What Type Of Hospital Bed Will Medicare Pay For ?

by | Beginners Info, Health Care

As the costs for the equipment for looking after our elderly loved ones mounts up, it becomes really important to get help wherever you can. So, here’s an outline of Medicare’s hospital bed coverage guidelines and the types of beds they cover. If you don’t qualify, there’s more information on Medicaid and other forms of state funding.

Original Medicare Part B will cover 80% of the cost of variable height hospital beds, semi-electric hospital beds, heavy duty extra wide hospital beds, extra heavy duty hospital beds if you have a prescription from a Medicare-enrolled physician and you use a Medicare-enrolled supplier.  

To qualify for coverage from Original Medicare Part B you have to have a signed prescription from a Medicare-enrolled physician certifying that the bed is “medically necessary”, in concurrence with the Medicare guidelines.

One important point to note is that, Original Medicare Part B will not provide cover for just any hospital bed of the type a person requires, but will usually offer coverage for a basic model of the type for which you qualify.

In some circumstances, if you wish to have a more sophisticated model than the one offered by Medicare, you may be able to pay the difference out of your own pocket to get a model more to your liking.

The reason for the small range of beds that you can choose from, is that Medicare negotiates with suppliers to obtain a certain price for certain beds, and these are the only models which are going to be covered by Original Medicare Part B.

To get the 80% coverage for a hospital bed from Original Medicare Part B, you will have to strictly adhere to their procedures, and also make sure that you use the right equipment suppliers.

What are the different types of hospital bed available ?

There are 4 main types of hospital bed for which you may be able to get coverage for use in your home  –

 

  • manual hospital bed
  • semi-electric hospital bed
  • variable height hospital bed
  • bariatric hospital bed

Manual hospital bed

These beds are fully manual, and adjustments are made by turning a crank. 

The number of cranks may vary.

These are the most economical of all the hospital beds, but also the most physically demanding for the carer.

Variable height hospital bed

Variable height beds are another type of manual bed, which has the added option of adjustable height, so as well as being able to adjust the head and foot sections of the bed, you can change the overall bed height.

The adjustments are made using a hand crank.

The variable height bed is often used for individuals who need to get very low to the floor, and for those who risk falling from the bed, where the best solution for this is to lower the bed as close to the floor as possible while they are sleeping.

Semi-electric hospital bed

Semi-electric beds use motors to adjust the head and foot sections of the bed, and a manual crank to adjust the height of the bed.

The electric motors are easily controlled with a hand held device, which allows the person in the bed to adjust the head, and foot, sections for themselves without calling for help.

This is also a lot easier for the caregiver, both because they can save on time and, and it’s easier on their back, as they don’t need to use a crank to adjust the head and foot sections – although they will still have to use a crank to adjust the height.

Bariatric or “Heavy Duty” Hospital bed

These are hospital beds which are made for heavier individuals.

There are two weight categories for bariatric hospital beds which are covered  –

  

  • 300 lb to 600 lb – Heavy Duty extra wide hospital beds
  • 600 lb and above – Extra Heavy Duty hospital beds

What are the Medicare Part B criteria to qualify for a hospital bed ?

If you meet one or more of the following criteria Original Medicare will typically cover 80% of the cost a hospital bed :

  • If you have 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”
  • If you require “positioning of the body in ways not feasible with an ordinary bed in order to alleviate pain, or”
  • If you require “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. Pillows or wedges must have been considered and ruled out, or”
  • If you require “traction equipment which can only be attached to a hospital bed.”

 

Variable Height Hospital Beds – can be covered by Medicare if you have met one or more of the above criteria , and require “a bed height different than a fixed height hospital bed to permit transfer to chair,  wheelchair or standing position.”

Semi-electric Hospital Beds  – can be covered if you have met one or more of the above criteria, and require “frequent changes in body position and/or has an immediate need for a change in body position.”

  • The “immediate need for a change in body position” here is important, as with a semi-electric bed the user doesn’t need assistance if they can use an electric hand held device to immediately change the position of the head or foot sections.

Heavy Duty Extra Wide Hospital Beds – can be covered if you have met one or more of the above criteria, and your body “weight is more than 350 pounds but does not exceed 600 pounds.”

Extra Heavy Duty Hospital Beds – can be covered if you have met one, or more, of the criteria above, and your body“weight is more than 600 pounds”

Total Electric Beds are considered to be a “convenience feature” and are not covered Medicare, and so are denied as not reasonable and necessary.”

