Does Medicare Cover Hospital Beds

Does Medicare Cover Hospital Beds? How to Get a Hospital Bed Through Medicare, Medicaid, VA or Private Insurance

By Maurice

Does Medicare Cover Hospital Beds

The goal behind this article is to provide every senior citizen in the United States with the information they need to get a free hospital bed for home use.

Seniors can get free hospital beds through major government programs like Medicare, Medicaid, and Veterans Affairs programs, or through private health insurance. What’s critical is to get familiar with and then stick to the required terms each program requires for you to get your bed.

Below, we will walk through the various types of beds and the programs available to acquire them. One critical vocabulary term to know is “durable medical equipment,” or DME. A hospital bed is a type of DME.

Often, government programs or private insurance policies refer to “DME” in their terms, and not “beds” specifically; but, of course, any terms that apply to DME apply to hospital beds as well as other types of medical equipment.

Does Medicare Cover Hospital Beds for Home Use?

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Medicare DOES cover hospital beds for home use. In fact, individuals can choose to buy or rent the hospital bed.

If an individual has the appropriate medical documentation and purchases a hospital bed from a supplier who is enrolled in Medicare, they will receive coverage. A supplier is a vendor who sells hospital beds, although usually they also sell other forms of medical equipment, too.

An individual then only pays 20% of the Medicare-approved cost of the bed. This value, which is the amount of covered costs that the individual has to pay out of pocket, is known as "coinsurance". And so, for every medical expense (like a hospital bed) covered by Medicare, an individual is expected to pay 20% of the cost before Medicare pays for the other 80%.

There is an additional annual Medicare Part B "deductible" requirement, which boils down to a certain amount of money that an individual must spend each year before Medicare coverage kicks in.

And so, with a Medicare-covered purchase of a hospital bed, the maximum that an individual will pay is their annual deductible plus 20% of the cost of the hospital bed.

Types of Hospital Beds Covered by Medicare

A manual lift bed is covered by Medicare, while a full-electric bed is not. Total electric hospital beds are considered to be a convenience, not a necessity.

The hospital bed must also be a “basic bed,” which refers to its size and shape. A basic bed is very close to a twin-sized bed.

Some larger beds may be covered for individuals depending on their weight. Larger hospital beds are known as “bariatric” or “heavy duty” beds and are addressed in their dedicated section below.

Medicare Requirements for Hospital Bed

The most important requirement for obtaining Medicare assistance towards a hospital bed is that the rental or purchase is made from a Medicare-approved supplier. The prescription of a hospital bed for home use must also come from a Medicare-approved doctor.

Unless both terms are met, the bed will not be covered by Medicare.

Before buying or renting a hospital bed from a supplier, ask for their Medicare supplier number as the safest way to confirm that they participate. It is also important to confirm that they “accept assignment,” which limits how much they can charge you. If the supplier accepts assignment, they comply with the Medicare-approved price of the bed. You will then only be charged the coinsurance, while Medicare will cover the Part B deductible.

Medicare Qualifying Diagnosis for Hospital Bed

It is always best to review with your doctor whether your specific diagnosis qualifies you for a medically required hospital bed.

The primary application of a hospital bed is to elevate the upper or lower body at angles greater than thirty degrees. A lift of thirty degrees or more can help in a wide range of health conditions, including congestive heart failure, pulmonary diseases, and even some pain relief. And for angles smaller than that, pillows and wedges are the standard recommendations.

Most providers speak in terms of the following criteria when it comes to qualifying diagnoses for Medicare coverage of hospital beds:

  1. 1
    Diagnosis with a medical condition that would be alleviated by or requires the body to be positioned in ways that a regular bed cannot, such as elevation of more than thirty degrees;
  2. 2
    Diagnosis with a medical condition that requires traction equipment to be attached to the bed, which can only be mounted safely onto a hospital bed.

Traction equipment refers to any bed accessories that help people with mobility issues get into and out of the bed more easily.

Medicare Requirements for Hospital Bed at Home

An individual enrolled in Medicare may obtain coverage for the purchase or rental of a hospital bed at home if they adhere to certain guidelines.

The individual must have received a qualifying diagnosis from a provider who is enrolled in Medicare; they must have been prescribed a hospital bed as medically necessary. If a bariatric hospital bed is required, that must also be part of this prescription.

In order for Medicare to provide coverage for the hospital bed, it must be purchased from a supplier who participates in Medicare and accepts assignment, or the Medicare-approved cost of the bed.

Medicare Requirements for Bariatric Hospital Bed

While typically Medicare only covers a “basic bed,” which is approximately the size of a twin bed, there are some situations in which a larger bed is warranted.

There are two types of classifications for larger hospital beds, which are also known as “bariatric hospital beds.” For individuals who weigh between 350 and 600 pounds, a heavy-duty extra-wide hospital bed may be covered. For people who weigh over 600 pounds, an extra heavy-duty hospital bed might be covered by Medicare.

Medicare Guidelines for Semi Electric Hospital Bed

The Medicare guidelines for a semi-electric hospital bed are the same as for a manual-lift hospital bed, except for one special provision. The prescribing doctor must specify that the individual needs frequent and/or immediate changes in their body position, which would make a semi-electric hospital bed a medical necessity. Remember, Medicare will cover equipment as long as it is a medical necessity.

