Is an adjustable bed covered by Medicare?

Welcome to our comprehensive guide on Medicare coverage for adjustable beds. Are adjustable beds covered by Medicare? We will answer this question and delve into the essential topics surrounding Medicare coverage for these beds. Learn about the qualification process, including enrolling in Part B and obtaining a doctor’s prescription.

Discover the significance of choosing the right provider and understanding the approval process. To make informed decisions and find the best insurance providers in your area, enter your ZIP code and compare rates. Don’t miss out on the opportunity to secure the coverage you need for your adjustable bed.

How To Qualify for Medicare Adjustable Bed Coverage

Before Medicare will pay for your adjustable bed, there are several necessary conditions that must be met. It may seem daunting, but once the steps are broken down, things should start to become clear.

Step One: Get Medicare Part B

You can get Medicare Part A for free once you turn 65, but that does not cover personal medical equipment. To qualify for an adjustable bed that is covered by Medicare, you have to be enrolled in Medicare Part B.

An adjustable, hospital-style bed is considered Durable Medical Equipment, or DME, and DME is only covered in Part B. Once you are enrolled, see your doctor to determine if an adjustable bed is right for you.

Step Two: Get a Prescription

If your doctor determines you have a need for a medical bed, they will write you a prescription. Medicare DME coverage is only provided if the bed is prescribed by a doctor.

According to the Centers for Medicare and Medicaid Services, there are several medical conditions that require the use of an adjustable bed, and your doctor will determine if you have sufficient need.

This prescription is absolutely necessary before Medicare will even consider your claim, so see your doctor before you buy anything. If your doctor does not prescribe an adjustable bed, you still have options. Those will be detailed below.

Step Three: Get it from the Right Company

In order for Medicare to cover your adjustable bed, your order must be placed with a Medicare durable medical equipment provider. Your doctor will be familiar with these companies and best able to help you choose the right one for you.

If you are getting a medical prescription for your bed, you will want to order from a reputable provider. Most likely, you do not want your essential medical equipment to come from a retail furniture store. It is important you receive your bed from a company that specializes in the kind of equipment you need.

Read more: Best Business Insurance for Furniture Stores

Your doctor will know which companies will be covered, and who can deliver the type of bed that will best help you.

Step Four: Get Approved by Medicare

At the end of the day, Medicare itself will determine whether your bed is covered, based on your policy stipulations and other factors to be considered.

Once you have been diagnosed with a need, and had your doctor place the order, you will still have to wait to see if Medicare will approve the bed. If you do not get approved by Medicare, you may be able to pursue other options.

What are other options for an adjustable bed if Medicare denies coverage?

In certain circumstances you may not need a hospital-grade adjustable bed. Maybe you just want some tension relief, or a little aid in blood circulation.  In such cases, you can shop the market, and you may find affordable options.

Standard adjustable beds often feature several attractive customization options. You may see beds that raise or lower the head and feet, or provide personalized cushioning and support. It can be difficult to know how best to proceed. Of course, without insurance coverage, things can get expensive in a hurry.

If you have a serious health condition, a medically prescribed hospital bed is likely going to be necessary. As always, you should see your doctor to find out.

How to Pay for an Adjustable Bed

It is important to know up front how all of this is going to be financed, and exactly what your options are. In most cases, if Medicare approves the bed, they will cover 80% of the cost, leaving you to come up with the remaining 20%.

This remainder can sometimes be covered with supplemental insurance for Medicare, if you qualify and have coverage. Check your policy before your doctor places the order, so you will know what payments will be your responsibility.

Some suppliers require full payment upfront. In such cases you may have to come up with a sizable dollar amount, and wait for Medicare to reimburse you. Other suppliers may allow you to make payments over time, which can soften the blow.

You may be allowed to make rental payments for a specific time period, or even to rent the bed until it is paid in full. It is wise to discuss all of these options with your doctor and Medicare representative before placing your order.

Medicare Coverage for Adjustable Beds: The Bottom Line

If you or a loved one is in need of Durable Medical Equipment, such as an adjustable, hospital-style bed in the home, there are several options to pursue. It can be difficult to navigate all the possibilities.

Hopefully, you now have a clear understanding of just how to go about taking the necessary steps. If you have a need, talk to your doctor. They can determine if an adjustable bed is right for you, and get the process started. Then you can be on your way to better sleep, and better health, in the future.

If you need to compare Medicare Supplement quotes, try entering your ZIP code into our search tool now.

Case Studies: Medicare Coverage for Adjustable Beds

Below are a few case studies that shed light on the issue of Medicare coverage for adjustable beds:

Case Study 1: John’s Experience

John, a Medicare beneficiary, suffers from chronic back pain and has difficulty finding a comfortable sleeping position. His doctor recommended an adjustable bed to alleviate his discomfort. However, when John inquired about Medicare coverage for the bed, he discovered that it was not covered under his current plan. This forced John to pay out-of-pocket for the adjustable bed, significantly impacting his finances.

Case Study 2: Sarah’s Situation

Sarah, an elderly Medicare recipient, developed mobility issues due to arthritis. Her doctor prescribed an adjustable bed to help her with positioning and improve her sleep quality. Sarah was pleasantly surprised to learn that her Medicare Advantage plan covered a portion of the cost of the bed. Although she had to pay a deductible and copayment, the coverage eased the financial burden and enabled her to acquire the bed.

Case Study 3: Michael’s Challenge

Michael, a Medicare enrollee, was diagnosed with a severe respiratory condition that necessitated an adjustable bed for better breathing support during sleep. Despite the medical necessity of the bed, Michael faced challenges obtaining coverage through Medicare. His initial request was denied due to the bed being considered “not primarily medical in nature.” Michael had to file an appeal and gather supporting documentation to prove the medical necessity of the bed, which eventually led to a successful coverage approval.

Case Study 4: Maria’s Success Story

Maria, who is covered by Medicare Part B, was diagnosed with severe acid reflux, which worsened during sleep. Her doctor recommended an adjustable bed as a way to alleviate her symptoms. Maria discovered that Medicare Part B covered durable medical equipment, including adjustable beds, if they were deemed medically necessary by a doctor. She worked with her healthcare provider to obtain the required documentation and successfully received coverage for the adjustable bed.

Case Study 5: David’s Denial

David, a Medicare beneficiary, suffered from sleep apnea and sought an adjustable bed to alleviate his symptoms. However, his request for coverage was denied as the bed was deemed “not medically necessary” by Medicare. Despite providing medical records and letters of support from his healthcare team, David was unable to convince Medicare to cover the cost of the bed. As a result, he had to explore alternative funding options or consider other sleep apnea treatment methods.