Yes, Medicare does cover mattresses, given a doctor prescribes one as medically necessary and you purchase it through a Medicare-approved bed supplier. Medicare classifies mattresses as durable medical equipment (DME), so Part B usually reimburses most of the purchase price. However, depending on the cost and available suppliers, patients occasionally have to rent their prescribed model.
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Your mattress must present a clear medical reason to warrant a prescription from a Medicare-approved doctor. For example, Medicare will cover an air-fluidized bed that minimizes pressure on bony areas of the body. Other mattresses that alleviate bed sores, ulcers, or chronic pain may also see coverage.
Medicare mattress coverage hinges on your medical condition and your Medicare policy details.
For Medicare to cover a mattress or any other DME, a doctor must prescribe it as medically necessary in treating or managing a chronic condition. Ailments that require specialized bedding include:
Your doctor and DME provider must have already enrolled in Medicare to receive coverage. Likewise, Medicare mattresses for seniors must prove reliable enough to withstand repeated use within their homes and last for at least three years. Medicare will not authorize coverage for support surfaces that do not have explicit physical health benefits.
Part A will rarely cover a take-home mattress. Still, it will pay for your bedding expenses and other equipment you require while registered as an inpatient resident at a hospital, skilled nursing facility (SNF), or nursing home. In exceptional cases, Part A will pay for temporary in-home hospital beds required of recently discharged hospital or SNF patients receiving home health care services that meet specific criteria.
Medicare classifies mattresses as DME, so they usually see coverage under Medicare Part B. To activate these benefits, a doctor who accepts Medicare assignment must prescribe a specific mattress as medically necessary to treat or manage a chronic condition. You must purchase this support surface through a Medicare-approved bed supplier in your area.
Part B pays for 80% of all covered doctor’s services and Medicare-compliant DME, leaving patients with a 20% coinsurance and their 2023 Part B deductible of $226. For example, if a medically necessary orthopedic mattress costs $600, you will owe at least $120. You will only have to pay your deductible if you have not fulfilled it as part of other medical expenses earlier in the year.
Medicare Advantage must legally provide equal or greater benefits to Original Medicare. Therefore, all Medicare Advantage Plans will pay for some or all of the cost of a medically necessary mattress ordered by a Medicare-approved doctor. However, since private companies govern these policies independently, they may charge varying <a class=”wpil_keyword_link” href=”https://assurance.com/health-insurance/copays-deductibles-and-coinsurance, copayment, or deductible rates.
Medicare most commonly covers orthopedic beds designed to alleviate back pain and pressure-reducing mattresses that distribute weight away from sensitive body parts. 5 types of support surfaces specifically require patients to get advance approval from Medicare, also known as prior authorization. These include:
Among these, popular models covered by Medicare include:
Yes. As with other specialized mattresses, Medicare Part B covers in-home hospital beds as DME. After meeting your deductible, you would owe 20% of the Medicare-approved amount for a medically necessary hospital bed rented or purchased through a Medicare-enrolled supplier. In exceptional cases, a hospital bed may see total coverage under Medicare Part A for eligible home health care patients.
Yes. If you have trouble getting in and out of bed or have chronic pain from arthritis, cardiac disease, or injuries, Medicare Part B will likely cover a take-home adjustable bed as medically necessary DME. Due to their high prices, Medicare often requires patients to rent these beds rather than permanently purchase one. Similarly, Medicare might not cover all adjustable mattresses or upgrades, such as electrically powered models or side rails.
Your out-of-pocket share of a Medicare-covered mattress depends on numerous factors, including:
Without insurance, medically-specialized support surfaces can cost anywhere from $200 to $30,000. In most cases, Medicare Part B will cover 80% of your medically necessary mattress, leaving you to pay the remaining 20%. An example of your out-of-pocket costs may look like the following:
Pressure Relief Mattress Total Cost
Medicare Part B Coverage
Your Coinsurance
Your Deductible
Your Total Cost
$2,289
80% of the mattress cost: $1,831
20% of the mattress cost: $458
$226
$684
Medicare Advantage costs for a covered mattress depend on the same criteria listed above and the specific details of your plan. Because Medicare Advantage policies operate independently of Original Medicare, some might charge a higher coinsurance and deductible. However, other benefit packages may pay up to 100% of a prescribed support surface or impose less stringent coverage requirements.
Follow these steps to secure a Medicare-covered mattress:
You may need a specialized mattress if you experience trouble getting in and out of bed, suffer from chronic pain, or have persisting ulcers or bed sores. In most cases, your Medicare plan will cover most of the cost of a medically necessary support surface prescribed by a doctor and purchased through a compliant DME provider.
Your share of expenses will ultimately depend on the type of mattress you require, DME suppliers in your area, and whether you have Original Medicare or Medicare Advantage. If you have any questions about how to proceed, simply schedule an appointment with your doctor or call 1-800-MEDICARE to determine your health needs and discuss your coverage options.