Medicare Documentation Guidelines for Hospital Bed

In order for Medicare to provide coverage for renting or buying a hospital bed, there must be formal documentation showing that it is a medical necessity for the individual.

A prescription from a physician who participates in Medicare is needed. There must be notes in your medical records that show, from at least one face-to-face encounter with the doctor, that one of the medical requirements is present in the patient. This is the proof that Medicare needs to know that the hospital bed is medically required.

This prescription for a hospital bed must clearly state the patient’s name, the hospital bed, the diagnosis that creates the medical requirement for the hospital bed, and how long the bed will be needed.

Medicare Approved Hospital Bed Suppliers

Hospital bed suppliers are also often known as DME suppliers. In order to receive financial assistance with the purchase or rental of a hospital bed, the supplier must participate in Medicare, and they must accept assignment. Medicare assigns a cap on how much a piece of equipment, such as a hospital bed, can cost; the supplier must accept this Medicare assignment.

Will Medicare Pay for Hospital Bed Rental?

Individuals may receive assistance through Medicare for a hospital bed rental. After thirteen months of rental, the bed becomes the individual’s own property.

Will Medicaid Pay for a Hospital Bed?

Medicaid will cover the cost of a medically necessary hospital bed for anyone who is eligible for Medicaid coverage. In order to receive this coverage, the appropriate documentation must be submitted that shows that the hospital bed is a medical necessity.

How to Get a Hospital Bed Through Medicaid

Individuals must be eligible for Medicaid, which means they must be residents of the state in which they receive Medicaid and must meet certain criteria in their Modified Adjusted Gross Income (MAGI).

What is the MAGI? You may be familiar with your adjusted gross income (AGI) from doing your taxes each year; your AGI is the sum of all the income you received in a year, minus any tax-deductible expenses you take like alimony payments or moving expenses for military households. To calculate your MAGI, you take your AGI and add back certain expenses like any non-taxable Social Security benefits, any tax-exempt interest, and any untaxed foreign income.

The same criteria for demonstrating medical necessity as seen with Medicare also apply for Medicaid. This medical documentation is expected to come from a doctor who participates in Medicaid.

The supplier of the equipment should be accredited and licensed according to local laws, with no cases of fraud or abuse against them.

Hospital Beds Covered by Medicaid

The exact hospital beds covered by Medicaid vary by state, and so it is best to check locally before purchasing a bed. However, the purchase of hospital beds and other DME are unofficially viewed in a positive light because they help keep individuals outside of institutions like hospitals and other inpatient care facilities—which are far more costly and limited in availability.

Free Hospital Beds for Veterans - How to Get One

The Department of Veterans Affairs (VA) covers DME like hospital beds. The first step in obtaining this coverage is the same as seen with Medicare: a doctor must prescribe the bed as medically necessary, following the same conditions as seen with Medicare.

TRICARE will cover the bed for veterans who are not covered by Medicare. TRICARE, as the healthcare plan for uniformed service members or retirees and their families, can even cover the 20% copayment for veterans who are eligible for Medicare. CHAMPVA, or the Civilian Health and Medical Program of the Department of Veterans Affairs, can cover the cost of a hospital bed for any spouses or children of veterans, if they are not eligible for TRICARE. This can include the spouses and children of veterans permanently disabled by or dead from service-related disability or who died in the line of duty.

If a veteran is unable to receive an official prescription for a hospital bed, the Veteran-Directed Home and Community-Based Services Program (VD-HCBS) can provide support.

Additionally, there are state-based organizations that provide additional support to veterans. These state organizations sometimes cover costs like home hospital beds, and so it is worth reaching out directly to them. Often, the beds they provide are refurbished.

Does Insurance Cover Hospital Beds? What You Need to Know

Medicare coverage can also be provided by contracted private insurance companies, through plans that include PPOs and HMOs. These private Medicare options are known as "Medicare Advantage Plans," and they can help cover the cost of a hospital bed. The precise terms and costs vary according to the specific plan, and so it is best to confirm them directly with the insurance provider.

In case you are wondering, PPO stands for "Preferred Provider Organization," and is an insurance plan where patients can pick any physician they want to see. In contrast, in an HMO (or "Health Maintenance Organization"), only physicians listed as approved by the plan (or "in-network") can be seen by people enrolled. Often, an HMO can cost people less out-of-pocket, and so the compromise of being restricted to a network of physicians might be worth the savings incurred. PPOs and HMOs are some of the most common types of insurance plans, but do not be surprised if you run into other varieties. The key thing to look for is that they are "Medicare Advantage Plans."

Overall, these Medicare Advantage Plans align with Medicare’s requirements for both a prescription and an approved supplier. The difference is that these plans may offer more coverage than just Medicare alone.

Conclusion

If you have not yet spoken with your doctor to obtain a prescription for a hospital bed, that should be your next step. In every instance, receiving financial assistance to pay for a hospital bed requires that you prove it’s a medical necessity.


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