Contrary to popular belief, older individuals do not require less sleep than other adults. Adults of any age require roughly seven to nine hours of sleep each night.

The misconception stems from the fact that many older adults develop conditions that impact the quality of their sleep. Common conditions like arthritis, insomnia, anxiety, and depression all disrupt our natural sleep patterns.

Adjustable beds are a great option to help position the body for a better night’s rest. If so many older adults could use one, are these part of Medicare’s benefits? Let’s find out.

What Is the Benefit of an Adjustable Bed?

Adjustable beds are a great option for older adults that struggle with mobility and need to sleep in different positions. The adjustable bed allows them to adjust the height of their head and feet, as well as the mattress position. This is beneficial for those who suffer from arthritis, joint pain, or muscle spasms because it reduces pressure on their joints. Raising the top portion of the bed will also reduce snoring by increasing airflow and prevent acid reflux by elevating the head.

The adjustable bed can also be used by people who have difficulty getting out of low-set beds. It can also be helpful to those recovering from hip surgery or other orthopedic surgeries and injuries like broken hips and femurs because they allow you to raise your legs higher than a regular bed does, which speeds up recovery time.

Does Medicare Provide Coverage for Adjustable Beds?

Yes! Original Medicare does offer coverage for adjustable beds as part of a beneficiary’s Part B benefits. Part B offers coverage on durable medical equipment (DME), which includes adjustable beds. Medicare will pay for 80% of the cost of an adjustable bed after you have met your Part B deductible.

This does not apply to just any bed on the market, and there are requirements that must be met. Let’s talk about those next.

Requirements for Medicare Coverage on Adjustable Beds

First and foremost, you must have a prescription from your doctor that says an adjustable bed is recommended for your medical health. You cannot simply decide you would like one, purchase it, and expect to be reimbursed by Medicare.

For coverage to be considered, you must meet the following requirements:

● Have a condition that requires special positioning;
● Have a prescription from your doctor that includes a narrative explaining the medical necessity of an adjustable bed;
● Have medical records that support the narrative of medical necessity; AND
● Have a physician’s report that further details the medical condition requiring an adjustable bed.

Your doctor may recommend an adjustable bed to treat body pains, cardiac diseases, chronic pulmonary obstructive disease (COPD), quadriplegia or paraplegia (spinal cord injuries), severe arthritis, or other injuries.

For Medicare coverage to apply, the bed must be purchased from a supplier that accepts Medicare assignments. Also, you may be offered the option to either rent or purchase the bed. (Or Medicare may dictate one or the other based on your condition.)

What Kind of Adjustable Bed will Medicare Cover?

As a general rule, Medicare Part B will cover basic hospital beds. However, additional items may also be covered if your doctor says that they are medically necessary.

Beds with adjustable heights, side rails, and electrically-powered beds are not part of Medicare’s basic coverage. If your doctor includes these in the prescription, Medicare may at least pay a portion of the cost.

There are quite a few beds and bedding extras that also fall into the durable medical equipment category. As long they are considered medically necessary, you may get full or partial coverage under Medicare Part B.

These extras include things like:

● Mattress pads of various kinds
● Air-fluidized beds
● Air, water, or dry pressure pads for regular mattresses
● Extra-wide, heavy-duty hospital beds (weight capacities are 350 to 600 pounds)

Would a Sleep Number Adjustable Bed Be Covered by Medicare?

It is unlikely that Medicare will cover the latest and greatest beds, which includes Sleep Number beds. Of course, individuals have the option to purchase an adjustable bed outside of Medicare’s coverage.

Whether you need an adjustable bed to help with a temporary injury or require one for long-term use, there is a good chance that you’ll be able to utilize your Medicare benefits. Consult with your doctor to find out if you qualify.

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Beds and Medicare

Beds and Medicare

Does Medicare Cover Hospital Beds?

Medicare will cover a hospital bed when you can show a medical necessity for the bed. You must also be covered under Medicare Part B and have been assessed by your doctor. The doctor must document your need in your medical records and write you an order (prescription) for the equipment. Only your doctor can prescribe the equipment for you.

The supplier must receive the order before Medicare is billed and it must be kept on file by the supplier.

 

How Do I Qualify For a Hospital Bed?

To qualify for a hospital bed you must show that you:

• Change positions in ways not possible on a normal bed
• Lay or sleep in positions not possible with a normal bed in order to relieve pain
• Have to sleep with the head of the bed higher than 30 degrees because of conditions such as congestive heart failure, breathing problems, or other types of problems
• Use traction equipment that must be attached to a hospital bed
• Have a Certificate of Medical Necessity that is completed, signed and dated by the treating doctor

The above is the basic criteria for coverage for hospital beds. There are a number of different kinds of beds, such as an adjustable hospital bed. Each will have additional requirements for coverage. Your treating doctor and/or your supplier will know what needs to be documented in order for you to qualify for the bed and equipment that is right for you. Adjustable beds, full-electric beds and electric hi-lo beds are considered convenience devices, and are not covered by Medicare.

How Much Does It Cost to Rent or Buy a Hospital Bed?

After you have paid your annual deductible, you will pay 20% of the Medicare-approved amount for the hospital bed purchase or rental and maintenance. If you have Supplemental insurance you may have little to no out-of-pocket cost for a manual crank, or a semi-electric Hospital bed.

Those costs may be higher if the supplier doesn't accept assignment. Hospital beds are in the Capped Rental category, which means you may choose to rent or purchase the bed. Once Medicare has made 10 monthly rental payments you will be given an opportunity to purchase the bed. The supplier will send you a "Purchase Option" letter in the ninth month of the rental. You will have 30 days to reply.

If you reply and want to buy the bed:

• Medicare will make three more payments and the bed is yours.
• You will be responsible for maintenance (Medicare may cover some of the maintenance cost).

If you do not answer or choose to continue renting:

• Medicare will make a total of 15 rental payments and the bed is yours to use as long as you need it.
• The supplier keeps ownership of the bed and is responsible for maintaining it.
• You may be charged a maintenance and service fee every six months.

 

Where Do I Purchase or Rent Hospital Beds?

You will save money if you order your items from a Medicare-approved provider that accepts the assignment. You may also buy your hospital bed from any store that sells them. However, if the supplier from which you order your bed is not enrolled in Medicare, Medicare will not pay for the equipment.

Things to review before you choose a supplier:

• There are two types of Medicare suppliers: participating suppliers, and those who are enrolled but have chosen not to participate.
• Participating suppliers will not charge more than the Medicare allowed amount.
• A Medicare approved provider who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15% above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up the bed. In this situation, Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple of months to receive payment.
• If you receive your Medicare coverage through a Medicare Advantage Plan (like an HMO or PPO), it is likely that the plan will have its own steps for the purchase. In addition, the plan may have restrictions on which suppliers you can use.

 

Will Medicare Pay for Electric Hospital Beds?

Medicare does not cover full electric hospital beds. They are considered a convenience device. However, you can apply the cost of the manual lift towards the purchase price of an full electric model by using an Advance Beneficiary Notice (ABN). You will have to pay the difference between the two items. In some cases it may be cheaper to purchase an electric bed directly from the medical equipment store.