Older individuals with certain medical ailments can frequently take advantage of having an “adjustable bed” in their homes. However, these beds often come with a hefty cost, and seniors usually seek assistance paying for them with Medicare benefits.
These adjustable beds, commonly referred to in the medical field as “hospital beds,” resemble the beds found in hospitals. Medicare will not cover the more plush adjustable beds, primarily used for comfort and ease. However, in certain circumstances, Medicare will assist in paying for a hospital bed.
Medicare Coverage
Hospital beds belong to the group referred to as Durable Medical Equipment (DME). Individuals must be subscribed to either Part B or C of Medicare (Medicare Advantage) to be considered for coverage. Signing up for Part B or C is not done automatically. Moreover, only authorized and participating doctors and providers can offer any potential coverage.
Basic Eligibility Requirements
Medicare will not give any form of DME, including hospital beds, unless it is critically necessary for the patient. It must be ordered and noted by a doctor and come from a face-to-face medical exam within half a year before applying to Medicare for compensation. Concerning Medicare regulations, they generally accept hospital beds as a reimbursable medical requirement merely if any of the following conditions are satisfied: The recorded medical ailment necessitates placing the body in manners not achievable with a traditional bed. Elevation of the head/upper torso under 30 degrees typically doesn’t necessitate the use of a hospital bed. The patient necessitates arranging the body in a manner not achievable with a conventional bed to reduce pain. The patient requires that the head of the bed be raised beyond 30 degrees, predominantly due to congestive heart failure, chronic pulmonary disease, or issues with swallowing. Pillows or wedges should have been assessed and discarded. The patient needs medical apparatus that can only attach to a hospital bed.
Types of Hospital Beds and Specific Eligibility
Manual Hospital Beds – This is the basic kind of hospital bed and can be paid for by Medicare by adhering to the eligibility criteria outlined above. They work with hand cranks that change the incline of the head and the foot of the bed.
Variable Height Hospital Beds – These are identical to the basic manual bed but with a hand crank to alter the height of the bed. They can be obtained if you meet the basic qualifications and require a bed elevation different from a pre-set height hospital bed to allow movement to a chair, wheelchair or upright stance. Semi-electric Hospital Beds – These beds have the tilt of the head and feet adjusted through an electric motor managed by a handheld tool. It may be covered if the basic requirements have been fulfilled and a person requires frequent adjustments in body position or needs an immediate alteration in body position. Heavy Duty Extra-Wide Medical Beds – These can be covered if a person meets the basic requirements and their body weight is over 350 lbs but does not surpass 600 lbs.
Extra Heavy Duty Hospital Beds – Qualification criteria must be fulfilled, and if weight surpasses 600 lbs, these can be acquired. Complete Electric Beds – These are not reimbursed as Medicare deems them to be a convenience, and thus they are declined as not being sensible or essential.
Monetary Details
If Medicare approves your application for a hospital bed, the following are the financial specifics entailed: Any out-of-pocket sum on your Medicare Part B or C will be considered before any reimbursement is granted. Medicare will finance the bed purchase provided proof of a long-term requirement (at least six months). Should the requirement be only for a brief period, they will simply cover the cost of a rental for the bed.
Medicare might grant you the option to “lease with an option to purchase,” where the bed is leased for 13 months, and you have the option of owning it afterward.
Regardless, Medicare will cover 80% of the expense, with you responsible for the last 20%. Medicare will only reimburse a claim (their 80%) to a Medicare-permitted and involved medical equipment supplier.
Special Considerations
Generally, the hospital bed should be put in your residence, yet it could be allowed in a relative’s house or a nursing home if that is where you reside. In the event that you require the hospital bed on a lasting basis, Medicare could grant a renewal every five years. You must secure Medicare’s approval before making an investment or renting the bed.