Understanding Medicare Coverage for Adjustable Beds: What You Should Know

Will Medicare Pay for an Adjustable Bed?

Understanding whether Medicare will pay for an adjustable bed can be a complicated process. If you’re looking for a quick answer, here’s a summary:

• Yes, Medicare may cover the cost of an adjustable bed if it’s deemed medically necessary.
• It must be prescribed by a doctor.
• The bed must be obtained from a Medicare-approved supplier.
• You will likely need to cover 20% of the cost.

Medicare considers adjustable beds to be a type of Durable Medical Equipment (DME). Such equipment is prescribed for home use to improve a patient’s quality of life. To qualify, the bed must be medically necessary, which means your doctor needs to clearly state that the bed is required for your treatment or recovery.

I’m Ben Trapskin, the creator of Yawnder. After struggling with sleep-related issues and navigating the complexities of Medicare coverage for my own adjustable bed, I aim to simplify this topic for you. Let’s dive in to see if you qualify and how you can make your next steps easier.

Next, we will explain what adjustable beds are and how they can benefit you. Let’s get started!

What Are Adjustable Beds?

Adjustable beds are specialized beds that allow you to change the position of the mattress to suit your needs. These beds can lift the head, feet, or both, offering a range of positions that can help with various health issues and improve overall comfort.

Why Consider an Adjustable Bed?

Adjustable beds are not just for hospitals anymore. They have become popular in homes, especially for seniors who need extra support and comfort. Here are some key benefits:

• Mobility Aid: Adjustable beds can make it easier to get in and out of bed, reducing the risk of falls.
• Improved Sleep Quality: By allowing you to find a comfortable sleeping position, these beds can help you sleep better.
• Arthritis Relief: Elevating the head or feet can reduce pressure on joints, making it easier to manage arthritis pain.
• Joint Pain: Adjusting the bed can help alleviate joint pain by providing better support and reducing stress on painful areas.
• Muscle Spasms: Changing positions can help reduce muscle spasms by relieving tension and improving circulation.
• Acid Reflux: Elevating the head can help prevent acid reflux by keeping stomach acid from rising into the esophagus.
• Snoring: Raising the head can also help reduce snoring by keeping airways open.

How Do Adjustable Beds Work?

Adjustable beds come with a motorized frame that allows you to change the position of the mattress. You can usually control these adjustments with a remote control or a smartphone app. Some models also come with additional features like massage settings, under-bed lighting, and USB ports for charging devices.

Types of Adjustable Beds

Adjustable beds come in various types to suit different needs. Here are some common options:

• Basic Hospital Beds: These are the most straightforward type and are often covered by Medicare. They usually have manual or semi-electric adjustments.
• Semi-Electric Beds: These beds have electric head and foot adjustments but require manual adjustments for height.
• Fully Electric Beds: These offer complete electric adjustments for head, foot, and height positions.
• Air-Fluidized Beds: These beds use air to reduce pressure on the body, ideal for people with severe skin conditions or pressure ulcers.
• Pressure Pads: These can be added to regular mattresses to provide extra comfort and support.

Real-Life Example

My sister, who is 74, recently bought an adjustable bed to help with her back pain. She says it was worth every penny because her pain has greatly reduced, and she finds it much easier to get in and out of bed.

Next, we will explore if Medicare will pay for an adjustable bed and the requirements you need to meet.

Will Medicare Pay for an Adjustable Bed?

Yes, Medicare will pay for an adjustable bed under certain conditions. Specifically, Medicare Part B covers durable medical equipment (DME), which includes adjustable beds. However, there are several requirements you must meet to qualify for coverage.

Requirements for Medicare Coverage

To get Medicare to cover an adjustable bed, you’ll need to follow these steps:

1. Doctor’s Prescription: Your doctor must write a prescription stating that the adjustable bed is medically necessary. This could be for conditions like severe arthritis, spinal cord injuries, or cardiac disease.

2. Medical Records: You’ll need supporting medical records that detail your condition and why an adjustable bed is necessary.

