Does Medicare Cover Bed Rails ?
Raised toilet seats will, for a lot of elderly people, become a pretty standard, and wonderfully helpful, piece of equipment, if mobility, stiffness and balance start to become an issue in their lives. And in partcicular, if like my mom, your parent has a hip, or knee replacement, you will find out just how much of a relief it will be to them, both in terms of pain and in worry/stress relief.
Original Medicare Part B does not typically give cover to raised toilet seats, as it sees them as not “medically necessary” , but as “comfort items”. It will though give cover to a portable bedside commode if a Medicare-enrolled doctor signs a prescription for one certifying that it is “medically necessary”, and that can be used as a raised toilet seat . If you have Medicare Advantage Plus, Medicaid, if you qualify for a state waiver or HCBS program, are a veteran, or qualify for a non-Medicaid state financial assistance program you may be eligible for any type of raised toilet seat.
What is Medicare’s basic coverage criteria for equipment ?
For Original Medicare Part B hospital beds and other medical equipment for use in the home comes under the category of “Durable Medical Equipment” or DME’s.
You can find a full list of Durable Medical Equipment covered by Medicare below. If you wish to got straight to the list click here.
Durable medical equipment has to meet these basic criteria:
- Durable (it must be able to withstand repeated use over a sustained period of time)
- Used for a medical reason, as opposed to for comfort
- Not usually useful to someone who isn’t sick or injured
- Used in your home
- Generally has an expected lifetime of at least 3 years
So if the equipment you are looking at doesn’t meet these criteria you probably won’t be able to get it covered by Medicare.
Medicare’s definition of Durable Medical Equipment is “Durable Medical Equipment is reusable medical equipment like, walkers, wheelchairs, or hospital beds”
How does my loved one get a hospital bed for their home with Medicare coverage ?
To qualify for a hospital bed for your loved one’s “home” under Medicare Part B, or accessories for a hospital bed (if they already have one), your loved one will have to –
- be enrolled in Medicare Part B
- obtain a signed prescription from your Medicare enrolled doctor stating it is a medical necessity
- be purchasing the hospital bed, or accessories, through a Medicare-enrolled supplier
For someone claiming DME’s for their “home”, a hospital or nursing home which is providing Medicare coverage cannot qualify as their “home”, although a long-term care facility, such as an assisted living can qualify as “home”.
The following forms of residence qualify as living at “home” for Medicare –
- living in your own home
- living in the family home
- living in the community, such as assisted living
Here is the passage from Medicare’s own publication on what you have to do to get your DME’s.
“If you need DME in your home, your doctor or treating practitioner (like a nurse practitioner, physician assistant, or clinical nurse specialist) must prescribe the type of equipment you need by filling out an order. For some equipment, Medicare may also require your doctor to provide additional information documenting your medical need for the equipment. Your supplier will work to make sure your doctor submits all required information to Medicare. If your needs and/or condition changes, your doctor must complete and submit a new, updated order.
Medicare only covers DME if you get it from a supplier enrolled in Medicare. This means that the supplier has been approved by Medicare and has a Medicare supplier number.
To find a supplier that’s enrolled in Medicare, visit Medicare.gov/ supplierdirectory. Or, call 1-800-MEDICARE (1-800-633-4227).
A supplier enrolled in Medicare must meet strict standards to qualify for a Medicare supplier number. If your supplier doesn’t have a supplier number, Medicare won’t pay your claim, even if your supplier is a large chain or department store that sells more than just DME.”
The above passage is taken from 11045-medicare-coverage-of-dme.pdf. You can read or download the entire Medicare document here
What happens next ?
Medicare may refuse your loved one’s purchase, and will in all cases only provide the most basic form of the equipment requested for the medical necessity.
If Medicare accepts to cover the equipment for your loved one , without supplemental private insurance policies, your loved one will still have to pay their annual deductible, if it has not already been used, and their co-payment of 20% of the Medicare-approved price of the item they are seeking to purchase.
In the case of cheaper items Medicare will usually purchase the items, but in cases such as hospital beds, it is more likely that they would rent a hospital bed on a monthly basis.
If the item is rented by Medicare from a Medicare-approved supplier who accepts assignment, your loved one will have to pay a monthly co-payment of 20% the Medicare-approved rental price, and Medicare would pay 80%, and of course if your loved one has not already paid the annual deductible they have to pay that once as well.
