Medicare Advantage Plans Can Cover Some Additional Costs
Medicare Advantage plans are sold by private insurance companies as an alternative to Original Medicare .
Every Medicare Advantage plan must cover everything that Part A and Part B covers. This means thatif your hospital bed is covered by Original Medicare, it will also be covered by a Medicare Advantage plan.
Some Medicare Advantage plans may also offer additional benefits, such as:
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About the author
Christian Worstell is a licensed insurance agent and a Senior Staff Writer for MedicareAdvantage.com. He is passionate about helping people navigate the complexities of Medicare and understand their coverage options.
His work has been featured in outlets such as Vox, MSN, and The Washington Post, and he is a frequent contributor to health care and finance blogs.
Christian is a graduate of Shippensburg University with a bachelors degree in journalism. He currently lives in Raleigh, NC.
Where you’ve seen coverage of Christian’s research and reports:
MedicareAdvantage.com is a website owned and operated by TZ Insurance Solutions LLC. TZ Insurance Solutions LLC and TruBridge, Inc. represent Medicare Advantage Organizations and Prescription Drug Plans having Medicare contracts enrollment in any plan depends upon contract renewal.
Medicare has neither reviewed nor endorsed this information.
Medicares Qualifying Diagnosis For A Hospital/adjustable Bed
Original Medicare Part B will partially cover a hospital bed for use in the home if you meet one or more of the following criteria:
- If you have a medical condition which requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed, or
- You require positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain, or
- You require the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration. Pillows or wedges must have been considered and ruled out, or
- You require traction equipment which can only be attached to a hospital bed.
Variable Height Hospital Beds beds that allow the height of the bed to vary can be covered if you have met one or more of the principal criteria above, and require a bed height different than a fixed height hospital bed to permit transfer to chair, wheelchair or standing position.
Semi-electric Hospital Beds can be covered if you have met one or more of the principal criteria above, and require frequent changes in body position and/or has an immediate need for a change in body position.
Heavy Duty Extra Wide Hospital Beds can be covered if you have met one or more of the principal criteria above, and your weight is more than 350 pounds but does not exceed 600 pounds.
The Medical Equipment Covered By Medicare
The following is a list of DMEs generally covered by Medicare. To qualify for coverage one needs to have Original Medicare Parts A and B, and purchase from an accredited supplier.
- Air-Fluidized Bed
- Conventional glasses or contact lenses after surgery with insertion of an intraocular lens
- Intraocular lenses
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Drive Medical Alternating Pressure Low Air Loss Mattress System
This is much more than a mattress. The Drive Medical Alternating Pressure Low Air Loss Mattress System is actually a machine that can adjust the pressure of your mattress, giving alternating or static pressure as needed. A quiet pump provides air flow and helps direct or decrease pressure depending on whats feeling sore.
Will My Private Insurance Cover An Adjustable Bed
Adjustable beds serve some medical purposes and are beneficial for older people who live alone. Most private insurers cover them. Some insurers consider them a medical device while others require the adjustable bed to be prescribed by a doctor.
However, insurance companies usually won’t cover any adjustable bed, only medical-grade hospital beds. If you do get a prescription from a doctor, you won’t need to worry about sales tax.
Mattresses usually are not reimbursed by insurance companies because they’re not deemed medically necessary.
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Is It Medically Necessary
Even though your doctor might determine that there is a medical purpose for DME, it does not mean it will be approved by Medicare. Once the doctor recommends it, it must be considered and reviewed by Medicare before it will pay. Not all DME is created equal. In other words, there might be a specific type of bed that is approved, while others are not.
Adjustable beds are usually prescribed to patients to help cure, relieve, and minimize circulatory and respiratory health issues. These beds help people get in and out of bed with more comfort and ease.
Medicare Part B will cover 80% of the adjustable bed expense, leaving you to pay the rest .
Your Mattress Covered By Health Care Why Sleep Number Thinks It Could Happen
As technology gets more sophisticated and stressed-out consumers find it harder to get some shut-eye Sleep Number thinks the day could arrive when a mattress can be covered by health insurance.
Sleep disorders which the Centers for Disease Control has deemed a public health crisis have been linked to health conditions like heart disease.
Meanwhile, institutions like the Mayo Clinic are shelling out millions to fund studies on why people find it harder to rest. And just Friday, Sleep Number competitor Casper Sleep filed paperwork to go public, citing the opportunities presented by what it estimated is a $432 billion sleep economy.
Its also a hot button issue for technology companies looking to get a slice of health care spending thats set to get even larger. Apple , Samsung and Google which recently acquired Fitbit are all analyzing sleep patterns through wearables.
