What Kind Of Adjustable Beds Are Covered By Medicare

What Kind of Adjustable Beds Are Covered by Medicare?

Medicare, the federal health insurance program for individuals 65 and older and those with certain disabilities, covers a wide range of medical expenses, including durable medical equipment (DME). DME is equipment used in the home to aid in medical treatment, and it can include a variety of items, such as wheelchairs, walkers, and oxygen concentrators. While Medicare covers many types of DME, the coverage for adjustable beds is limited. This article will delve into what types of adjustable beds Medicare will cover, the criteria for coverage, and alternative options for individuals seeking a more comfortable sleep experience.

Medicare Coverage for Adjustable Beds

Medicare coverage for adjustable beds is restricted to situations where the bed is medically necessary for treating a specific medical condition. Medicare Part B, which covers medically necessary services, will cover an adjustable bed only if it is prescribed by a doctor and deemed necessary for the treatment of a qualifying medical condition.

Some of the conditions that may qualify for Medicare coverage of an adjustable bed include:

Decubitus ulcers (bedsores): This is a common condition affecting individuals with limited mobility, where pressure on the skin can lead to sores and ulcers. An adjustable bed can help reduce pressure on vulnerable areas, aiding in healing and prevention.
Chronic obstructive pulmonary disease (COPD): This respiratory disease affects breathing and can make lying flat uncomfortable. An adjustable bed can help elevate the head, improving lung capacity and breathing comfort.
Congestive heart failure: This condition can lead to fluid buildup in the lungs, making breathing difficult. An adjustable bed with an elevated head can help alleviate this symptom by easing lung pressure.
Reflux disease: Gastrointestinal issues can be aggravated by lying flat. An adjustable bed can help elevate the head, reducing acid reflux and promoting better digestion.
Spinal conditions: Some spinal conditions benefit from elevated head and leg positions. Adjustable beds can provide customized positioning to alleviate pain and improve comfort.

It is important to note that even with a qualifying medical condition, Medicare will not automatically cover the cost of an adjustable bed. The bed must meet specific criteria, such as having a certain number of adjustable sections and meeting safety standards. Additionally, Medicare beneficiaries will need to pay a 20% coinsurance for the covered portion of the bed, along with any applicable deductible.

Obtaining Medicare Coverage for an Adjustable Bed

To obtain Medicare coverage for an adjustable bed, individuals need to follow specific steps. The first step is to see a doctor who can determine the medical necessity of an adjustable bed. The doctor will need to document the diagnosis, the severity of the condition, and how an adjustable bed will directly improve the patient's health. They will then prescribe the specific type of adjustable bed and its features.

With a doctor's prescription in hand, individuals can contact a Medicare-certified DME supplier. The supplier will assess the specific needs of the individual and ensure the chosen bed meets Medicare's standards. The supplier will then submit the claim to Medicare for review and approval. If the claim is approved, Medicare will typically pay a portion of the cost, and the beneficiary will be responsible for the remaining balance.

Alternative Options for Adjustable Beds

While Medicare coverage for adjustable beds is limited, there are alternative pathways to acquire and pay for these beds. Individuals can explore options like private health insurance, which may cover adjustable beds with varying levels of coverage based on the policy. Another option is to use flexible spending accounts (FSAs) or health savings accounts (HSAs) to pay for the bed. These accounts allow individuals to set aside pre-tax money for qualified medical expenses, including durable medical equipment.

Individuals may also consider purchasing an adjustable bed without seeking insurance coverage. Many adjustable beds are sold at reasonable prices, and some manufacturers offer financing options. While this route avoids the complexities of Medicare coverage, individuals need to carefully assess their financial situation and budget for the full cost of the bed.

Ultimately, the decision to purchase an adjustable bed is a personal one that should be made based on individual needs and financial resources. It is crucial to consult with a doctor to determine the medical necessity of the bed, explore all available financing options, and carefully consider the potential benefits and costs involved.