Does Medicare cover bed alarms ?

by | Beginners Info, Health Care, Safety

For a caregiver of elderly loved ones and parents such as myself, nighttime can present some of the more difficult situations, and bed alarms can be part of the solutions.

If your loved one is a wanderer, if they need help getting out of bed, or just to make you aware that you may need to check on them in a few minutes, bed alarms can discreetly let you know that your loved one is on the move. 

What helps even more is to know how you are going to pay for a bed alarm…..

Does Medicare cover bed alarms ? Original Medicare does not cover bed alarms or bed exit sensors, but there may be other sources of funding for which you, or an elderly loved one, may qualify. Just because you can’t get one covered by Medicare doesn’t mean that you can’t get one under one of the different state funded programs for which many elderly adults can qualify.

Why won’t Medicare cover bed alarms ?

Original Medicare Part B covers medical equipment for use in the home, and unfortunately bed alarms do not qualify as they are not deemed to be “medically necessary”.

There are many items, which like bed alarms we may consider totally necessary as caregivers because they make our job easier, and our loved one’s lives more comfortable, but as long as they are not “medically necessary” it will be virtually impossible to get them covered by Original Medicare Part B.

Gauze, adult diapers, air cleaners, disposable sheets, fall alarms and incontinence pads are all items that are extremely helpful and often necessary, but these are not typically covered by Original Medicare, as they are not “medically necessary”. Of course, if your doctor says the items are “medically necessary” you may have a chance of getting them covered.

I have include the full list of what is not typically covered below.

If you want to learn about the different types of bed alarms, I have a long article which looks at the different types and their possiblities – I have bought and tested the basic types and used them with my mom to find out what we found to be best. You can read that article here.

Does Medicare cover bathroom equipment ?

Like bed alarms for the nighttime, there’s quite a few pieces of equipment which could make the bathroom safer to use for our elderly loved ones. Unfortunately though, for the same reasons, most of this equipment is not considered “medically necessary” and is not covered.

Grab bars, shower chairs, raised toilet seats, walk in bathtubs, bathtub transfer seats, non-slip mats, floor to ceiling poles, and toilet safety frames are all not covered by Medicare Part B, and it’s because Medicare considers them to be “for comfort’s sake”.

Medicare does though cover walkers, bedside commodes and crutches, if they are deemed to be “medically necessary” by a Medicare enrolled doctor.

If bathroom safety is one of your concerns for your loved one, I have a long article with over 50 practical tips and products for making it safer, that I have put together over the years of caring for my elderly parents. You can read that here.

How does Original Medicare define equipment that it will covered ?

For equipment which is for use in the home the Medicare classification is “Durable Medical Equipment” or DME’s.

I have made a thorough list of Durable Medical Equipment typically covered by Medicare below. To go straight to it click here.

An item is considered, by Medicare, as “Durable Medical Equipment” if it fulfills their following criteria:

  • the equipment must be durable (must be able to withstand repeated use overtime)
  • the equipment can only be used for a medical reason, as opposed to just for comfort
  • the equipment is not normally of use to someone who isn’t sick or injured
  • the equipment must be for use in your home
  • the equipment should have an expected lifetime of at least 3 years

If your choice of equipment does not meet these  criteria, you most likely won’t be considered for coverage by Medicare.

To find a local Medicare supplier check this link at Medicare.gov

How does your loved one qualify for Medicare covered DME’s ?

For your loved one to qualify for DME’s for use in their home with Medicare coverage, your loved one –

  •  has to be enrolled in Medicare Part B
  •  has to have a prescription signed by their Medicare enrolled doctor which states that the DME is a medically necessary and meets the medicare criteria for that particular piece of equipment
  • has to buy the DME’s from a Medicare-enrolled supplier

 

For Original Medicare part B “living at home” is  –

  • living in your own home
  • living in the family home
  • living in the community, such as assisted living

Care facilities – hospitals or nursing homes, don’t qualify as a “home” for Medicare Part B (they are covered under Medicare Part A – hospital treatment – DME required in a nursing facility for up to 100 days will be provided by the facility).

But a long-term care facility, such as assisted living, can qualify as a “home” for Medicare part B.

 

What to do once your loved one has a doctor’s signed prescription for a DME ?

If Medicare Part B is agreed that  your loved one’s purchase is “medically necessary”, they will cover 80% of the Medicare-approved price of your loved one’s DME.

Your loved one is then responsible for their Medicare co-payment, the equivalent of 20% of the Medicare-approved price of the DME, and only if they have used a Medicare-enrolled “participating” supplier who accepts assignment.

If not, they may pay much more – so read on !

In addition to the co-payment of 20%, your loved one will also  have to pay their annual deductible, if it hasn’t already been met.

