Does Medicare Cover Over-Bed Tables ?

by | Beginners Info, Health Care

As my mom gets older and I need to find different types of medical and safety equipment that may make her life easier and safer, I am constantly checking to see how she will be able to finance it. Fortunately my mom is not bed bound, but she liked the idea of a large over-bed table which could be wheeled around. And so the inevitable question arose …

Does Medicare cover over-bed tables ? Original Medicare Part B does not cover over-bed tables for use in the home, as they are not considered “medically necessary”. Over-bed tables may be covered under Medicaid, state HCBS programs, waivers and 1915 waivers, and other state financial assistance plans for the elderly.

Medicare considers over-bed tables to be a convenience item which is “not primarily medical in nature”, and as such they will not cover them as durable medical equipment.

The medicare guidelines for over-bed tables are –

“Over-bed Tables  –  Deny – convenience item; not primarily medical in nature (§1861(n) of the Act).”

Source: National Coverage Determination (NCD) For Durable Medical Equipment Reference List (280.1) – which if you wish to, you can look at here, on the Center for Medicare and Medicaid Services website (cms.gov).

For anyone who isn’t quite sure what I mean by an over-bed table, these are the tables that you see in hospitals which which have a stand, generally with four wheels or casters, which slides under the bed as the table top moves in over the bed. 

For anyone who spends a large percentage of their time in, or on their bed, these tables can be extremely helpful. You can typically alter both the height, and the angle of the table top from horizontal to vertical, and all the angles in between.

So what is Durable Medical Equipment ?

Original Medicare calls the medical equipment that it is will cover Durable Medical Equipment.

Please note that –

Original Medicare Part B covers durable medical equipment for “use in the home”.

Original Medicare Part A (hospital care) covers medical equipment used in skilled nursing facilities, including durable medical equipment for short term stays.

For an item of equipment to make it into the Medicare pantheon of Durable Medical Equipment it must fulfill  following criteria –

 

  • it must be able to withstand continuous use over a long period of time – durable
  • it is only to be used for medical reasons – not for comfort or convenience
  • it must be useful to person who is sick, and of virtually no use to a person who well
  • it’s primary usage must be in the home
  • it has to be able to perform it’s function properly for at least of 3 years

Let’s now take a look at some medical and safety equipment so we can broadly outline –

 

  • what Medicare will and won’t typically cover
  • how to get Medicare coverage when it is offered
  • what mistakes not to make with Medicare
  • how to get free Medicare counseling in your state

What about bathroom safety equipment ? Will Original Medicare Part B cover it ?

Before becoming a caretaker for my mom and dad, and really taking a long look into Medicare, I thought that equipment such as grab bars, raised toilet seats or shower chairs, or any equipment which would make the bathroom a safer place for our elderly parents, would likely get insurance coverage ……

Well it ain’t necessarily so !

Medicare is not there to help prevent the elderly from having accidents in the home, it is there to provide medical equipment for those who have a condition which qualifies them for help.

All equipment which is covered by Medicare, as I have already said, must be “medically necessary” as certified by a Medicare-enrolled Doctor. 

And if you read the latter part of this article, you will see how this differs from state funding sources which work to help the elderly maintain their independence in their own homes, and largely by creating a safe environment for them.

Medicare will not cover any of the following items for bathroom safety –

  • grab bars
  • raised toilet seats 
  • bath lifts
  • bath seats
  • floor to ceiling poles
  • shower chairs
  • bath chairs
  • transfer seats
  • toilet safety frames

Medicare does recognize equipment for those with serious mobility issues as “medically necessary”, and if you meet their qualification guidelines, you can coverage for –

  • crutches
  • walkers
  • bedside commodes

Each of these items can be used in the bathroom as safety equipment.

How do you get coverage from Medicare Part B for DME ?