Is there a trial period for mattresses acquired through Medicare?
Many bed suppliers offer trial periods of 90 days or more to guarantee customer satisfaction. If your new mattress fails to alleviate your medical condition, you can usually return it and secure another prescription from your doctor to try another model. If you rent a bed and the DME supplier fails to sufficiently maintain or repair it within the first 13 months, you can terminate your rental contract and find a new supplier.
What if Medicare prescribes a used mattress?
If your doctor prescribes a particularly expensive pressure-relief mattress, Medicare may require you to purchase a used model through a compliant DME supplier. While these companies are responsible for sanitizing their products thoroughly, always ensure you select the cleanest available model. Contaminated mattresses can hide bacteria, allergens, chemicals, and parasitic insects that all pose serious health concerns.
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Medicare’s Policy on Home Hospital Beds
Basic home hospital beds may be paid for, in part, by Medicare Part B. Anyone who has Medicare Part B, and has a medical need for a hospital bed in their home, is able to get partial coverage under Medicare’s Durable Medical Equipment (DME) policy. DME is defined as medical equipment that can be reused, and a hospital bed falls under this policy. A Medicare enrolled doctor must deem the hospital bed necessary and prescribe it for use in an individual’s home.
Medicare will pick up 80% of the amount that is Medicare approved for the purchase of a hospital bed for home use. The individual must cover the remaining 20%. This can be paid out-of-pocket or with help from supplemental insurance, such as Medigap. One must also have met their Medicare Part B deductible, which as of 2019 is $185. Medicare will also help to cover the cost of some bed accessories, which may include trapeze bars, mattress covers that are intended to avoid bedsores, and bedside rails.
Rather than buy a home hospital bed straight out, one can also rent a hospital bed and still receive financial assistance from Medicare. With current Medicare regulations, after 13 months of renting, the individual owns the bed.
It’s important to note, Medicare will not cover the cost of full electric beds. However, one can pay the difference out-of-pocket between a manual-lift bed and a fully electric one. In addition, Medicare only covers a basic bed, meaning a shape very similar to a twin bed, but not identical.
In order for Medicare to pick up part of the bill, an individual must get the hospital bed from a Medicare approved supplier. If the hospital bed is purchased from a supplier that is not approved, Medicare won’t cover any of the cost of the hospital bed. Participating suppliers have Medicare supplier numbers. To find participating suppliers, click here or call 1-800-633-4227.
Medicare Advantage Plans, such as a PPO or HMO, may also help to cover the cost of hospital beds. Since plans vary, one will need to call their provider and ask about their specific plan. It is very likely their policies will be the same as Medicare’s policy.
Financial Assistance & Payment Options
Since Medicaid is a joint federal and state program, with each state running the program as they see fit within the guidelines set forth by the federal government, rules and regulations about durable medical equipment (DME) such as home hospital beds, is not consistent across the states. That being said, each state has a Medicaid State Plan and most states also have Home and Community Based Services (HCBS) Medicaid Waivers. Both State Plans and Waivers provide assistance to help the elderly avoid nursing home placement. Therefore, Medicaid very often will cover the cost of DME, which includes home hospital beds. As with Medicare, the bed must be deemed necessary by a physician. Learn more about Medicaid and their stance on DME here.
Some states offer non-Medicaid assistance in obtaining durable medical equipment and hospital beds for home use for aging or low income residents. However, it’s important to note that these programs vary widely across the board. Click here to learn more about these programs and to see if one is available in your state.
The Department of Veterans Affairs (VA) offers medical benefits for veterans that also include covering DME, such as home hospital beds. However, once again, a doctor must deem the bed medically necessary.
TRICARE for Life (TFL), a supplemental medical insurance for retired veterans, helps to cover the costs for those enrolled in Medicare that are not covered by Medicare. This holds true for DME, as TFL will pick up the 20% copayment that Medicare requires when purchasing DME. CHAMPVA for Life (CFL) offers the same benefit. But it is meant for spouses at least 65 years of age of vets who have been permanently disabled or killed in service. TRICARE, also for retired vets, also covers hospital beds (both rented and purchased), given they have been prescribed by a doctor.
There are other avenues in which a veteran can get a home hospital bed should a family feel one is required, but is not able to get a prescription. The Veteran-Directed Home and Community Based Services Program (VD-HCBS) allows participants control over what care and services meet their needs. This program should give veterans the flexibility to purchase a hospital bed even if they are unable to have one officially prescribed.
Another option is the Aid & Attendance (A&A) Program. This is a pension program for veterans who need help with their activities of daily living. Their care requirements do not need to be related to their military service. Under A&A, monies can be allocated as the beneficiary sees fit.
In addition, many states also have programs specifically for veterans. For instance, Project MEND is for residents of Texas and provides refurbished home hospital beds and mattresses to veterans and their spouses.