 

The above guidelines are from the CMS (Centers for Medicare and Medicaid Services) Requirements list for Hospital Beds and Accessories.

There is a technical document which you can read on CMS.gov – National Coverage Determination (NCD) for Hospital Beds (280.7)here.

What type of equipment does Medicare Part B typically cover for use in the home ?

Original Medicare Part B typically covers 80% of the cost of equipment for use in the home if it falls into its category of “Durable Medical Equipment” or DME.

I have a long list of Durable Medical Equipment covered by Medicare which you can skip ahead to here.

For Medicare to class equipment as Durable Medical Equipment it must fit the following criteria :-

  • Durable (can withstand repeated use)
  • Used for a medical reason
  • 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

Source: Medicare.gov website – here

Original Medicare Part B covers equipment such as wheelchairs, crutches and walkers, which it sees as “medically necessary”.

Original Medicare Part B doesn’t cover what Medicare considers to be comfort items, such as bathroom safety equipment, air purifiers or a wedge pillow.

Original Medicare Part B’s coverage of the Durable Medical Equipment typically extends to 80 % of the cost of the item, and the beneficiary is responsible for the co-payment of 20%, and if it applies their deductible. 

Does Medicare cover bed rails ?

Original Medicare Part B does not cover bed rails for a standard bed, Medicare does, however, cover hospital beds which come with side rails.

I have already laid out the guidelines above for qualifying for a hospital bed, so if you don’t qualify you may want to look into Medicaid, or some of the other state funding programs.

There is, in every state in the US an Assistive Technology Program, and these programs run online exchanges where state residents can register and either donate, buy, sell (at a very low cost), or exchange, durable medical equipment and AT devices.

You can skip ahead to the Assistive Technology Program section here, and find out about projects and online exchanges in you state.

If you are interested in getting bed rails you may want to take a look at my article “Alternative to bed rails for the elderly”.

Bed rails are not the safest option for certain categories of elderly, or frail individuals, and have been linked to deaths in certain cases.

In my article, I outline a range of safer options which can also stop an elderly loved one from falling out of bed, and you can find that here.

Does Medicare cover trapeze bars ?

Yes, Original Medicare Part B will typically cover 80 % of the cost of trapeze bars in certain situations.

The beneficiary must be bed bound, and the trapeze bar has to be prescribed as “medically necessary” by a Medicare-enrolled doctor according to the Medicare guidelines.

The Medicare guidelines are as follows –

If you already have a Medicare covered hospital bed, a trapeze bar attached to a bed is covered –

“if patient is bed confined and the patient needs a trapeze bar to sit up because of a respiratory condition, to change body position for other medical reasons, or to get in or out of bed”.

A trapeze which is attached to an ordinary bed will not receive Medicare coverage, but –

if you do not have a Medicare covered hospital bed a “Free standing” trapeze bar is covered –

“if patient is bed confined and the patient needs a trapeze bar to sit up because of a respiratory condition, to change body position for other medical reasons, or to get in or out of bed”.

The source text of the guidelines is the “National Coverage Determination (NCD) for Durable Medical Equipment Reference List (280.1) implemented in 7/5/2005 which is available for all to read at CMS.gov.

If the user’s body weight exceeds 250 lb and they meet the criteria outlined above, they will qualify for Medicare coverage for a “heavy duty” trapeze bar.

Does Medicare cover bed wedges ?

Original Medicare Part B does not consider bed wedges to be “medically necessary”, and as such bed wedges don’t receive any coverage.

State programs such as Medicaid, non-Medicaid State Financial Assistance Programs and Assistive Technology Projects may give coverage for bed wedges, if you are eligible for any of those programs.

You may also be able to find bed wedges through you state Assistive Technology Project online exchange.

As I said earlier, you can register to their site, look for donated items, and items for sale at a low cost.

The programs also “reuse” schemes in partnership with community groups.

You can either, contact your local Area Agency on Aging to find out about the community groups in your area running reuse schemes, or simply go to the section in this article on Assistive Technology Projects here, and see what your state is offering.

Does Medicare cover bed alarms ?

Original Medicare Part B does not give any coverage to bed alarms or bed exit sensors, as they are deemed to be “not medically necessary”.