Medicare may purchase or rent DME’s 

It will depend on the cost of the equipment as to whether Medicare purchases the item form the supplier outright, or if they rent it.

The more important the cost of the equipment, the greater the chance that Medicare will  rent it on a monthly basis from a supplier.

Medicare has certain arrangements with suppliers whereby after a certain number of months the equipment is considered purchased, and the payments for rental are stopped. The your loved one then pays for two yearly services of their equipment by the supplier – they pay them even if they do not use them.

During the rental period if the equipment is rented from a Medicare-enrolled “participating” supplier who accepts assignment, there will be a monthly co-payment of 20% of the Medicare-approved rental price.

How to avoid over-paying for the equipment ?

As I said earlier your loved one needs to be careful to meticulously follow all the steps of the process to get the best coverage for their equipment. Here’s why…

To avoid over-paying for their DME your loved one has to use a Medicare enrolled “participating” supplier  who accepts “assignment”.

This ensures the DME is being bought for the lowest possible price – the Medicare-approved price.

Why is this ?

There are two types of Medicare suppliers –

  • Medicare Suppliers

or

  • Medicare “Participating” Suppliers

Medicare and Medicare “Participating” Suppliers have an agreement that Medicare “Participating” Suppliers will accept what is called “assignment” – they will only charge the Medicare-approved price for  DME’s.

Suppliers who are not “Participating” can charge what they want for DME’s over and above the Medicare-approved price.

What happens if my loved one doesn’t use a “Participating Supplier” ?

 

A Medicare-enrolled supplier who is not a “Participating” supplier –

  • accepts payment from Medicare for DME at the Medicare-approved price
  • but can actually sell the DME to the beneficiary at whatever price they choose

As a result –

  • Medicare pays the Medicare-enrolled supplier  80% of the Medicare-approved price for the DME
  • your loved one pays their 20% c0-pay of the Medicare-approved price + the difference between the Medicare-approved price, and the supplier’s price
  • your loved one also pays their deductible if it applies

So in real terms it plays out like this –

Medicare-approved bed alarm price – 100$

Medicare-enrolled Supplier bed alarm price price -125$

  • Medicare pay 80% 0f the Medicare-approve price = 80$
  • Your loved one pays 20% co-pay of Medicare-approve price = 20$
  • Your loved one then pays the difference between the Medicare-approved price, and the Medicare-enrolled Supplier price – 125$ – 100$ = 25$
  • So, your loved one pays 20$ + 25$ = 45$

If your loved one’s Medicare-enrolled supplier had been a “participating” supplier who accepts assignment, they would have paid 25$ less because he only charges the Medicare approved-price.

Your loved one should always use a Medicare-enrolled Participating Supplier and confirm that the supplier accepts “assignment”, and this way they won’t over-pay for their DME.

What happens with Medicare Advantage ?

Private companies which have been contracted by Medicare to provide Medicare services run the Medicare Advantage plans and must, by law, provide at least the same coverage and services, as Original Medicare Parts A and B.

The plans may also provide more than Original Medicare Parts A and B, and some may include extra DME’s not covered by Medicare.

Medicare Advantage plans usually have a co-payment just like Original Medicare Parts A and B, and the rates of the co-pay will be specific to each plan, and its provider.

For the exact terms, process, and which suppliers to use, your loved one must consult with their provider, if they have a Medicare Advantage plan.

The plan provider will have their own network DME suppliers whom your loved one will have to use. If they don’t, the provider can leave them to pay the whole bill for their equipment.

 

Durable Medical Equipment generally covered by Medicare if you qualify

If you don’t find the equipment you are looking for in my list of  Medicare covered DME’s below, you can use this link to Mediace.gov 

Air-Fluidized Bed
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
Bead Bed
Bed Side Rails
Bed Trapeze – covered if your loved one is confined to their bed and needs one to change position
Blood sugar monitors
Blood sugar (glucose) test strips
Canes (however, white canes for the blind aren’t covered)
Commode chairs
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Crutches
Cushion Lift Power Seat
Defibrillators
Diabetic Strips
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Heat Lamps
Hospital beds
Hydraulic Lift
Infusion pumps and supplies (when necessary to administer certain drugs)
IPPB Machines
Iron Lung
Lymphedema Pumps
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mattress
Medical Oxygen
Mobile Geriatric Chair
Motorized Wheelchairs
Muscle Stimulators
Nebulizers and some nebulizer medications (if reasonable and necessary)
Oxygen equipment and accessories
Patient lifts (a medical device used to lift you from a bed or wheelchair)
Oxygen Tents
Patient Lifts
Percussors
Postural Drainage Boards
Quad-Canes
Respirators
Rolling Chairs
Safety Roller
Seat Lift
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Sitz Bath
Steam Packs
Suction pumps
Traction equipment
Ultraviolet Cabinet
Urinals (autoclavable hospital type)
Vaporizers
Ventilators
Walkers
Whirlpool Bath Equipment – if your loved one is homebound and the pool is medically needed. If your loved one isn’t homebound Medicare will cover the cost of treatments in a hospital.

