Types of Mattresses That Are Covered by Medicare

Types of Mattresses That Are Covered by Medicare

If you’re searching for what types of mattresses are covered by Medicare, here’s a quick answer: Medicare covers pressure-reducing mattresses, hospital bed mattresses, and air-fluidized beds under specific conditions that classify them as Durable Medical Equipment (DME). These mattresses must be prescribed by a doctor and deemed medically necessary to treat certain health conditions.

Pressure-Reducing Mattresses:

1. Solace Resolution Glissando Heavy Duty Mattress
2. Joerns PrevaMatt Defend Pressure Relief Mattress
3. Drive Medical Therapeutic 5-Zone Support Mattress
4. ThevoRelief Pressure Relief Mattress
5. Drive Medical Alternating Pressure Low Air Loss Mattress System

Medicare ensures seniors and those with specific health issues receive the right mattress to alleviate pain and improve sleep quality. When a mattress is classified as DME, it means the equipment is durable, used for medical purposes, beneficial to someone sick or injured, and intended for home use.

I’m Ben Trapskin, the creator of Yawnder. With experience in sleep health, I know how challenging mattress shopping can be, especially for medical needs. I’m here to help you steer what types of mattresses are covered by Medicare.

Understanding Medicare Coverage for Mattresses

Medicare coverage for mattresses falls under Medicare Part B, which handles outpatient medical costs and durable medical equipment (DME). Let’s break down the essentials to help you understand how this works.

Medicare Part B

Medicare Part B covers medically necessary services and supplies. This includes certain types of mattresses when they are deemed essential for treating or managing a medical condition.

DME Classification

For a mattress to be covered by Medicare, it must meet the criteria for durable medical equipment (DME). According to Medicare, DME must be:

• Durable: Can withstand repeated use.
• Medical Purpose: Used for a medical reason.
• Beneficial: Typically only useful to someone who is sick or injured.
• Home Use: Intended for use in your home.
• Long-Lasting: Expected to last at least 3 years.

Medical Necessity

Medicare will cover a mattress if it is considered medically necessary. This means a healthcare provider must diagnose a condition that justifies the need for a specialized mattress. Common conditions that might warrant a Medicare-covered mattress include:

• Chronic pain
• Bedsores or pressure ulcers
• Severe arthritis
• Other conditions that impair mobility

Doctor’s Prescription

A prescription from your doctor is crucial. The prescription should detail the medical condition and explain why a specific type of mattress is needed. Without this, Medicare will not approve the coverage.

Medicare-Approved Suppliers

To receive coverage, you must purchase the mattress from a Medicare-approved supplier. This ensures the mattress meets Medicare’s standards and qualifies for reimbursement. You can find approved suppliers using the Medicare Supplier Directory.

Example: Jane, a senior with severe arthritis, gets a prescription from her doctor for a pressure-reducing mattress. She finds a Medicare-approved supplier and provides the necessary documentation. Medicare Part B then covers 80% of the cost after her deductible.

Key Takeaways

• Medicare Part B covers medically necessary mattresses classified as DME.
• DME criteria include durability, medical use, and home suitability.
• Medical necessity must be established through a doctor’s diagnosis and prescription.
• Purchase from Medicare-approved suppliers to ensure coverage.

Understanding these basics can help you steer the process of obtaining a Medicare-covered mattress. Next, we’ll dive into the types of mattresses Medicare covers, including pressure-reducing mattresses, hospital bed mattresses, and air-fluidized beds.

What Types of Mattresses Are Covered by Medicare?

Medicare covers certain types of mattresses if they are classified as Durable Medical Equipment (DME) and are deemed medically necessary by a doctor. Let’s explore the specific types of mattresses that meet these criteria.

Pressure-Reducing Mattresses

Pressure-reducing mattresses are designed to prevent and treat pressure ulcers, and they provide relief for conditions like sciatica and arthritis. Here are some examples of Medicare-approved pressure-reducing mattresses:

• Solace Resolution Glissando Heavy Duty Mattress: This mattress reduces friction and shear to prevent ulcers. It features high-density foam and built-in sidewalls for added comfort and support.

• Joerns PrevaMatt Defend Pressure Relief Mattress: Known for even pressure redistribution, this mattress helps prevent pressure ulcers. It comes with a two-way stretch, nylon cover and offers options for flat or sidewalls.

• Drive Medical Therapeutic 5-Zone Support Mattress: This mattress has a convoluted top layer that distributes weight evenly across five zones, offering a comfortable sleep surface. It also has a water-resistant, anti-microbial cover for easy cleaning.

• ThevoRelief Pressure Relief Mattress: Specifically designed for those with arthrosis and body aches, this mattress features wing suspensions that create a soft sleeping surface, stimulating nerve tracts to relieve soreness.

• Drive Medical Alternating Pressure Low Air Loss Mattress System: This mattress can switch between alternating and static pressure modes to help prevent and manage pressure ulcers. It offers different settings to meet various comfort levels.

Hospital Bed Mattresses

Medicare Part B also covers mattresses designed for hospital beds if they are medically necessary. These mattresses typically cater to patients who need long-term care at home. Hospital bed mattresses must meet the DME criteria and be prescribed by a doctor.

Air-Fluidized Beds

Air-fluidized beds are another type of mattress covered under Medicare Part B. These beds use airflow to reduce pressure on the skin, making them suitable for patients with severe pressure ulcers or other conditions requiring specialized care. Like other DME, air-fluidized beds must be prescribed by a doctor and meet Medicare’s criteria for medical necessity.