Just because you can’t get one covered by Medicare though, doesn’t mean that you can’t get one under Medicaid, or one of the different state funded programs for which many elderly adults can qualify.

I will be laying out the different options with state level programs, and funding opportunities, once I have outlined the procedure for applying for a hospital bed with Medicare.

If you want to learn about bed alarms and bed exit sensors, I have a long article which takes an in depth look at the different types and their possible uses – I have bought and tested a range of types, and with my mom we used them to find out which we preferred and found to be the best. You can read that article here.

Does Medicare cover over-bed tables ?

Over-bed tables are the tables that you typically see in hospitals, which have a stand at one side with a base with wheels or casters, and that slips under the bed as the table top moves into place over the bed.

Original Medicare Part B does not offer coverage for over-bed tables, as it does not considered them as “medically necessary”, but rather as a “convenience item” which is “not primarily medical in nature”.

The medicare guidelines 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) – You can find the document here, on the Center for Medicare and Medicaid Services website (cms.gov).

Over-bed tables may well be covered under Medicaid, state HCBS programs, waivers and 1915 waivers, and other state financial assistance plans for the elderly and disabled, which I will be covering after the next section on the Medicare purchasing procedure.

How often can you get an adjustable bed with Medicare ?

For Original Medicare to replace any covered durable medical equipment which is worn out, including a hospital bed, it must have been in your possession for its whole lifetime.

For Original Medicare the lifetime of a covered piece of durable medical equipment cannot be less than 5 years.

Original Medicare will only replace “like for like” – when an item is replaced you cannot get an upgraded version, the replacement will be same as the equipment it replaces.

And if a DME is damaged or stolen?

If any durable medical equipment which had Original Medicare Part B coverage is lost, stolen, or damaged in an accident or a natural disaster, and so badly that it can’t be repaired, Original Medicare Part B will, as long as you have the proof of coverage, replace it.

To locate a Medicare-enrolled supplier you can use this link to Medicare.gov

You can check Medicare’s documentation on DME’s here – Mediace.gov 

How do you get coverage from Original Medicare Part B ?

The criteria for getting coverage from Original Medicare Part B for Durable Medical Equipment for “use in the home”

 

  • you must be enrolled in Original Medicare Part B program
  • you will have to have a prescription signed by your Medicare-enrolled doctor certifying the equipment is a “medically necessary”
  • the procuring of the equipment  must be done through a Medicare-enrolled supplier

What does Medicare mean by “living at home” for coverage –

This can be

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

What do you do with the signed prescription ?

With your prescription in hand prescription you will proceed as follows –

  • you find a Medicare-enrolled DME supplier
  • ensure that the supplier is a Medicare-enrolled “participating supplier who accepts “assignment’ – this minimizes your costs
  • do all of the required Medicare paperwork with the supplier to make sure that you comply for the Medicare coverage guidelines for your hospital bed

Assuming that you have done exactly what I have laid out above, Original Medicare Part B typically covers 80% of the Medicare-approved price for your hospital bed.

And, assuming that you are acquiring your hospital bed from a Medicare-enrolled “participating” supplier who accepts assignment, you will be responsible for paying your Medicare 20% co-payment of the Medicare-approved price of the hospital bed, plus your deductible if it applies.

Always confirm with the supplier before you enter into any agreement that the supplier is a Medicare-enrolled “participating” supplier who accepts “assignment”  !

 

Medicare Rentals – if your hospital bed is rented from a Medicare-enrolled supplier, you will still have the same amount to pay as if you bought it rather than renting.

With a hospital bed, it is more than likely that Original Medicare Part B coverage will be done on a rental basis, as this is standard practice for larger items.

The difference is that you will still pay a 20% co-payment, but it will be a monthly rental ie 20% of the Medicare agreed monthly rental price that you will pay monthly. And your deductible will be paid at the outset, if it applies.

Find a local Medicare-enrolled DME Supplier near you

This link will help you to find a Medicare-approved supplier who is local to you –  Medicare.gov

What do you do if you have a Medicare Advantage Plan ?

Medicare Advantage plans have to offer at least the same coverage as Original Medicare Parts A and B, as they are companies which have been contracted by Medicare to provide the same Medicare services, and sometimes a few extra benefits as well.

So Medicare Advantage plans will cover  hospital beds so long as you fulfill the Original Medicare criteria.

This is the list of durable medical equipment which is typically covered by Medicare

To qualify you will need to have Original Medicare Parts A and B.