DME’s usually not covered by Medicare

Adult Diapers
Air Cleaners
Air Conditioners
Alcohol Swabs
Augmentative Communication Device
Bathroom Aids
Bathtub Lifts
Bathtub Seats
Bed Bath
Bed Boards
Bed Exit Alarms
Bed Sensor Pads
Bed Lifter
Beds – Lounge
Bed Wedges
Blood Glucose Analyzers
Braille Teaching Texts
Caregiver Paging Systems
Catheters – except those which are used for permanent medical conditions where the catheter is considered as a prosthetic
Chair Exit Alarms
Chair Sensor Pads
Communicator
Contact Lenses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens
Dehumidifiers
Dentures
Diathermy Machines
Disposable Bed Protectors
Disposable Sheets
Door Exit Alarms
Easygrip Scissors
Elastic Stockings
Electrical Wound Stimulation
Electrostatic Machines
Elevators
Emesis Basins 
Esophageal Dilators
Exercise Machines
Exit Alarm Mat
Eye Glasses – Medicare helps pay for corrective lenses if you have cataract surgery to implant an intraocular lens.
Fall Alarms
Fans
Fabric Supports
Fomentation Device
Grab Bars
Grabbers
Gauze
Hearing Aids
Heat and Massage Foam Cushion Pad
Heating and Cooling Plants
Home Modifications
Humidifiers – not room humidifiers
Incontinence Pads
Injectors (hypodermic jet pressure powered devices for Insulin injection)
Irrigating Kits
Insulin Pens
Massage Equipment
Motion Sensors
Motion Sensor Exit Systems with Pagers
Needles
Oscillating Beds
Over bed Tables
Paraffin Bath Units (if not Portable)
Parallel Bars
Portable Room Heaters
Portable Whirlpool Pumps
Preset Portable Oxygen Units
Pressure Leotards
Pressure Stockings
Pulse Tachometer
Pull String Alarms
Raised Toilet Seats
Ramps
Reading Machines
Reflectance Colorimeters
Sauna Baths
Special TV Close Caption
Speech Teaching Machines
Stair Lifts
Standing Table
Support Hose
Surgical Face Masks
Surgical Leggings
Syringes
Telephone Alert Systems
Television Assistive Listening Devices
Telephone Arms
Toilet Seats
Treadmill Exercisers
Walk in Bathtubs
Wheelchair Lifts
Whirlpool Pumps
White Canes
Wigs

Get free assistance with understanding Medicare

You can get free help at SHIP – State Health Insurance Assistance Programs for Medicare.

SHIP offers free counseling services in each for people to speak with someone who’ll help them better understand Medicare, Medicare Advantage, Medigap and Medicaid benefits.

Typically it’s a phone service, but there are programs that also offer in-person meetings.

To find your local Medicare help click on this link  here

How to contact a SHIP counselor in your state step by step

Step 1 –

After you have clicked on the link you will arrive here –

Step 2 –

Click on one of the two buttons to find your state – they both lead to the same menu to choose your state

Step 3 –

Pick your state from the list and click on it

Step 4 –

The screen will open a window with the contact info and a phone number for you to call in your state.

Does Medicaid cover bed alarms ?

Due to the fact that Medicaid is funded both at a federal and a state level, a state may have multiple Medicaid programs and waivers, and each can have its own guidelines for eligibility.

These programs and waivers are intended for those on very low incomes, and your loved one will have to find out what the criteria are and if there are any places left. All of this can be done through your loved one’s State Medicaid Office. 

Your local Area Agencies on Aging should be able to help you find out as well.

Medicaid for skilled nursing facilities and hospitals

Hospitals and skilled nursing facilities handle the of ordering the equipment needed for your loved ones within while they are in the facility.

Medicaid and state programs for care services in the home

Medicaid programs which are not for inside skilled nursing facilities are called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”.

The purpose of these programs and waivers is to help the beneficiaries maintain their independence living in their own homes.

You will find a comprehensive explanation of HCBS programs and waivers with more technical information is available at this link to medicaid.gov –

https://www.medicaid.gov/medicaid/hcbs/authorities/index.html

Just like Medicare, the programs and waivers pay for “home medical equipment”, but unlike Medicare, they will often cover 100% of the cost of the equipment.

