Does Medicare Cover Adjustable Beds for Seniors?

For many seniors, the prospect of needing an adjustable bed raises questions about coverage, particularly concerning Medicare. As individuals age, certain health conditions may necessitate specialized bedding to manage symptoms and promote well-being. Understanding Medicare’s coverage for such equipment is a common concern for beneficiaries. This guide clarifies how adjustable beds may be covered under Medicare, outlining the criteria and processes involved.

Understanding Medicare’s Durable Medical Equipment Coverage

Medicare provides coverage for various medical supplies and equipment, categorizing them as Durable Medical Equipment (DME). To qualify as DME under Medicare Part B, an item must meet specific criteria.

The equipment must be durable, able to withstand repeated use. It must be primarily used for a medical purpose, not generally useful to someone without an illness or injury. It must be suitable for home use and have an expected lifespan of at least three years.

Medicare Part B, covering outpatient medical services, handles costs for qualified DME. Adjustable beds, when covered, fall under this category.

Conditions for Adjustable Bed Coverage

Coverage is for “hospital beds” deemed medically necessary. A physician’s order is required, documenting the medical condition needing the specialized bed. This includes situations where a patient needs specific body positioning not achievable with an ordinary bed, such as to alleviate pain, prevent respiratory infections, or promote proper alignment.

Common medical conditions qualifying a patient for a hospital bed include severe arthritis, chronic obstructive pulmonary disease requiring head elevation, or paralysis. The bed must offer features addressing these medical needs, such as adjustable head and foot sections or side rails.

Basic manual or semi-electric hospital beds are covered. Luxury features like massage or advanced motorized functions are not included, as Medicare focuses on medical necessity.

Navigating the Coverage Process

Obtaining Medicare coverage for an adjustable bed involves several procedural steps. The process begins with securing a prescription and supporting documentation from a Medicare-enrolled physician. This documentation must explicitly state the medical necessity of the bed, detailing the specific condition and how the bed will address it. A face-to-face visit with the treating practitioner within six months of the order is a requirement.

Once the physician’s order is secured, work with a Durable Medical Equipment supplier that is enrolled in Medicare and accepts assignment. Accepting assignment means the supplier agrees to accept Medicare’s approved amount as full payment, which helps limit out-of-pocket costs. Beneficiaries are responsible for the Medicare Part B annual deductible, which is $257 in 2025, and a 20% coinsurance of the Medicare-approved amount for the equipment after the deductible is met.

Medicare covers hospital beds on a rental basis for a period of 13 months, after which ownership of the equipment transfers to the beneficiary. For some items, beneficiaries may have the option to rent or purchase. If coverage is denied, beneficiaries have the right to appeal the decision, following a multi-level process that begins with a redetermination request to Medicare.