Those efforts laying the groundwork for Sleep Number, which is pivoting toward health and wellness. Already, the 32-year old company is working with Mayo to analyze Sleep Numbers anonymous data from its SleepIQ technology.
In 2012…I could see the value of having that technology in our beds, Shelly Ibach, president and CEO of Sleep Number, told Yahoo Finance on the sidelines of last weeks CES technology confab in Las Vegas.
Ibach said the use of wearables helps the company take sleep analysis a step further, since a mattress functions as a whole-body monitoring system.
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Does Medicare Pay For Hoveround
If you meet their criteria, Medicare will pay 80% of the cost of your Hoveround, and if you have met your deductibles, your supplemental insurance may cover the remaining 20% of the cost. Insurance coverage depends on medical necessity which is determined by your insurer. A valid doctors prescription is required.
Invacare Full Electric Homecare Bed
The best selling hospital bed on Amazon, this bed functions fully electronically but does come with a manual hand crank. Additionally, this bed measures 88×36, has a 450lbs weight capacity, offers a full or half-rail option, and comes in a wood finish. The bed includes a waterproof mattress cover and a 2-year warranty.
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The Types Of Hospital Bed Which Medicare Part B Will Pay For
Original Medicare will not provide cover for just any adjustable bed for use in the home, but it will cover for a basic hospital bed which is not fully electric.
You can, though, pay the difference out of your own pocket to get a fully electronic bed.
Hospital beds are a type of adjustable bed, but are designed to be easily maintained and cleaned.
The hospital beds will have height, and angle, adjustable areas under
- the head and shoulders at the top of the bed
- the feet and lower leg
The height of the whole bed may also be adjustable.
Medicare negotiates with suppliers to obtain a certain price for certain beds, and those are the models which are going to be covered by Medicare.
For this reason, its important to stick to the correct procedure if you want to be covered.
Here are the types of bed covered by Medicare
These beds are fully manual, and are adjusted by turning a crank.
The number of cranks may vary.
Of all the hospital beds, these are the most economical, but also the most physically demanding for the carer.
Can You Get A Hospital/adjustable Bed If You Have A Medicare Advantage Plan
If you have a Medicare Advantage Plan you should be able to get a bed covered by the plan if it is considered medically necessary by Medicare, but you must consult with your plan provider.
Medicare Advantage Plans are run by private companies, which are contracted by Medicare to provide Medicare services, and are bound by law to provide, at least, the same coverage as Original Medicare Parts A and B.
The companies providing these plans will have their own requirements for a claim.
Almost certainly, you will have to use a DME supplier in their network, otherwise you really are risking having to pay the whole bill for the bed yourself.
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State Financial Assistance Programs
As well as the programs we have looked at, some states have non-Medicaid programs which help the elderly and the disabled to maintain their independence in their homes with financial assistance.
State Financial Assistance Programs will help to purchase assistive devices, safety equipment, durable medical equipment, as well as necessary home modifications.
The participants may get grants or loans, or both.
Your local Area Agencies on Aging should be able to advise on programs for the elderly, and in particular if there is one in your state.
Does Medicare Cover Adjustable Beds
Medicare covers adjustable beds under Part B.
Medicare Part B pays for outpatient medical costs, such as durable medical equipment. This includes adjustable beds. Part B will cover these beds when your doctor orders one for you to use in your home.
For Part B to cover your adjustable bed, both your doctor and the company thatll supply the bed must be enrolled as Medicare providers.
Depending on the bed you need and the supplier, you might be able to:
- rent the bed
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Medicare Could Cover The Cost Of Your Next Mattress
Health insurance is not easy to understand, especially with all clauses buried in the fine print. Sneaky qualifications, hidden charges, and deductibles make it complicated to find out what youre covered for and what you have to pay. That process can be particularly tough if youre on Medicare.
Medicare coverage is confusing. Still, there are some major benefits worth-looking into, such as a brand-new bed. Your Medicare plan may offer a way to pay for a new bed if you are suffering from back pain. Heres what you need to know about qualifying for a free bed.
How Much Does A Sleep Number Bed And Base Cost
Sleep Number Modular Base is a modular bed frame that has a sleep number on it. Pricing for a single room starts at $199 and goes up to $399 for a king. You may purchase additional legs, which will elevate the bed and provide more storage space, for an additional $80-159.99, depending on the size of the bed.
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Drive Medical Full Electric Ultra
Similar to the Invacare bed, this bed is a fully electric bed measuring 88×36 with full or half rails and a 450lbs weight capacity. The warranty on the Drive Medical bed is only for a year. This bed features the capacity to lower up to four inches from the floor and comes with removable wood grain panel head and footboards. Although the bed is fully electric, the bed comes with a battery backup to maintain functionality at all times.
