections. This also includes situations where the patient requires special attachments that cannot be used on a standard bed.

A doctor’s prescription is required and must clearly establish the medical necessity for the hospital bed. This prescription, or other supporting documentation, needs to describe the medical condition, such as severe arthritis, severe bone fractures, heart disease, spinal cord injuries, or chronic obstructive pulmonary disease, and explain why the bed’s features are needed.

A face-to-face examination by the treating practitioner is a prerequisite for ordering a hospital bed. This examination must occur within six months prior to the bed’s ordering, and the medical record from this visit must document the medical necessity for the bed.

The hospital bed must be obtained from a supplier enrolled in Medicare for Medicare to cover its share of the cost. Medicare may cover various types of hospital beds, including manual, semi-electric, and full-electric, if medically necessary. Features like variable height may be covered if needed for conditions such as severe arthritis or severe cardiac conditions to assist with ambulation or patient transfers.

Steps to Obtain a Medicare-Covered Hospital Bed

The initial step in obtaining a Medicare-covered hospital bed involves a discussion with your treating physician. Your doctor will confirm the medical necessity of the bed and provide a detailed prescription, ensuring all Medicare documentation requirements are met, including the face-to-face examination.

After receiving a prescription, locating a Medicare-approved supplier is necessary. You can find enrolled suppliers through the Medicare website’s supplier directory or by calling 1-800-MEDICARE. It is important to confirm that the supplier accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment and will only charge you the coinsurance and deductible.

The supplier typically manages the submission of the prescription and other medical necessity documentation to Medicare. You will need to provide your Medicare card and any requested medical records to the supplier. Some DME, including certain hospital beds, may require prior authorization, which the supplier usually handles.

You are responsible for 20% of the Medicare-approved amount after meeting your Part B deductible, with Medicare covering the remaining 80%. If a claim is denied, beneficiaries have the right to appeal the decision through a multi-level appeals process, beginning with a redetermination request.