One may make a deduction from their federal income taxes in the event they buy a needed home hospital bed for themselves, their spouse or other dependent. It’s important to note that deductions for durable medical equipment can only be made in the year that they were purchased. The following examples presume the tax filer has no other medical expenses for the year.
The tax filer can deduct the cost of the bed that is over 10% of their adjusted gross income. If part of the bed was covered by insurance, the tax filer would only be able to deduct the part that was paid out-of-pocket.
Example: Carol’s adjusted gross income is $20,000. 10% of $20,000 is $2,000. She purchased a hospital bed for $3,000 out-of-pocket. Therefore, she can deduct $1,000 from her federal taxes.
Example: John has an adjusted gross income in the amount of $15,000. Medicare picked up $2,400 of a $3,000 bed, leaving John $600 to pay (the 20% co-payment). 10% of $15,000 is $1,500. Therefore, since the portion of the hospital bed John has to pay is not over 10% of his adjusted gross income, he cannot deduct this amount from his federal taxes.
Depending on the area in which one resides, there may be non-profits and charitable organizations that give away or loan home hospital beds. For instance, the Muscular Dystrophy Association has an equipment loan program. It includes home hospital beds for those who have neuromuscular diseases, such as ALS. To learn more, click here.
For more information on non-profit organizations that provide DME, click here.
Home Hospital Bed Costs
The cost of a home hospital bed ranges from $500 to $10,000. The variance is largely due to features and size.
Electric vs. Manual
Manual Hospital Beds – Hospital beds that are manual are the most basic hospital beds and are adjusted via a hand crank. This crank is either attached to the head or the foot of the bed, depending on the model. This type of bed is the most affordable option, which generally starts at about $500.
Semi-Electric Hospital Beds – Semi-electric beds offer more convenience than do manual beds, making it much easier for one to move the position of the bed. With this type of bed, one is able to move the head and foot of the bed electronically, but still has to manually adjust the height of the bed via a crank. The price of a semi-electric bed generally starts at approximately $1,000.
Full-Electric Hospital Beds – Full-electric beds offer the ultimate in convenience since all movements / adjustments are made electronically. However, this type of hospital bed is the priciest, starting at around $2,000.
Bed Dimensions
The length of a standard hospital bed from the top of the bed to the bottom of the bed is 38” width by 84” length, with the sleep surface being 36” width by 80” long. However, there are extension kits to extend the length of some hospital beds by 4”, which is ideal for persons that are taller than 6’. There are also full size hospital beds, which are 54” wide by 80” long, queen size beds that are 60” wide by 80” long, and king size beds that are 76” wide by 80” long. In addition, there are also bariatric beds that come in a larger width of 48”. Of course, the larger one goes in size, the more the bed will cost.
Weight Bearing
Most home hospital beds can accommodate weight up to 450 pounds. For individuals who weigh more than this, a bariatric bed is required, which can hold up to 1,000 pounds. Bariatric beds are generally full-electric beds. In general, bariatric beds can cost as much as three times more than standard hospital beds. Bariatric beds also require specific sheets and mattress pads.
Bed Sheets
Home hospital beds require sheets that are specifically made for this type of bed. This is because a typical hospital bed is the size of a twin bed in width, but is longer in length. One should expect to pay approximately $50 for a set of sheets for a standard home hospital bed.
Mattress Pads
Home hospital beds also require mattress pads that are specifically made for home hospital beds. A variety of different types of mattresses are available for purchase, including air, gel, and foam. Also, some serve specific purposes, such as adding comfort and helping to prevent sores from body pressure. One can find basic mattress pads starting at approximately $100.
Trapeze Bars
These bars are used to assist individuals in switching positions, whether it be repositioning to get more comfortable or offering assistance in getting in and out of bed. Bars add $100 – $200 in cost.
Rails
Both manual and electronic rails are available for purchase. One should expect to pay an additional $75 – $400.
IV Poles
For those who require an IV pole, there are both IV poles that attach to hospital beds and freestanding IV poles. One should expect to pay approximately $50.
Others
Other add-ons for home hospital beds include bed trays, table trays, bedpans, call cords, and bed rail pads.
Used hospital beds are available and can save one a significant amount of money. In fact, one can purchase a used hospital bed starting at approximately $300. While one can purchase used hospital beds from websites such as Ebay and Craigslist from private owners, these hospital beds generally will not come with any sort of warranty. Many dealers sell refurbished beds, which typically come with a 3-month to 1-year warranty. Make note, used bariatric beds are more difficult to find than standard home hospital beds.
Renting a home hospital bed (manual, semi-electric, and full-electric) is a great option for those who will only need it for a limited period of time. This is a much more cost efficient option for short-term use. On average, it costs one $200 – $500 / month to rent a home hospital bed. One can also find mattresses for rent. Some companies that rent home hospital beds may charge an initial fee for set-up. If this is the case, one should expect to pay an additional $50 to $100.
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Manufacturers
To assist in one’s search for home hospital beds, below is a list of reputable manufacturers.
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