To get coverage from Medicare Part B for DME for “use in the home” –

  • you have to be enrolled in Medicare Part B
  • have your Medicare-enrolled doctor sign a prescription certifying that the equipment is a “medically necessary” 
  • you must purchase or to rent the DME through a Medicare-enrolled supplier

For Medicare coverage “living at home” is  defined as –

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

So what about exercise equipment, that’s for your health ?

Exercise equipment is not considered “medically necessary” by Original Medicare, and typically neither are exercise classes.

Original Medicare Part B will provide some cover for physiotherapy and occupational therapy where it has been prescribed as “medically necessary’ by a physician.

  • the treatment must be provided on an outpatient basis
  • the therapist must be Medicare-certified
  • the therapy must be regularly reviewed by the prescribing physician

As with equipment you will need to make sure that the provider charges the Medicare-approved amount. Medicare will pay 80% of the Medicare-approved fee for the therapy, and the patient covers the remaining 20% of the cost, plus their deductible if it applies.

Some Medicare Advantage Plans have coverage for exercise plans and gyms, but you will need to ask your provider.

How often does Medicare cover something it covers, like a walker for instance ?

Original Medicare Part B will replace DME that you rent, or own, if they –

  • are worn out through use
  • have always been in your, and only your, possession for its lifetime
  • so worn out that it can’t be repaired
  • have exceeded their lifetime (five years is the minimum period considered to be a lifetime for an item) – the lifetime can vary depending on the type of equipment

For a piece of equipment such as a walker which is worn out, Medicare Part B will typically replace it every five years, if it has always been in your possession, and if it is beyond repair.

If your equipment is worn out before it gets to the end of it considered lifetime, Medicare will have it repaired, unless that is the repair is more costly than a new item.

To replace a worn out item, you will have repeat the whole procedure of getting a prescription from a Medicare-enrolled doctor and then going to a medicare-enrolled supplier to get the new piece of equipment.

The process may be different for items which require prior approval, where you need to contact Medicare before you go to a supplier.

How do you proceed once you have the signed prescription from your Medicare-enrolled doctor ?

Once you have a signed prescription from a Medicare-enrolled physician for your piece of equipment –

  • you have to search out a Medicare-enrolled DME supplier – I have placed a link to Medicare’s website to their supplier locator just at the end of this current section
  • you should ensure that the supplier is a Medicare-enrolled “participating supplier who accepts “assignment’, and not just a Medicare-enrolled supplier – this will help you to avoid paying any more than you absolutely have to
  • the models of each type of equipment to which Medicare gives coverage are often the most basic in any range, so if you want an upgrade you are going to have to pay for this out of your own pocket, if an upgrade is possible – but be warned that it isn’t always possible
  • do all of the Medicare part B coverage paper work with the Medicare-enrolled supplier to make sure you get coverage

Medicare part B covers 80% of the Medicare-approved price for DME, 

  • if you have used a Medicare-enrolled supplier
  • with your prescription from a Medicare-enrolled doctor certifying that your DME is “medically necessary”

 

If you used a Medicare-enrolled “participating” supplier who accepts “assignment” for your purchase or rental, you will only pay your Medicare 20% co-payment of the Medicare-approved price, plus, if it applies, your deductible .

A Medicare-enrolled supplier who is not a “participating” supplier and who doesn’t accept “assignment” can add up to 15% to the cost of equipment above the Medicare-approved price for that particular piece of equipment, and you will have to pay this extra along with your co-pay of 20% of the Medicare agreed price.

So, don’t forget – You must purchase, or rent, from a Medicare-enrolled “Participating” supplier who accepts “assignment, otherwise you may pay a lot extra for no reason.

Confirm this with the supplier !

 

Medicare Rentals – if your equipment is rented from the supplier (rather than purchased outright), you will still have the same payment structure (as if it was purchased), so you will pay a monthly 20% co-payment of the monthly rental, rather than the one time 20% co-payment of the purchase price.

With a rental you will pay your deductible at the outset, if it applies.

And Medicare will pay the remaining 80% of the monthly rental each month.

