Medicare will not cover a hospital bed for home use if it isn’t a medical necessity. This coverage will only kick in if a doctor’s order is provided. The doctor’s order must state in clear terms that a hospital bed is needed for your condition.
80% of the total cost of your home hospital bed will be handled by Medicare Part B. You may enjoy more coverage under the Medicare Advantage plan.
A hospital bed may be included in a doctor’s order for a host of reasons. One of such is when the patient is finding it difficult to breathe, enduring so much pain, or has a swollen leg or feet.
If the hospital bed is medically necessary to make you feel better, Medicare will cover it.
Medicare will pay for durable medical equipment such as hospital bed under Medicare Part B. Under this scheme, 80% of the total value of the hospital bed will be covered.
The Medicare Advantage plan and Medigap may be able to offer you more coverage.
When will hospital beds for home use be covered by Medicare?
Hospital bed for home use is classified as durable medical equipment (DME). DME coverage is available under Part B of Medicare. For your hospital bed to be covered, it must meet some conditions.
Your hospital bed will be paid for by Medicare if:
- A documented ailment or sickness requiring a home hospital bed is available.
- Your doctor is enrolled in Medicare
- The provider of the equipment is enrolled in Medicare
- The bed is ordered by the doctor for home use
- Your condition is managed by a doctor and you are seen at least once every half-year.
- Your condition and why you will benefit from a hospital bed are included in your doctor’s order.
Coverage can be provided by Medicare for rent or outright purchase of the hospital bed. The decision to buy or rent a hospital bed depends on a few factors such as the policy of the insurer and the type of bed involved.
What are the ideal Medicare plans for someone that needs a hospital bed at home?
Coverage for hospital bed is available through different parts of Medicare.
People that use original Medicare, i.e., Medicare parts A and B have their coverage through Medicare Part B. Part A of Medicare takes care of inpatient stays and treatment received within a medical facility.
The healthcare needs covered by Medicare Part B include:
- Emergency room care
- Medical equipment
- Doctor’s office visit
80% of the total amount approved for your hospital bed will be covered by Part B. You will be required to pay the remaining 20%.
Coverage can also be gotten from Medicare Part C which is also called Medicare Advantage plans.
Prescription drug coverage, also called Medicare Part D doesn’t cover any part of DME cost including hospital bed.
However, payment can be made for a hospital bed through Medigap. Medigap is Medicare supplement insurance which covers some of the out-of-pocket costs of Parts A and Parts B such as coinsurance and copayments. What this means is that if 80% of the total value of the hospital bed is covered in Part B, the 20% coinsurance amount you are required to pay can be covered by a Medigap plan.
What is a home hospital bed?
A hospital bed has additional functionalities such as gel cushioning, adjustable feet or head, and side rails. A hospital bed may be ordered for home use if:
- A person has a spinal cord injury or condition
- A person has arthritis, osteoporosis, or similarly painful conditions.
- A person has heart conditions that require elevation of the limbs, heart, or head.
- A person is battling a condition requiring repositioning for pain or pressure relief
Which hospital beds are covered?
There are different types of hospital beds covered by Medicare. They include:
- Adjustable beds
- Beds with side rails
- Semi-electric beds with adjustable feet and heads
- Extra-wide bariatric beds capable of holding weight more than 600 pounds
- Extra-wide bariatric bed capable of holding between 350 to 600 pounds
These bed types may either be available with or without a mattress. Mattress pads including those listed below are covered by Medicare
- Water pressure pads
- Air pressure pads
- Dry pressure pads
- Gel pressure pads
- Synthetic sheepskin pads
- Lambswool sheepskin pads
Extra features that have been confirmed medically necessary will also be covered by Medicare. These features include trapeze pull bars necessary for sitting up in bed. Medicare will however not cover things regarded as convenience features. An example of such is an over-the-bed-table.
Your chosen bed must be considered a medical necessity for your condition. It is also important to state that Medicare does not cover fully electric beds but may cover semi-electric beds with adjustable heads and feet.
This is because adjustable height (which fully electric hospital beds offer) is regarded as convenience feature by Medicare. Hence, it won’t be paid for.
What is the average cost of hospital bed for home use?
The value of the bed will depend on factors such as the type of bed and available features.
However, the price range of a hospital bed is between $500 and a few thousands of dollars. This is according to Consumer Affairs.
However, the cost of hospital bed rentals ranges from $200 to $500 monthly depending on the type of bed.
As earlier stated, Medicare will help you lower this cost by covering 80% of the total value. This is available under the Medicare Part B scheme.