3. Physician’s Report: The doctor must provide a narrative explaining why a regular bed won’t suffice and why an adjustable bed is needed. For example, if you need frequent repositioning to relieve pain or prevent respiratory infections.

4. Medicare-Approved Supplier: Ensure you get the bed from a supplier who accepts Medicare assignment. This is crucial because if the supplier does not accept Medicare, you may end up paying much more out of pocket.

Types of Adjustable Beds Covered by Medicare

Medicare doesn’t cover all types of adjustable beds. Here are the types that are generally covered:

• Basic Hospital Beds: These are the most commonly covered types and include features like adjustable head and foot sections.

• Semi-Electric Beds: These beds allow you to adjust the head and foot sections electronically but require manual adjustment for height.

• Variable-Height Beds: These beds can be adjusted in height, making it easier to get in and out of bed.

• Electric-Powered Beds: Fully electric beds that allow for adjustments to the head, foot, and height sections.

• Air-Fluidized Beds: These beds are used for patients with severe pressure sores and provide a fluid-like support.

• Pressure Pads: These can be added to regular mattresses to provide extra comfort and support.

• Side Rails: These are often necessary for patient safety and can be included in the prescription.

For example, the Centers for Medicare & Medicaid Services outline specific criteria for hospital beds, which include the need for special positioning or attachments that a regular bed can’t provide.

To summarize, Medicare will pay for an adjustable bed if it’s deemed medically necessary and you follow the proper steps to get it approved.

Next, we will explore how to obtain an adjustable bed through Medicare, including the steps you need to take and what to expect.

How to Obtain an Adjustable Bed Through Medicare

Steps to Get Coverage

Getting an adjustable bed through Medicare involves several important steps. Here’s a simple guide to help you steer the process.

1. Face-to-Face Doctor Visit

Your journey begins with a visit to your doctor. You need to discuss your medical condition and why an adjustable bed is necessary for your treatment. Your doctor will assess your situation and determine if you meet the medical necessity criteria.

2. Doctor’s Prescription

If your doctor agrees that an adjustable bed is necessary, they will write a prescription. This prescription must include specific details about your medical condition and why a regular bed won’t suffice.

3. Medical Condition Documentation

Your doctor will also need to provide supporting medical records. These records should clearly document your condition and the need for special positioning or attachments that only an adjustable bed can offer. This documentation is crucial for Medicare approval.

4. Supplier Selection

Next, you need to find a Medicare-approved supplier. You can use Medicare’s online tool or call 1-800-MEDICARE (1-800-633-4227) to locate a supplier. Ensure that both your doctor and the supplier accept Medicare assignment to get the maximum coverage.

5. Medicare Assignment Acceptance

Make sure the supplier accepts Medicare assignment. This means they agree to the Medicare-approved amount for the bed. If they don’t, you could end up paying more out of pocket.

6. Rental vs. Purchase

Medicare usually covers the rental of an adjustable bed for the first 13 months. After 13 months of continuous use, the supplier must transfer ownership to you. During the rental period, Medicare covers the monthly payments, and the supplier takes care of repairs.

7. Part B Deductible and Coinsurance

You will need to pay the Medicare Part B deductible, which is $240 for 2024. After the deductible is met, you are responsible for 20% of the Medicare-approved amount for the bed, while Medicare covers the remaining 80%.

By following these steps, you can obtain an adjustable bed through Medicare and ensure you receive the coverage you need. Next, we will look at additional financial assistance options to help cover any remaining costs.

Additional Financial Assistance Options

Medicare might not cover all the costs associated with an adjustable bed. Luckily, there are several ways to get additional financial help.

Medigap Plans

Medigap, or Medicare Supplement Insurance, can help cover the costs that Medicare does not. For example, Medigap plans can pay the 20% coinsurance you owe after Medicare Part B covers its share. Some plans, like Plan F, even cover the Part B deductible. This means you might not have to pay anything out of pocket for an adjustable bed if your Medigap plan covers it.