What if your loved one is in a skilled nursing facility ?
If your loved one, is in a Skilled Nursing Facility or hospital, their care is covered by Medicare Part A (Hospital Insurance).
Medicare requires skilled nursing facilities providing Medicare services to provide any necessary equipment fo up to 100 days.
What if your loved one has Medicare Advantage ?
For those with Medicare Advantage Plans (which are private insurance policies sold by private companies), your loved one will be covered to the same degree as Medicare Parts A and B, and depending on the Plan it may cover them for extra areas.
You, or your loved one, will need to check with their plan to find out everything it covers, and from whom they are allowed to purchase their DME’s to qualify for coverage.
How can my loved one pay the minimum amount for a hospital bed with Medicare coverage ?
If you want to get the best deal, you must make sure that your loved one’s Medicare enrolled “participating” supplier accepts “assignment” so that your loved one is only paying their Medicare co-pay of 20% of the Medicare-approved price, and if they haven’t already paid it, their annual Medicare Part B deductible.
Here’s Why –
Medicare enrolled suppliers are divided into two camps –
- Medicare Suppliers
- Medicare “Participating” Suppliers
Medicare “Participating” Suppliers have accepted what is known as “assignment” – they have agreed to charge the Medicare-approved price only.
When your loved one buys their durable medical equipment from a Medicare Participating Supplier, they will not be paying more than the 20% co-payment of the Medicare-approved price for the equipment, and if they have not yet paid it, their annual deductible.
What happens if they are not a Participating Supplier ?
If your loved one is dealing with a supplier who is Medicare enrolled, but not a “Participating” Supplier, this means that the supplier has agreed to take payment from Medicare, but that they don’t have to accept “assignment” if they don’t want to. They are then free to charge your loved one an extra 15% above the that of the Medicare-approved price.
Medicare then pays the supplier 80% of the Medicare-approved price, and your loved one has to pay their 20% co pay of the Medicare-approved price, plus the difference over and above the Medicare approved price for the equipment to the supplier.
To get durable medical equipment at the lowest price through Medicare, you must make sure that your supplier is Medicare enrolled “Participating” Supplier, and that they accept “assignment”, prior to doing anything else.
I have an article where I have researched the alternatives to bed rails that I could use for my mom. Even if you are eligible for a hospital bed, or the rails for a bed you have, you may want to re-think bed rails as they have caused a significant number of deaths in at risk groups over the last 30 yrs, and there are some perfectly good and much safer alternatives available.
You can read my article here
Durable Medical Equipment usually covered by Medicare
In addition to durable medical equipment Medicare covers some prosthetics and also corrective lenses for certain conditions. These items are listed below here as well.
If you have a Medicare Advantage Plan (Medicare Part C), which is a supplemental private coverage, you need to check your policy as you may be covered for more than just the items on the list below.
As a legal minimum Medicare Advantage Plans have to cover at least the same items as Original Medicare.
Although these items are covered by Medicare, your loved one still needs to have the equipment prescribed by a doctor enrolled in Medicare, and to get the lowest co-pay you will need a Medicare-enrolled DME “Participating” supplier who accepts “assignment”.
Here’s the list of Durable Medical Equipment generally covered by Medicare once you have qualified.
You need to have Original Medicare Parts A and B.
- Part A (Hospital Insurance) covers DME’s for beneficiaries who are living in skilled nursing facilities
- Part B (Medical Insurance) covers DME’s for those living at “home” – I outlined the definition of “home” here
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
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)
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Cushion Lift Power Seat
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Infusion pumps and supplies (when necessary to administer certain drugs)
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mobile Geriatric Chair
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)
Postural Drainage Boards
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Urinals (autoclavable hospital type)
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.
Prosthetic and Orthotic Items
Orthopedic shoes only when they’re a necessary part of a leg brace
Arm, leg, back, and neck braces (orthotics), as long as you go to a supplier that’s enrolled in Medicare
Artificial limbs and eyes
Breast prostheses (including a surgical bra) after a mastectomy
Ostomy bags and certain related supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.
Cataract glasses (for Aphakia or absence of the lens of the eye)
Conventional glasses or contact lenses after surgery with insertion of an intraocular lens
Important: Only standard frames are covered. Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare, no matter who submits the claim (you or your supplier).
