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Does Medicare Cover Hospital Beds to Use at Home?

Author: Marina

Jul. 15, 2024

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Does Medicare Cover Hospital Beds to Use at Home?

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When medically necessary, Medicare will cover hospital beds to use at home. You&#;ll need a doctor&#;s order stating that your condition requires one. Medicare Part B will pay 80% of the cost. Medigap or Medicare Advantage plans may pay more.

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Your doctor might order a hospital bed for you to use at home for many reasons, such as if you&#;re in severe pain, having trouble breathing, or experiencing swelling in your legs and feet.

Medicare will cover the hospital bed as long it&#;s medically necessary to help your condition. Your doctor will need to order the bed and show how it will help your condition.

Medicare pays for all medical equipment, including hospital beds, under Medicare Part B. Part B will pay 80% of the cost of your hospital bed.

You might be able to get more coverage if you have a Medigap or Medicare Advantage plan.

When does Medicare cover hospital beds for home use?

Hospital beds for home use are considered durable medical equipment (DME). Medicare covers DME under Part B. Your hospital bed will need to meet a few conditions in order to be covered.

Medicare will pay for your hospital bed if:

  • You have a documented medical condition that requires a home hospital bed.
  • You&#;re under the care of a doctor for your condition and being seen at least once every 6 months.
  • Your doctor orders the bed for home use.
  • Your doctor&#;s order includes your condition and why a hospital bed will help you.
  • Your doctor participates in Medicare.
  • The equipment provider participates in Medicare.

Medicare can provide coverage for you to either rent or buy a bed.

Whether you rent or buy will depend on the type of bed your doctor orders and the policies of the company you use. You might also rent a bed at first, then purchase it if you still need it later on.

Which Medicare plans may be best for you if you know you need a hospital bed at home?

You can get coverage for hospital beds through a few different parts of Medicare.

If you use Medicare parts A and B, together called original Medicare, your coverage will be through Medicare Part B. That&#;s because Medicare Part A covers inpatient stays and care you receive in hospitals and skilled nursing facilities.

Medicare Part B covers your other healthcare needs, including:

  • doctor&#;s office visits
  • emergency room care
  • medical equipment

Part B will cover 80% of the Medicare-approved amount of your hospital bed. You&#;ll pay the remaining 20%.

You can also get coverage through a Medicare Part C plan. Part C plans, also known as Medicare Advantage plans, are offered by private companies that contract with Medicare.

They&#;re required to provide the same coverage as original Medicare. Plus, many Advantage plans go beyond the coverage of original Medicare to offer additional covered services.

So, since original Medicare covers hospital beds, all Advantage plans will also cover hospital beds. Your cost might be more or less than with original Medicare, depending on your plan.

Medicare Part D is prescription drug coverage. It won&#;t help you pay for any DME, including hospital beds.

Medigap, however, can help you pay for a hospital bed. This is Medicare supplement insurance. It covers some of the out-of-pocket costs of using original Medicare, like copayments and coinsurance amounts.

So, if you use Medicare Part B to get a hospital bed, a Medigap plan could cover the 20% coinsurance amount you&#;d normally need to pay.

What is a home hospital bed?

A hospital bed is a bed that has extra features, such as side rails, gel cushioning, or the ability to raise your head or feet. Your doctor might order a hospital bed for home use if you have:

  • arthritis, osteoporosis, or another chronic pain condition
  • heart conditions that require you to keep your head, heart, or limbs elevated
  • a condition that requires you to be repositioned for pain or pressure relief
  • a spinal cord condition or injury
  • chronic obstructive pulmonary disease that&#;s affected by your sleeping position

Which hospital beds are covered?

Medicare covers several types of hospital beds. This includes:

  • adjustable beds
  • semielectric beds with adjustable heads and feet
  • beds with side rails
  • extra-wide bariatric beds that can hold weights of 350 to 600 pounds
  • extra-wide bariatric beds that can hold weights of more than 600 pounds

Bed types are all available with a mattress or without one. Medicare also covers mattresses pads, including:

  • lambswool sheepskin pads
  • synthetic sheepskin pads
  • gel pressure pads
  • dry pressure pads
  • water pressure pads
  • air pressure pads

Hospital bed accessories

Medicare will also cover some additional features if they&#;re medically necessary. However, it won&#;t cover things that are considered convenience features.

For example, Medicare will cover accessories like trapeze pull bars that help you sit up in bed but won&#;t cover things like over-the-bed tables, which are considered a convenience and not a necessity.

Any bed you order needs to be considered medically necessary for your condition. For example, to get approved for a bariatric bed, you&#;ll need to send a medically documented recent weight.

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It&#;s also important to note that while Medicare covers semielectric beds with adjustable heads and feet, it doesn&#;t cover fully electric beds.

Fully electric beds have adjustable height in addition to the adjustable head and feet. Medicare considers adjustable height a convenience feature, and won&#;t pay for it.

How much does the average hospital bed for home use cost?

The cost of a hospital bed depends on the type of bed your doctor orders.

According to Consumer Affairs, hospital bed costs start at around $500 and can often reach thousands of dollars. When you rent a hospital bed, Consumer Affairs reports, you can spend between $200 and $500 per month depending on the bed type.

Medicare can help you reduce this cost. Medicare Part B will pay 80% of your costs when you use original Medicare.

So, let&#;s say your doctor orders a bed with a cost of $1,000. In this case, Medicare would pay $800 and you&#;d pay $200. If you decide to rent a bed instead for $300 per month, Medicare would pay $240 and you&#;d pay $60.

If you have a Medigap plan, it can pick up those remaining costs, meaning you wouldn&#;t need to pay anything for your hospital bed.