Medicaid

Medicaid is a joint federal and state program that helps with medical costs for those with limited income. Coverage varies by state, but Medicaid may help pay for the out-of-pocket costs of an adjustable bed. If you qualify for both Medicare and Medicaid (known as Dual Eligibles), you can receive benefits from both programs, which can further reduce your costs.

Department of Veterans Affairs (VA)

Veterans may be eligible for financial assistance through the VA. Programs like TRICARE for Life can help cover Medicare copays. Additionally, the Veteran-Directed Home and Community Based Services program and the Aid and Attendance program may provide financial support for homebound veterans needing adjustable beds.

Philanthropic Organizations

Several non-profit organizations offer help to those in need of medical equipment like adjustable beds. For example, Project C.U.R.E. distributes donated medical equipment to communities in need. Other organizations, such as the Muscular Dystrophy Family Foundation, may assist with accessing financial resources for specific conditions.

Community Assistance

Local community programs and charities can also provide support. Ask your doctor about resources available in your area. Sometimes, local agencies and support groups can offer financial aid or connect you with organizations that do.

These additional financial assistance options can help cover the costs not paid by Medicare, making it easier for you to afford an adjustable bed. Next, we’ll answer some frequently asked questions about Medicare and adjustable beds.

Frequently Asked Questions about Medicare and Adjustable Beds

Can a doctor write a prescription for an adjustable bed?

Yes, a doctor can write a prescription for an adjustable bed. For Medicare to cover part of the cost, the bed must be medically necessary. This means it should help with a specific health condition, like severe arthritis, chronic obstructive pulmonary disease (COPD), or spinal cord injuries.

The prescription should include:

• A narrative explaining why the adjustable bed is necessary.
• Medical records supporting the need.
• A detailed physician’s report on the condition requiring the bed.

Does Medicare cover Tempur-Pedic beds?

Medicare might cover part of the cost of a Tempur-Pedic adjustable bed, but there are conditions to meet. The bed must be medically necessary and prescribed by a doctor. You also need to get it from a Medicare-approved supplier.

However, Tempur-Pedic beds are often more expensive and have features beyond what Medicare typically covers. It’s best to contact Medicare directly to check if you meet the eligibility requirements for coverage.

Can you get a Sleep Number bed with Medicare?

Sleep Number beds are another popular option, but like Tempur-Pedic beds, they come with additional features that Medicare might not cover. Medicare will cover a portion of the cost if the bed is deemed medically necessary and is obtained from a Medicare-approved supplier.

To determine if you can get a Sleep Number bed covered by Medicare, you’ll need to:

• Ensure your doctor provides a prescription stating the necessity.
• Verify that the supplier accepts Medicare assignment.
• Confirm that the bed meets Medicare’s criteria for adjustable beds.

For more detailed information, consult with your doctor and contact Medicare directly.

These FAQs should help clarify common questions about Medicare coverage for adjustable beds. Next, we’ll guide you through the steps to obtain an adjustable bed through Medicare.

Conclusion

Navigating Medicare coverage for adjustable beds can seem overwhelming, but it’s easier when you know what to expect. At Yawnder, we aim to simplify the process, ensuring you get the best sleep products to meet your needs.

Yawnder offers a range of adjustable beds designed to improve your comfort and health. Our expert evaluations help you choose the right bed, considering both your medical requirements and personal preferences.

When it comes to Medicare coverage, Medicare Part B can cover 80% of the cost for an adjustable bed, provided you meet specific criteria. You’ll need a doctor’s prescription and must purchase from a Medicare-approved supplier. If you need extra financial assistance, options like Medigap plans and Medicaid can help cover additional costs.

Our goal is to make it easy for you to find the perfect adjustable bed. Visit our Yawnder Adjustable Beds page to explore our selection and learn more about how we can help you achieve a better night’s sleep.

For personalized advice, don’t hesitate to consult with your doctor or a financial advisor. With the right information and support, you can make an informed decision that improves your comfort and well-being.