1. Does Medicare Cover Adjustable Beds?

Yes, Medicare can cover certain adjustable beds, but only if they’re classified as durable medical equipment (DME) and deemed medically necessary by a doctor. Under Medicare Part B, which covers outpatient services and DME, an adjustable bed may be covered if it meets specific criteria. Generally, Medicare covers “hospital beds,” which have features like adjustable head and foot positions, which may overlap with what some people consider “adjustable beds.” However, not all adjustable beds fall under this category.

2. Types of Beds Covered by Medicare

Medicare typically covers basic hospital beds rather than luxury adjustable beds commonly found in furniture stores. Here’s a look at the types of beds Medicare might cover:

• Hospital Beds: Medicare generally covers beds designed for hospital use, which include adjustable head and foot positions, height adjustability, and safety rails.

• Semi-Electric Beds: These beds have an electrically adjustable head and foot area but require manual adjustment for height. Medicare often covers semi-electric beds as they meet basic medical requirements without added luxury features.

• Fully Electric Beds: These beds are entirely adjustable through electric controls, including head, foot, and height adjustments. However, Medicare doesn’t typically cover the extra cost for fully electric models, so you may have to pay the difference if you prefer this type.

• Low Air Loss Beds: Medicare covers certain specialized beds, like low air loss mattresses, which help prevent bedsores for people confined to bed for extended periods.

3. Eligibility Requirements for Medicare Coverage

To qualify for Medicare coverage for an adjustable bed, you must meet the following requirements:

Doctor's Prescription: Medicare requires a prescription or a “Certificate of Medical Necessity” from a doctor, indicating that an adjustable bed is necessary to treat your condition. This typically involves detailed information about how the bed will help your health.

Medical Necessity: Medicare covers adjustable beds only for conditions like severe arthritis, spinal issues, respiratory issues, heart conditions, or other situations that require elevation or position adjustments for improved health and comfort.

Approved Suppliers: Medicare will only cover beds purchased or rented from Medicare-approved suppliers. Using a supplier not approved by Medicare can result in out-of-pocket costs.

4. How Much Does Medicare Cover?

Medicare Part B covers 80% of the Medicare-approved cost for an adjustable bed, leaving you responsible for the remaining 20%. This cost-sharing applies once you’ve met your annual Part B deductible. It’s also worth noting that many people have supplemental insurance, like Medigap, which may help cover the remaining costs.

If you qualify, you can opt to rent or purchase the bed through a Medicare-approved DME supplier. Some beds may be available only for rent, while others can be bought outright depending on the supplier’s policies.

5. How to Get Medicare Coverage for an Adjustable Bed

Here’s a step-by-step guide to obtaining Medicare coverage for an adjustable bed:

Consult Your Doctor: Your first step is to discuss your needs with a healthcare provider, who can determine if an adjustable bed is medically necessary and provide the required documentation.

• Find a Medicare-Approved Supplier: Search for a durable medical equipment supplier approved by Medicare. You can find a list of suppliers on Medicare’s website.

• Submit Your Documentation: The supplier will typically help you file the necessary paperwork with Medicare, including your doctor’s prescription and any other required documents.

• Choose a Rental or Purchase Option: Depending on Medicare’s assessment and the supplier’s offerings, you may be able to rent or purchase the bed.

• Pay Remaining Costs: Once Medicare approves your bed, remember you’ll be responsible for the 20% coinsurance unless you have supplemental insurance to cover it.

6. What Conditions Qualify for Medicare Coverage?

To qualify for an adjustable or hospital bed covered by Medicare, you generally need to have a medical condition that makes it difficult or uncomfortable to sleep in a regular bed. Some qualifying conditions include:

• Severe arthritis

• Spinal cord injuries

• Respiratory issues that require head elevation

• Severe heart conditions

• Recovery from surgery or serious injury

Your doctor will assess your condition and determine if an adjustable bed is necessary to manage your health effectively.

7. Additional Tips for Finding an Adjustable Bed Covered by Medicare

• Contact Your Local Medicare Office: Local Medicare offices often have resources and information to help you find approved suppliers and clarify any questions.

• Consider a Medigap Plan: If you frequently require DME, a Medigap plan can help cover out-of-pocket costs, such as the 20% coinsurance Medicare doesn’t pay.

• Evaluate Alternative Payment Options: If you don’t qualify for Medicare coverage or prefer a higher-end adjustable bed, some suppliers offer financing options to make out-of-pocket purchases more affordable.