Your costs with a Medicare Advantage plan will depend on the plan. Each Part C plan has its own copayment or coinsurance amounts. You can call your Advantage plan if you&#;re not sure.

The bottom line

Medicare will pay for a hospital bed for home use if it&#;s medically necessary and ordered by your doctor.

Medicare covers a variety of hospital beds to help with different conditions. Your doctor will need to specify your condition and why a hospital bed will help it.

Medicare will pay for you to buy or rent a bed. Original Medicare will pay 80% of the costs. A Medicare Advantage or Medigap plan might cover more.

LCD - Hospital Beds And Accessories (L)

Coverage Indications, Limitations, and/or Medical Necessity

For any item to be covered by Medicare, it must 1) be eligible for a defined Medicare benefit category, 2) be reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, and 3) meet all other applicable Medicare statutory and regulatory requirements.

The purpose of a Local Coverage Determination (LCD) is to provide information regarding &#;reasonable and necessary&#; criteria based on Social Security Act § (a)(1)(A) provisions.

In addition to the &#;reasonable and necessary&#; criteria contained in this LCD there are other payment rules, which are discussed in the following documents, that must also be met prior to Medicare reimbursement:

  • The LCD-related Standard Documentation Requirements Article, located at the bottom of this policy under the Related Local Coverage Documents section.
  • The LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section.
  • Refer to the Supplier Manual for additional information on documentation requirements.
  • Refer to the DME MAC web sites for additional bulletin articles and other publications related to this LCD.

For the items addressed in this LCD, the &#;reasonable and necessary&#; criteria, based on Social Security Act § (a)(1)(A) provisions, are defined by the following coverage indications, limitations and/or medical necessity.

A fixed height hospital bed (E, E, E, E, and E) is covered if one or more of the following criteria (1-4) are met:

  1. The beneficiary has a medical condition which requires positioning of the body in ways not feasible with an ordinary bed. Elevation of the head/upper body less than 30 degrees does not usually require the use of a hospital bed, or
  2. The beneficiary requires positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain, or
  3. The beneficiary requires the head of the bed to be elevated more than 30 degrees most of the time due to congestive heart failure, chronic pulmonary disease, or problems with aspiration, or
  4. The beneficiary requires traction equipment, which can only be attached to a hospital bed.

A variable height hospital bed (E, E, E, and E) is covered if the beneficiary meets one of the criteria for a fixed height hospital bed and requires a bed height different than a fixed height hospital bed to permit transfers to chair, wheelchair or standing position.

A semi-electric hospital bed (E, E, E, E, and E) is covered if the beneficiary meets one of the criteria for a fixed height bed and requires frequent changes in body position and/or has an immediate need for a change in body position.

A heavy duty extra wide hospital bed (E, E) is covered if the beneficiary meets one of the criteria for a fixed height hospital bed and the beneficiary's weight is more than 350 pounds, but does not exceed 600 pounds.

An extra heavy-duty hospital bed (E, E) is covered if the beneficiary meets one of the criteria for a hospital bed and the beneficiary's weight exceeds 600 pounds.

A total electric hospital bed (E, E, E, and E) is not covered; the height adjustment feature is a convenience feature. Total electric beds will be denied as not reasonable and necessary.

For any of the above hospital beds (plus those coded E - see Policy Article Coding Guidelines), if documentation does not justify the medical need of the type of bed billed, payment will be denied as not reasonable and necessary.

If the beneficiary does not meet any of the coverage criteria for any type of hospital bed it will be denied as not reasonable and necessary.


ACCESSORIES:

Trapeze equipment (E, E) is covered if the beneficiary needs this device to sit up because of a respiratory condition, to change body position for other medical reasons, or to get in or out of bed.

Heavy duty trapeze equipment (E, E) is covered if the beneficiary meets the criteria for regular trapeze equipment and the beneficiary's weight is more than 250 pounds.

A bed cradle (E) is covered when it is necessary to prevent contact with the bed coverings.

Side rails (E, E) or safety enclosures (E) are covered when they are required by the beneficiary's condition and they are an integral part of, or an accessory to, a covered hospital bed.

If a beneficiary's condition requires a replacement innerspring mattress (E) or foam rubber mattress (E) it will be covered for a beneficiary owned hospital bed.


GENERAL

A Standard Written Order (SWO) must be communicated to the supplier before a claim is submitted. If the supplier bills for an item addressed in this policy without first receiving a completed SWO, the claim shall be denied as not reasonable and necessary.

For Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) base items that require a Written Order Prior to Delivery (WOPD), the supplier must have received a signed SWO before the DMEPOS item is delivered to a beneficiary. If a supplier delivers a DMEPOS item without first receiving a WOPD, the claim shall be denied as not reasonable and necessary. Refer to the LCD-related Policy Article, located at the bottom of this policy under the Related Local Coverage Documents section.

For DMEPOS base items that require a WOPD, and also require separately billed associated options, accessories, and/or supplies, the supplier must have received a WOPD which lists the base item and which may list all the associated options, accessories, and/or supplies that are separately billed prior to the delivery of the items. In this scenario, if the supplier separately bills for associated options, accessories, and/or supplies without first receiving a completed and signed WOPD of the base item prior to delivery, the claim(s) shall be denied as not reasonable and necessary.

An item/service is correctly coded when it meets all the coding guidelines listed in CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, or DME MAC articles. Claims that do not meet coding guidelines shall be denied as not reasonable and necessary/incorrectly coded.

Proof of delivery (POD) is a Supplier Standard and DMEPOS suppliers are required to maintain POD documentation in their files. Proof of delivery documentation must be made available to the Medicare contractor upon request. All services that do not have appropriate proof of delivery from the supplier shall be denied as not reasonable and necessary.

 

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