Customization Options And Special Features
Customization options and features vary based on the Sleep Number collection and include:
- Flexfit, which allows users to raise their partners head to reduce snoring.
- Under-bed lighting, which helps users find their way around at night safely with additional illumination.
- Adjustable positions, which raise or lower portions of the bed to adjust the users overall sleeping experience.
- Foot warming, which provides targeted, adjustable heat at the foot of the bed.
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Will The Adjustable Beds Covered By Medicare Can Be Obtained Commercially
Accredited suppliers under Medicare can fulfill the need for your adjustable hospital bed if they are medically necessary. Only Medicare accredited suppliers can help cut costs. The price of Medicare will shoulder is often pre-agreed by the parties.
Adjustable beds bought outside of the suppliers provided will never be covered by Medicare. Many bed suppliers mislead patients into buying from them without being accredited Medicare suppliers of DME products. It is very likely that their sales personnel do so in an attempt to meet their monthly sales quota. It is always important to check if the supplier is enrolled under the Medicare program to be able to collect later on.
How Are Hospital Beds Covered Under Medicare
A hospital bed is considered durable medical equipment that your doctor can prescribe for use in your own home.
Medicare Part B medical insurance typically covers a medically-necessary hospital bed when it meets certain requirements, such as:
- The hospital bed is intended for use in your home
- The bed is used for specific medical reasons
- It can be used repeatedly
- The hospital bed is expected to last for 3 years or more
If the doctor that prescribes your hospital bed and the supplier that provides the bed are both enrolled in Medicare and are participating providers, it means they accept Medicare reimbursement as payment in full for the hospital bed.
If your hospital bed supplier doesnt accept Medicare assignment , they could potentially charge you any amount for the bed.
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Does Sleep Number Go On Sale
The availability of Sleep Number bed discounts cannot be guaranteed, but all of the personnel I spoke with stated that sales are available during most major holidays, with Black Friday and Cyber Monday being the most popular. If you have a certain model in mind, it may be worthwhile to keep an eye on the pricing during the course of the buying process.
Prosthetic And Orthotic Items
Orthopedic shoes only when theyre a necessary part of a leg braceArm, leg, back, and neck braces , as long as you go to a supplier thats enrolled in MedicareArtificial limbs and eyesBreast prostheses after a mastectomyOstomy bags and certain related suppliesUrological suppliesTherapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.
White CanesWigs
If you are trying to qualify for an adjustable bed through Medicare because you wanted a bed with side rails, you may be interested to know that they are not the safest option for certain categories of elderly, or frail individuals, and have been linked to many deaths.
In the article Alternative to bed rails for the elderly I outline lots of safer options to stop your parents from falling out of bed, and which are also far less costly than a hospital bed. It is worth a look, and you can find thathere.
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How To Find A Medicare Approved Mattress
You must be given a prescription for durable medical equipment, so talk to your doctor and see if you qualify.
There are a lot of benefits to buying a pressure reducing bed. They can improve your sleep, reduce pain and provide extra comfort compared to a normal mattress. Before buying a mattress, read up on your Medicare coverage and see how much of the cost will be covered. You could end up saving a lot of money depending on your health plan.
There are lots of online retailers that specialize in selling durable medical equipment. With so many options available, youll have to research which one will be the best for you and your health.
How Much Do Sleep Number Beds Cost
Sleep Number offers a number of different models of beds. Their low end model, the starts at around $500 for a Twin size mattress and is $1599 for a King size. Their high end model over $5,000 for the King size mattress. They will often run sales so you can usually find discounts on their beds.
Note: Medicare coverage changes all the time. And your specific coverage may vary from plan to plan for Medicare Advantage and Medigap plans. Always be sure to double check with your health care provider and/or Medicare insurance provider about what your plan covers and what it does not.
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If You Dont Use A Participating Supplier Whats The Result
A Medicare-enrolled supplier who is not a Participating Supplier
- has agreed with Medicare to accept from them the payment for DME at the Medicare-approved price
- but can sell the DME to you, the buyer, at up to 15% more than the Medicare approved price
What this means
- as agreed when your claim for a DME is submitted, if it is approved, Medicare will pay the supplier their 80% of the Medicare-approved price for your DME
- and you end up paying your 20% co-pay of the Medicare-approved price for your item + the difference between the Medicare-approved price and the price the supplier is selling the item at to you
- And you will have to pay your annual Medicare deductible if it applies
Some states, such as New York, restrict the supplier from charging a full 15% above the Medicare-approved price. In New York, they may only add 5%.
So do use a Medicare-enrolled Participating Supplier, and always ask if the supplier accepts assignment, as you can save a lot of money, particularly with an item as costly as a hospital bed. Dont get burned !