Free assistance with understanding Medicare
SHIP – State Health Insurance Assistance Programs –
Your SHIP offers guidance and advice on Medicare.
This is usually a phone service, but some programs will offer face-to-face appointments as well.
You may also get advice on Medicare Advantage, Medigap and Medicaid benefits.
To find your local SHIP click on this link here
How to contact a SHIP counselor in your state, step by step
Step 2 –
Click on one of the two buttons to find your state
Step 4 –
A window will open with the contact info and a phone number for you to call in your state.
If Medicare won’t cover my DME’s, can Medicaid help me ?
Medicaid works in a different way from Medicare. The funding for the programs is both federal and state funding. Each state can have a number of different Medicaid programs each with different eligibility guidelines. As a result there are literally hundreds of programs for Medicaid across the US.
Medicaid programs are designed for people with extremely low incomes; mainly the elderly and the disabled, but also low income families.
Medicaid, like Medicare, will also pay for home medical equipment, and will very often cover 100% of the cost.
When Medicaid uses the term “home” for it’s programs, it means that for a person to be eligible for those programs they can be in –
- their own home
- their family home
- a group home
- an assisted living facility
- a custodial care facility
These Medicaid programs are designed to help people continue residing in their own homes, so that they don’t have to go into state facilities where the financial burden is far greater on the state.
The Medicaid programs are called Home and Community Based Services (HCBS) Waivers, or 1915 Waivers.
The programs do vary from state to state, but most allow for a good range of DME’s, and some are broader in their range than Medicare.
Certain waivers allow for what is called Consumer Direction. The beneficiary is given a budget which, with the help of financial planning, they may spend themselves, to cover their requirements. The budget can be used to buy products including durable medical equipment.
Another Medicaid program called Money follows the person was designed to assist people in nursing facilities to leave, and to return them to live in their homes, or assisted living facilities.
Durable medical equipment which is required so that the beneficiaries may relocate, and stay, in their homes is bought by the program.
What if your revenue is too high to qualify for Medicaid ?
The Spend Down Program
Simply put, Spend-Down programs reduce a person’s income level so that they may become eligible for Medicaid, HCBS’s and waivers.
The simplest method by which this is achieved, is to subtract a person’s medical expenses from their income, and if as a result their income level falls below the Medicare eligibility limit, the person will then qualify.
Unfortunately, not that many states have a Spend-Down program, but if yours does it may be just what you need.
Do check with your Area Agency on Aging, as some states have a similar program but under a different name.
US NEWS has an article which covers the topic here.
How do you purchase bed rails in a Medicaid and state funded program ?
If your loved one is in one of these programs, and their doctor prescribes bed rails as “medically necessary”, there is a chance they will be able to get them. Or the doctor may prescribe a hospital bed.
Your loved one will contact a DME supplier who is Medicaid-approved and furnish them with the medical justification letter form the doctor.
The supplier must then fill out a Prior Approval application.
The document is sent to Medicaid at the state office where the purchase is either approved, or denied, and your loved one and the supplier will be notified.
If your loved one is unsuccessful, they will be notified of the reasons why, and how to appeal the decision.
If your loved one’s purchase is approved, unlike with Medicare there is nothing to pay.
Find the HCBS programs, waivers and 1915 waivers in your state
The link below will take you to CMS.gov. to look at the different “HCBS programs”, “waivers” and “1915 waivers” offered by your state and Medicaid.
Select your state on the map and it will show you a section with your state waivers and programs, as well as their eligibility criteria – click here.
Step 1 – Find your state on the map.
Step 2 – Click on you state – I chose N.Dakota as an example
Step 3 – You will come to your state and it’s resources, and here you can choose
- your state Medicaid Agency which I marked with a (1), or
- your Home and Community Based Services, Waivers and 1915 Waivers which I 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 will be able to find out what programs and waivers there are in your state, and what the eligibility criteria are.
To find your State Medicaid State Agency
Step 1 – Once you have clicked the link to Medicade.gov, just look over to the right on the website page and you will see the section I have outlined in the image below
Step 2 – select your state and click on the button they have marked “GO” – it will take you to your State medicaid Agency, and you will be able to get all the contact info and make calls 0r do emails to get all the help you need.
State Funding Assistance
Assistive Technology Programs
All states across the US have what is called a State Assistive Technology Program, which has been designed to improve access to assistive devices in the home primarily for the elderly and the disabled.