The term “home” is used to mean that the beneficiary of the waivers and HCBS’s has to be living in –

  • their own home
  • their family home
  • a group home
  • an assisted living facility
  • a custodial care facility

 

DME’s for home use may be easier to get covered by certain Medicaid waivers than by others

Some HCBS programs and waivers have what is known as “Consumer Direction”or “Self Direction”

In such a program, the participant will have an allotted budget to cover their living needs, and to help them maintain their independence in their home. A financial planner is appointed to help each participant manage the funds across their living needs.

Equipment not covered by Medicare such as toilet safety frames, bathtub lifts, grab bars, if judged “medically necessary” and integral to the participant maintaining their independence in their home, and also within the person’s allotted budget, can be purchased on some of these programs or waivers.

To find out more about Medicaid Self Direction click here

Programs which transition people from care institutions back into their own homes

The Medicaid program Money follows the person transitions elderly adults, who are in nursing facilities, back into their homes – this can also be assisted living.

If a certain piece of equipment is needed to make this happen, the program will purchase the equipment for them.

What can be considered a DME’s is again much less restricted than under Medicare.

If you don’t quite qualify for Medicaid

Some states have a program called Spend Down.

For people whose incmoe is just too high or their assets to great, the Spend-Down program helps them reduce those, and so that they can become eligible for Medicaid and HCBS’s and waivers.

For those with a lot of Medical expenses, one method is to allow them to subtract the medical expenses from their income, and if they then fall below the Medicaid income limit, they may be eligible to receive Medicaid benefits.

If you want to read something with a lot more detail on Spend-Down this is a good article about it on the US NEWS website here.

What is the procedure for purchasing DME’s with Medicaid waivers and HBSC programs ?

Step 1

– your loved one has to get the doctor, or therapist, to provide a medical justification letter, which states that the equipment is medically necessary

Step 2

– your loved one has to find aDME supplier who is Medicaid approved, and to pass on to them the medical justification letter from the doctor, or therapist

Step 3

– the DME supplier then fills out a Prior Approval Application for Medicaid

Step 4

– the document is then sent to the Medicaid State Office for approval or denial

Step 5

– if your loved one is unsuccessful they will be notified as to the reasons why, and told how to appeal the decision

Step 6

– if approved your loved one will receive the DME

How to find the HCBS programs, waivers and 1915 waivers in your state

Click on the link below will it take you to CMS.gov (CENTER FOR MEDICARE AND MEDICAID SERVICES) to look at the different “HCBS programs”, “waivers” and “1915 waivers” offered by your state and Medicaid.

Once you select your state on the map, it will show you a section with your state waivers and programs, and also their criteria for eligibility- click here.

Step 1 – Find your state on the map.

Step 2 – Click on you state – I gave N.Dakota as an example

Step 3 – You will come to your state and it’s list of available resources, and here you can choose

 

  • your state Medicaid Agency marked with a (1), or
  • your Home and Community Based Services, Waivers and 1915 Waivers marked with a (2)

Below is an example of the type of page you will get if you click on the HCBS programs and waivers link.

You can find out what programs and waivers there are in your state, and what the criteria is for eligibility.

How to find your State Medicaid State Agency

If all the technical jargon was too much for you, I would contact your state Medicaid Agency, and you can do that here.

Step 1 – Once you have clicked the link to Medicade.gov, look at the section I have outlined in the image below

Step 2 – select your state, and click on “GO” – it will take you to your State medicaid Agency.

Other funding your loved one can get for a bed alarm

Assistive Technology Projects

These projects are have been developed to increase access to assistive devices in the home.

The elderly were one of the primary groups for these were projects conceived.

Here “DME” and “Assistive Technology” are pretty much interchangeable as terms, so with all manner equipment which can help in the home which can be covered.

Find out what projects your state is running here

Step 1/

Select you state on the map or from the drop down menu and click on the button “Go to state”

– I chose Florida for this example

Step 2/

Look for the link “Program Title” – for my example I outlined it in red – and click on that.

Step 3/ 

The state AT Project website will come up, and you can sign up or use ther contact info to get in touch and find out what they offer to help the elderly, and if you or a loved one are eligible.

State Financial Assistance Programs

To reduce the number of elderly persons entering into the Medicaid run nursing homes, non-Medicaid programs have been set up.

Designed to help the elderly to remain living independently in their own homes, these programs are run by individual states, and as such not all the states have one.

Eligibility differs with each program, but the programs are destined for the elderly and the disabled.

The work done by the programs includes modifying homes and purchasing any equipment necessary to the goal of helping the persons maintain their independence.

    I’m Gareth and I’m the owner of Looking After Mom and Dad.com

    I have been a caregiver for over 10 yrs and share all my tips here.

    Gareth Williams

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    Does Medicare cover bed alarms ?
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    Original Medicare does not cover bed alarms or bed exit sensors, but there may be other sources of funding for which you or an elderly loved one may qualify.
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