Finding a local Medicare-enrolled DME Supplier near you

Here is the link I mentioned above to find a Medicare-approved supplier who is local to you –  Medicare.gov

For those with a Medicare Advantage Plan ?

Medicare Advantage plans must cover everything that Original Medicare Parts A and B cover, as they are contracted by Medicare to provide all the Medicare services.

They will often have some extras benefits, but they are not obliged to cover over-bed tables.

According to your plan provider, the procedures for assuring coverage and acquiring the DME will vary, and each provider will have their own network of doctors and suppliers which you will be obliged to use.

Durable Medical Equipment generally covered by Medicare if you qualify

If you don’t find the equipment you are looking for on my list of Original Medicare Part B covered DME 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.

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
Urological supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.

Free one-on-one counseling to help with understanding Medicare

SHIP – State Health Insurance Assistance Programs – your SHIP has counselors who can talk with you and advise you about Medicare.

This normally functions uniquely as a phone service, but some programs will offer face-to-face appointments as well.

SHIP doesn’t just help with Medicare, but also advises on Medicare Advantage, Medigap and Medicaid benefits.

You can connect with your local Medicare SHIP counselors here.

Step by Step – How to contact a SHIP counselor in your state

Step 1 –

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

Step 2 –

Click on either “Ship Locator” button or the “Find Local Medicare Help” button.

Step 3 –

Click on your state.

Step 4 –

A window will come up with the website contact info and a phone number for you to call in your state.

Does Medicaid cover over-bed tables ?

Medicaid state programs receive their funding both federally and from the state, which means that so long as a program sticks within basic guidelines, the states have lots of options to adapt programs to better suit their needs.

Medicaid will often agree to waive particular requirements for eligibility for a program, so that a state can provide health care to specific groups of people who are being missed by the system up to that point.

Programs on which Medicaid waives requirements are called “waivers” – the programs will typically have quite targeted eligibility requirements, and limited places.

This method of Medicare dropping certain requirements in for different programs has resulted in there being literally hundreds of different “waivers”, or programs, across the US, all of which have different eligibility criteria and can address the needs of specific groups.

Each state has its own range of programs, so do check to see what they offer.

Health Care in the home – Medicaid and state programs

 

Health care in the home programs for low income families, the disabled, and the elderly are called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”.

These programs have as their main objective, to give the help that the program participants need to maintain their independence in their homes, and in the community.

One aspect of these programs’ work is to help cover the cost “home medical equipment”, and often the program will cover the costs 100%.

If you want to find out whether you are eligible for any programs contact your State Medicaid Agency here.

To delve deeper into the topic of HCBS programs, or waivers, you can use the link below to medicaid.gov –

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

For these Medicaid and state programs the term “home” for a participant is used to mean the following –

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

 

Programs and waivers for “in home care” which allow coverage for a broader spectrum of DME

Consumer Direction or Self Direction

Some HCBS programs and waivers employ a system of budget self-management which can be called either “Consumer Direction”or “Self Direction” 

The participant self-manages to a large extent how their allocated program budget is spent.

The program participants are allotted a sum of money to provide for their needs, plus the assistance of an appointed a financial advisor, who is there to guide them.

What is considered to be essential to the participant’s ability to maintain their independence in their own homes, including medical equipment, and devices, so long as the budget covers it, is usually covered.

The range of equipment considered to be in the category of Durable Medical Equipment is considerably greater than that with Medicare.

You can find out more about Medicaid Self Direction click here.  

The Medicaid program “Money Follows The Person”

 

“Money Follows The Person” is a Medicaid program designed to assist elderly adults in nursing homes with moving back to into their own homes.

The Medicaid program assists with the funding for the different states in order that they may build their own Money Follows the Person programs.

The state programs can adapt current HCBS waivers to assist the elderly to transition into their own homes, or it can take the Medicaid funding to design new programs from the ground up.

Each individual elderly case is assessed, and all that is essential to the move, and to maintaining that person’s independence will be covered by the program.

