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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, so do not order anything until you have visited your doctor, no matter what the sales person tells 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.
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 Medigap/Medicare Supplemental insurance you may have little to no out-of-pocket cost.
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 will cover 80% of 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.
For more information, you may call 1-800-MEDICARE (1-800-633-4227) 24 hours, 7 days a week, including some federal holidays. TTY/TDD users can call 1-877-486-2048. However, the interactive phone system is available 24 hours every day of the year.
Where Do I Purchase or Rent Hospital Beds?
You will save money if you order your items from a Medicare-approved provider. Suppliers must meet strict standards to qualify and will have a Medicare supplier number. 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 you should think about 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.