Does Medicare Pay for an Adjustable Bed?

Medicare is a federal health insurance program for individuals aged 65 or older and some younger people with disabilities. This article clarifies Medicare’s coverage for adjustable beds, which are often sought for comfort or specific health needs.

When Medicare Covers Adjustable Beds

Medicare covers adjustable beds only when classified as a “hospital bed” under its Durable Medical Equipment (DME) benefit. Durable Medical Equipment includes items that are reusable, used in the home, and serve a medical purpose. For a hospital bed to be covered, a physician must deem it medically necessary for the patient’s condition.

Medical necessity is a strict criterion that requires the bed to be essential for treating an illness or injury or to improve the functioning of a body part. Examples of conditions that might warrant a hospital bed include severe arthritis, cardiac conditions, or chronic obstructive pulmonary disease (COPD). The doctor’s order must clearly specify the medical reason for the hospital bed, such as positioning to alleviate pain, support respiratory function, or assist with transfers.

Medicare Part B is the component of Medicare that covers medically necessary DME, including hospital beds. The physician prescribing the bed must be enrolled in Medicare, and the supplier providing the bed must also be a Medicare-approved supplier. This ensures that the equipment meets Medicare’s quality and safety standards and that claims can be processed appropriately.

The physician’s prescription must detail the specific features required for the hospital bed, such as height adjustments, head and foot elevation, or side rails, linking each feature directly to the patient’s medical needs. Without a comprehensive and medically justified order, Medicare will not authorize coverage.

Financial Considerations

Even when a hospital bed is covered by Medicare Part B, beneficiaries typically incur some out-of-pocket expenses. Medicare Part B requires an annual deductible before coverage begins for most services, including DME. For 2025, the standard Medicare Part B deductible is $240. After this deductible has been met, Medicare generally pays 80% of the Medicare-approved amount for the hospital bed.

Beneficiaries are responsible for the remaining 20% coinsurance. The total cost will depend on whether Medicare covers the rental or purchase of the bed. Medicare often covers the rental of a hospital bed for a period of up to 13 months, after which the beneficiary may have the option to purchase it, or ownership may transfer to them.

It is important for beneficiaries to choose a supplier that accepts “Medicare assignment.” A supplier who accepts assignment agrees to accept the Medicare-approved amount as full payment for the item or service. This limits the beneficiary’s out-of-pocket costs to the deductible and the 20% coinsurance. If a supplier does not accept assignment, they can charge more than the Medicare-approved amount, and the beneficiary would be responsible for the difference.

Supplemental insurance policies, such as Medigap plans, can help cover some or all of the Part B deductible and coinsurance amounts. Additionally, Medicaid, a joint federal and state program for low-income individuals, may also provide assistance with these costs, depending on the beneficiary’s eligibility and the specific state’s program rules.

How to Obtain a Medicare-Covered Adjustable Bed

The process for obtaining a Medicare-covered hospital bed begins with a visit to the beneficiary’s treating physician. The doctor must conduct an examination and determine that a hospital bed is medically necessary for the patient’s condition. During this consultation, the physician will write a detailed prescription outlining the specific medical reasons for the bed and any required features, such as specific height adjustments or positioning capabilities.

After obtaining the physician’s prescription, the next step involves finding a Medicare-approved Durable Medical Equipment supplier. Beneficiaries can use Medicare’s online supplier directory or contact Medicare directly to locate approved providers in their area. Confirming that the chosen supplier accepts Medicare assignment is an important action to ensure predictable out-of-pocket expenses.

The chosen supplier typically handles the submission of the claim to Medicare on the beneficiary’s behalf. This process involves submitting the physician’s order and documentation of medical necessity to Medicare for review. The supplier will also provide information regarding the rental or purchase options available under Medicare’s guidelines.

Claim processing times can vary, but beneficiaries can generally expect a decision within a few weeks to a month. If a claim is denied, the beneficiary has the right to appeal the decision. This appeals process involves several levels, starting with a redetermination by Medicare, and provides an opportunity to submit additional medical documentation or clarification to support the claim.