State Assistive Technology Programs typically have –
- an online exchange where people can post used assistive devices and medical equipment for sale, donation, or exchange – state residents can just register and participate
- a main website where you can ask about how to get access to free equipment
- reuse and refurbishment programs which are run by the state program to provide free or extremely low cost equipment for the disabled and the elderly
- some states have loan closets as part of their program, these can be either long term or short term
Assistive Technology Programs will also have registers of people who need help, and will contact them when specific equipment becomes available.
To find out more go to your State Assistive Technology Program website.
Follow the steps below to see the projects in your state
Pick your state on the map or the drop down menu, and click on “Go to state”
– I chose Florida for this example
Click on the link “Program Title” – for my example I outlined it in red.
The AT Program state website will come up, and you can register, or use their contact info .
State Financial Assistance Programs
Some states, but not all, have non-Medicaid programs to help the elderly and the disabled to remain living independently in their own homes – this is financial assistance.
State Financial Assistance Programs will pay for assistive devices, safety equipment, durable medical equipment, as well as home modifications.
In general, the programs will pay with grants or loans, or sometimes a combination of the two.
Local Area Agencies on Aging should be able to advise you on programs for the elderly, and if there is one in your state.
Alternatives to bed rails for the elderly
You need to know why your loved one needs bed rails to pick an alternative.
Is it for –
- stopping your loved one from falling out of bed while they are sleeping
- to stop them from slipping from the bed when sitting
- helping to get in and out of bed
- to pull themselves into a better position in the bed
You may get one, or a combination, of the following items to help you with your loved one’s needs.
Here are some alternatives to bed rails for the elderly –
Adjustable height beds
If your loved one is falling out of bed when they are sleeping, an adjustable height bed can help. You can lower the bed to the floor when your loved one is sleeping, so that if they roll off the mattress, they aren’t going to fall.
If your loved one is rolling out of bed while they are sleeping, a simple solution is a concave mattress.
These mattresses have raised edges which slope down to the flat central part of the mattress, and stop a person from rolling out of the bed.
Bed Wedges, Bumpers and Bolsters
Bed Wedges, bumpers and bolsters are each names for the same thing, large pieces of foam which are placed on the mattress to raise up the edges, in relation to the center so a person sleeping can’t roll out of the bed.
As a last resort some people place mattresses on either side of the bed as “crash mats”, which will soften the impact of a fall from the bed.
Vertical Pole from floor to ceiling
A vertical pole can be fixed near the bed which your loved one uses for support to sit on the bed, and for help with getting out of bed.
A bed trapeze is a metal frame which is secured to the head of the bed, hanging from which is a triangular handle.
Your loved one can reach up, grab the handle, and then use it to reposition themselves in the bed while holding onto it.
Bed exit alarms, pressure mats with alarms, motion sensors and pagers, call buttons and pagers, and more, can all be used to alert you immediately your loved one tries to exit their bed.
Wireless baby monitors
Intended for babies, these monitors are perfectly suited for your parent to see if they are trying to get out of bed.
I have an article all about the different ways of monitoring elderly loved ones using, amongst other devices, wireless video baby monitors. You can find that article here.
Bed Rail Bumpers
Bed Rail Bumpers are padded covers for bed rails, and which slip down below the level of the mattress.
Posey All in one beds
Posey beds are really for the most at risk cases, and come at a far greater expense – around $15,000.
The beds are made for hospitals, and are designed to reduce fall risks and to prevent patients from trapping themselves inside bed rails.
You can look at Posey beds here – this is not an affiliate link
It isn’t possible to get bed rails for a conventional bed in the home, but you may be able to get a hospital bed if your loved one qualifies, and their doctor prescribes one.
You can get alternatives to bed rails, which may be a lot safer if your loved one is in any of the “at-risk” groups.
Always check that the Medicare-approved suppliers accept “assignment” before you order
Don’t forget, when arranging your loved one’s durable medical equipment, to make sure that you ask the supplier if they are a “Participating” Supplier who accepts “assignment”.
If you order something with out “assignment” you will be expected to pay the difference in price between the Medicare-approved price and the suppliers price, whatever that may be, plus your 20% co-payment of the Medicare- approved price and if you haven’t yet paid it, your annual deductible. The supplier can charge what he wants in this case.
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I’m Gareth and I’m the owner of Looking After Mom and Dad.com
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