Programs may remodel parts of the home to make things safer, improve lighting, build ramps etc, or help to buy simple medical equipment such as a shower chair.

The range of DME allowed is again considerably greater than that allowed on Medicare.

What if your income is a bit too high to qualify for Medicaid ?

The Spend Down Program

I must point out that, unfortunately, not all states have a Spend Down program.

Very simply put, Spend-Down programs lower a person’s income level, so that they are able to qualify for Medicaid, HCBS’s and waivers.

One specific method which is to subtract all the person’s medical expenses from their income, and if the resulting income level falls below the Medicaid eligibility limit, the person will be deemed eligible for Medicaid assistance.

There is a very good and comprehensive article on the US NEWS website here.

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

Step 1

– the doctor, or therapist, has to provide a medical justification letter, stating it is medically necessary

Step 2

–  find a Medicaid-approved DME supplier , and give them the medical justification letter

Step 3

– the Medicaid-approved supplier fills out a Prior Approval Application form for Medicaid

Step 4

– the Prior Approval Application is sent to the Medicaid State Office

Step 5

– if you are unsuccessful you will be contacted  and given the reasons as to why, as well as advice on how to make an appeal

Step 6

– if approved, you will receive the DME

Looking for HCBS programs, waivers and 1915 waivers and their eligibility criteria in your state

To program availability in your state click here.

Step 1 –

Select your state from those on the map.

Step 2

Click on you state 

Step 3 –

Choose –

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

You will then see a page like this example below, with the programs and waivers in your state, and their eligibility criteria.

To find your State Medicaid State Agency

If you want to discuss things, or to email someone, you can contact you state Medicaid Agency here.

Step 1 –

Click the link to Medicade.gov and look for the section that I have outlined in red.

Step 2 –

Select your state and click on the button they have marked “GO” – it will take you to your State Medicaid Agency with all their contact info.

State Funding Assistance

Assistive Technology Programs

Assistive Technology Programs exist in all states across the US, and are there to improve access to assistive devices in the home for primarily the elderly and the disabled.

The term “Assistive Technology” signifies equipment and devices which permit a person to complete actions they otherwise could not.

The items can be bathroom grab bars, jar openers, shoe horns or electronic digital devices.

A large number of states have an online exchange, with a website, which will have assistive devices and medical equipment posted by individuals for sale, or as donations. You can easily register for the online exchange, contact the other members if you find a piece of equipment which interests you.

Programs will also make contact with individuals who enroll, when they know that there is equipment available that the person needs – items for sale are usually at a low cost.

Reuse and refurbishment programs exist which are run either by the state assistive technology program, or by community groups who partner with the state program to provide free, or low cost equipment.

You can find out all about this on your state assistive technology program website.

To see what projects are in your state click here and then follow the steps below.

Step 1/

Pick your state on the map or  the drop down menu, and click on  “Go to state”

– I chose Florida for this example

Step 2/

Click on the link “Program Title” – for my example I outlined it in red.

Step 3/

The AT Program state website will come up, and you can sign up, or use their contact info .

State Financial Assistance Programs

A number of states have non-Medicaid financial assistance programs designed to help the elderly, and the disabled, to maintain their independence living in their own homes.

State Financial Assistance Programs will pay for assistive and safety equipment, and even home modifications –  wheelchair ramps, re-modeling a kitchen equipment, and safety equipment for the bathroom.

The programs pay with grants or loans, or sometimes a combination of both.

To start your search for such a program I would go talk to your local Area Agency on Aging who should be able to tell you more about the financial assistance programs for the elderly in your state.

    Summary

    You cannot get an over-bed table with Medicare Part B for use in the home, as it is not considered to be “Durable Medical Equipment” which is the category of equipment for which Medicare offers coverage.

    If you qualify for a Medicaid HCBS waiver or non-Medicaid state program, they, in many cases, accept a broader range of equipment as DME and will often pay 100% of the cost.

    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 overbed tables ?
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