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.

Corrective Lenses

Prosthetic Lenses
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
Intraocular lenses

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 help with understanding Medicare

SHIP – State Health Insurance Assistance Programs – your SHIP offers state one-on-one guidance on Medicare services, if you would like to talk to someone about Medicare.

The service is usually offered over the phone.

In addition SHIP offers free counseling for Medicare Advantage, Medigap and Medicaid benefits.

If you would like to connect State SHIP 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 hospital beds ?

On a state level there are different options as to what can be done with Medicaid.

In all states, Medicaid may agree to waive some of the requirements for eligibility for different programs.

The programs where Medicaid agrees to waive requirements are called “waivers”.

Check to see what your state offers.

Health Care in the home – Medicaid and state programs

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

The goal of the programs is to help the participants to maintain their independence in their homes, and the community.

The programs, and waivers, will all cover “home medical equipment”, and in some cases they will cover as much as 100% of the cost.

To check your eligibility for any programs contact your State Medicaid Agency here.

For more information on HCBS programs, or waivers, you can go here on Medicare.gov –

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

For the purposes of these programs the term “home” 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 home care with a greater breadth in what they understand to be DME

There are two main state program types which offer the broadest interpretation of durable medical equipment

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

Participants on these programs and waivers will, with the help of an appointed financial advisor, get to decide what equipment is necessary for them to maintain their independence in their homes. 

If the equipment they require is within their budgetary constraints, they will invariably be allowed to purchase it – but it must be proven to be necessary. 

The types of equipment which qualifies here is far more broad ranging than under Medicare.

To find out more about Medicaid Self Direction click here.  

The Medicaid program “Money Follows The Person”

This Medicaid program was set up to help elderly adults living in nursing homes to move back to into their own homes

It supports individual states with the funding to either, build a new program from the ground up, or to adapt an already existing program.

Programs may pay for remodeling parts of the home to make things safer, improve lighting, build ramps etc or just buy a shower chair.

The range of durable medical equipment is far wider than that which is allowed on Medicare.

What if you make too much for Medicaid assistance ?

Certain states have a program called Spend Down.

Spend-Down programs will help to lower a person’s income level so that they may consequently qualify for Medicaid, HCBS’s and waivers.

The particular method offered which is of interest here, is one which allows a person to subtract their medical expenses from their income, if as a result their income level falls below the Medicaid eligibility limit, they will be deemed eligible.

There is a good article on the subject on the US NEWS website here.

Sadly, Spend-Down is not available in every state of the US.

What’s the step by step procedure for getting DME with Medicaid, 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 find what programs your state has click here.

Step 1 –

Select your state from 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 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 in all states across the US have been designed to improve access to assistive devices in the home primarily for the elderly and the disabled.

Most state Assistive Technology Programs have  –

  • an online exchange where people will post assistive devices and medical equipment for sale, or as donations on a first come first serve basis – state residents can just register on the exchange website, and participate
  • a main website where you can make contact and ask about how to get access to free equipment, and what the eligibility requirements are
  • reuse and refurbishment programs which are run by the state program, or partnered with  community groups  to help them provide free or extremely low cost equipment for the disabled, the elderly and other disadvantaged individuals – sometimes the equipment is free, and in other cases you have to pay a little, depending on the individual’s circumstances
  • some states have loan closets as part of their program, and particularly short term loans for checking that the equipment suited to an individual

 

Assistive Technology Programs will also make contact with individuals who enroll when they know that there is equipment available that the person needs.

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

To see what projects are in your state click here

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 large number of states will have non-Medicaid programs designed to assist the elderly, and the disabled, in maintaining a more, or less, independent lifestyle in their own homes – these are usually known as State Financial Assistance Programs.

State Financial Assistance Programs will pay for a wide variety of assistive and safety equipment, and even home modifications.

The durable medical equipment and remodeling are paid for with grants or loans, or sometimes a combination of both.

To find out about your State Financial Assistance Programs ask at your local Area Agency on Aging. 

You can find your local Area Agency on Aging here.

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    What type of hospital bed will Medicare pay for ?
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    Original Medicare Part B will cover 80% of the cost of variable height hospital beds, semi-electric hospital beds, heavy duty extra wide hospital beds, extra heavy duty hospital beds if you have a prescription from a Medicare-enrolled physician. 
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