People looking for an adjustable bed are often someone who has had a recent injury or illness that will be managed more effectively with an adjustable bed. You probably wonder if the insurance will pay for this bed with Medicaid as the insurance coverage.
An adjustable bed is similar to a hospital bed with some key differences. Some insurance will cover adjustable beds, and even if you don't have insurance coverage, there are ways that you can get the bed for less cost or even free.
As a registered nurse, I get frequent questions when discussing an adjustable bed for home. Let's look at some of the questions asked, so it is easier for you to focus on caring for your illness and not worrying about a bed.
What is Durable Medical Equipment or DME?
Your physician or medical provider has mentioned DME several times in your conversation. So, we will start with this basic information on the DME portion of your insurance.
Medicaid looks at DME as equipment that can be used repeatedly. It is considered everyday use and extended use. DME items include wheelchairs, scooters, some adjustable beds with a specific prescription, hospital beds, mobility aides like walkers, canes, orthotics like braces, and oxygen supplies.
Adjustable and hospital beds are billed under the DME portion of your Medicaid Insurance.
What is the difference between an Adjustable Bed and a Hospital Bed?
The adjustable bed and the hospital bed are very similar.
An adjustable bed is made of wood or metal and has hinges that allow the bed's head or feet to go up and down. They can even adjust the pillow or neck support on some advanced models. The adjustments to the bed are made with electronic hand control or buttons. The size can also differ -an adjustable bed can be ordered in your standard size; twin, full, queen, or king. Aesthetically, the adjustable bed can gel with your home with matching wood or colors.
The hospital beds are a stark color difference, generally only metal, and they can be an eyesore. They come in a twin bed size or bariatric. The head and feet, along with the height of the bed, go up and down. They are adjusted with electronic hand control or a crank handle that you turn. They have wheels to move them, often have areas for IV poles or trapeze bars to fit into, and have side rails for safety.
Types of Medicaid
To start with, Medicaid is considered low-income insurance. There is not a single set of rules that follows Medicaid and DME. Instead, each state has different coverage for Medicaid, and many different types of Medicaid programs exist. So, it is essential to look at and understand your state and your policy guidelines. There are portions of Medicaid that are required by the Federal Government to be on every policy, and DME is not one of those requirements.
Regular or Straight Medicare is the most difficult to work with and can have strict guidelines. So, to assist with this, there is another program called HCBS Waivers. These waivers are designed to help a Medicaid beneficiary stay home instead of in a nursing home. And it can cover DME such as an adjustable bed.
How to Get an Adjustable Bed at Home through Medicaid?
Generally, Medicaid will cover an adjustable bed if it meets the strict DME guidelines. The key word is strict – and that often makes it difficult, if not impossible, to get an adjustable bed on Medicaid. Though if a person is elderly and qualifies for both Medicaid and Medicare, the Medicare portion of their insurance will often cover the needed DME.
The guidelines on the hospital bed that you can choose for home use and the adjustable bed must fit the same criteria. Due to these guidelines, the adjustable bed is more difficult to get coverage through Medicaid.
To get a bed through Medicaid, you must also meet specific criteria. The adjustable bed will have to be ordered by a physician who verifies that you need the bed to care for your condition. You will use the adjustable bed regularly in the home where you reside.
Your physician will prescribe the bed for you if you have a medical condition that requires an adjustable bed. The illness is not limited to this but could include difficulty breathing when you lie flat, a back injury, swollen feet and legs that need elevation, a wound, or receiving enteral feeding. The doctor will describe the condition that requires you to have an adjustable bed for Medicaid.
Medicaid also requires the person to remain under a doctor's care and be seen at least every six months. The doctor will see you for the condition that causes you to need a specialized bed and will continue to verify through documentation that you need this bed for your condition. Additionally, your doctor and the DME provider must be Medicaid Providers. You may have increased charges if you choose to use someone who does not take Medicaid or is not an authorized provider.
How Can I Get an Adjustable Bed for Free or Reduced Price if Medicaid Does Not Completely Cover it?
Sometimes Medicaid covers only a portion of the cost of the bed or will not pay for the bed at all. In this case, there are other ways to get a bed for free or at a reduced cost.
Sometimes people no longer need the adjustable bed they have at home and are often willing to give it away or charge just a small fee for the bed. So, then it just becomes locating some of these individuals.
To find an adjustable bed, you can start by asking people or looking at resources within your community. You can ask people you know or check places like Facebook Market Place or Craigslist. There is also a website that assists low-income individuals by looking at organizations that give beds or other equipment for free; they are charitable organizations that donate or pay for the needed equipment.
A final option if you have not found a reduced cost or free bed is to look at organizations for a particular illness, such as the ALS Association, The American Red Cross, Cancer associations, or a specific organization that supports your condition. Often, they can help you get an adjustable bed for home.
Getting an adjustable bed for home through Medicaid can be a complicated process. Once you receive the adjustable bed, you will find it will make life easier for you and your loved one. You can look at Medicaid.gov or your state’s Medicaid home page for more information on Medicaid.