By understanding the types of mattresses covered by Medicare, you can better steer your options and ensure you get the support you need. Next, we’ll look at the eligibility criteria for Medicare mattress coverage.

Eligibility Criteria for Medicare Mattress Coverage

To get Medicare to cover a mattress, you need to meet specific eligibility criteria. Here’s what you need to know:

Doctor’s Recommendation

First, you need a doctor’s prescription. This isn’t just a piece of paper; it’s a medical necessity statement. Your doctor must clearly state why you need a specialized mattress. For example, if you have chronic bedsores, your doctor might recommend a pressure-relieving mattress.

Medical Condition

Medicare covers mattresses only for specific medical conditions. These could include:

• Chronic bedsores
• Severe arthritis
• Spinal cord injuries
• Other conditions that require specialized support

Your medical records must back up your need for the mattress. Make sure your doctor includes all relevant details in your prescription.

Medicare-Approved Supplier

You can’t just buy a mattress anywhere. It has to come from a Medicare-approved supplier. These suppliers have agreed to Medicare’s pricing and quality standards. You can find a list of approved suppliers on the Medicare website.

DME Criteria

The mattress must qualify as Durable Medical Equipment (DME). To do this, it must:

• Be durable and withstand repeated use
• Serve a medical purpose
• Be useful only for someone who is sick or injured
• Be used in your home
• Last at least three years

Part B Deductible

Medicare Part B will cover 80% of the mattress cost, but you’re responsible for the remaining 20% and any Part B deductible. For 2024, the deductible is $240. Once you’ve met this deductible, Medicare will start covering its share of the costs.

Next, we’ll discuss how much Medicare will cover and what out-of-pocket costs you might expect.

How Much Will Medicare Cover?

When it comes to mattresses covered by Medicare, understanding the financial aspects is crucial. Here’s a breakdown of what you can expect:

80% Coverage

Medicare Part B typically covers 80% of the cost of a Medicare-approved mattress. This means that once your mattress is deemed medically necessary and meets the Durable Medical Equipment (DME) criteria, Medicare will pay for the majority of the cost.

Part B Deductible

Before Medicare starts covering its 80%, you must pay the Part B deductible. For 2024, this deductible is $240. Once you’ve met this amount, Medicare will begin to cover its portion of the costs.

Out-of-Pocket Costs

Even with Medicare’s coverage, you will still have some out-of-pocket costs. Specifically, you will be responsible for the remaining 20% of the mattress cost after Medicare pays its share. For example, if your mattress costs $1,000, Medicare would cover $800, leaving you to pay $200.

Rental vs. Purchase

Medicare often gives you the option to rent or purchase the mattress.

• Rental: If you choose to rent, Medicare will cover the monthly rental payments. After 13 months of continuous use, the equipment typically becomes your property.
• Purchase: If you decide to purchase the mattress outright, Medicare will cover 80% of the purchase price after you meet the deductible.

Medicare-Approved Amount

It’s essential to buy or rent your mattress from a Medicare-approved supplier. These suppliers agree to the price Medicare sets, known as the Medicare-approved amount. If you go to a supplier that does not accept Medicare, you may end up paying more out of pocket, as Medicare will not cover the excess costs.

For more information on finding a Medicare-approved supplier, you can visit the Medicare website.

Next, we’ll answer some frequently asked questions about what types of mattresses are covered by Medicare.

Frequently Asked Questions about What Types of Mattresses Are Covered by Medicare

Will Medicare pay for a Tempur-Pedic mattress?

Medicare may cover a Tempur-Pedic mattress if it’s deemed medically necessary and meets the Durable Medical Equipment (DME) criteria. This means:

1. Medical Necessity: Your doctor must prescribe the mattress for a specific medical condition.
2. DME Criteria: The mattress must be durable, used for medical reasons, and have a life expectancy of at least three years.

If these conditions are met, Medicare Part B might cover some costs. Always check with a Medicare-approved supplier for eligibility.

Are mattresses for seniors covered by Medicare?

Seniors often need specialized mattresses for health issues like arthritis or bedsores. Medicare can help if:

1. The mattress is medically necessary.
2. It meets DME criteria.

Pressure-relieving beds are more likely to be covered. A doctor’s prescription is essential. Coverage falls under Medicare Part B, which typically covers 80% of the Medicare-approved amount after the deductible is met.

Does Medicare cover mattresses for back pain?

Medicare covers mattresses based on medical necessity, not the condition itself. For back pain:

1. The mattress must be prescribed by a doctor.
2. It must meet DME criteria.

If your doctor prescribes a specialized mattress to alleviate back pain and it qualifies as DME, Medicare Part B may cover a portion of the cost. This includes pressure-reducing mattresses designed to help with pain management.

For more details on Medicare coverage, visit the Medicare website.

Conclusion

Understanding Medicare coverage for mattresses can help you make informed decisions about your health and comfort. Medicare Part B covers Durable Medical Equipment (DME), which includes certain specialized mattresses when prescribed by a doctor. These mattresses, such as pressure-reducing mattresses, hospital bed mattresses, and air-fluidized beds, must meet specific criteria to qualify.

At Yawnder, we aim to guide you through the process of finding a mattress that meets your medical needs and is covered by Medicare. A doctor’s prescription is essential, and you must purchase or rent the mattress from a Medicare-approved supplier.

For more information on different types of mattresses, visit our Yawnder mattress collection.

By understanding your options and the Medicare requirements, you can find the perfect mattress to improve your sleep and overall health.