Will Medicare Pay for a Hospital Bed to Use at Home?

Medicare may cover the cost if you or a loved one needs a home hospital bed. This article explores the ins and outs of Medicare coverage for home hospital beds, including the conditions Medicare will pay for a hospital bed and which Medicare plans cover this benefit.

What is a home hospital bed?

A home hospital bed is a specialized bed used for medical purposes. These beds are typically adjustable, allowing the user to change position to make it easier to get in and out or adjust the angle to relieve pressure on specific organs or limbs. Home hospital beds may also have features like rails, which can help prevent falls, or built-in mechanisms for lifting the head or feet.

Advantages and disadvantages of home hospital beds

There are several benefits to using a hospital bed at home, including:

• Improved comfort and safety for the patient.
• Easier transfer in and out of bed.
• Reduced risk of falls.
• Relief from or prevention of pressure sores.
• Ability to adjust the bed to a position to a more comfortable position.
• Assistance with breathing difficulties.

However, there are also some potential drawbacks to using a hospital bed at home:

• Hospital beds take up more space than traditional beds, so you may need to rearrange furniture or make other accommodations in your home.
• Some people may feel uncomfortable having a hospital bed in their home as it can symbolize illness or frailty.
• Hospital beds come with various features and functions, which can be complicated and challenging to operate without proper training.
• Hospital beds require regular cleaning and maintenance, which can be time-consuming.

Does Medicare cover hospital beds? Conditions that qualify

Medicare will cover 80% of the Medicare Approved costs of a hospital bed for qualifying individuals while the individual will cover 20%, although other plans may cover this remaining cost. A physician's prescription is necessary to qualify for a home hospital bed, and other documentation may be requested by the Medicare Administrative Contractor (MAC) staff. Individuals should acquire the hospital bed from an approved Medicare supplier that accepts the Medicare fee schedule.

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Medical conditions qualifying for a home hospital bed include:

• Quadriplegia and paraplegia
• Cardiac disease
• Severe arthritis
• Stroke
• Lower extremity injuries

Which Medicare plans cover home hospital beds?

Medicare may cover costs for a hospital bed for use at home. However, the specifics of the coverage vary, depending on if an individual has additional coverage through a Medicare Supplement or Medicare Advantage Plan. It's important to check with your plan to understand the coverage specifics. While Medicare may cover the cost of the bed, it may not cover all associated costs, such as upgrades or certain accessories.

Medicare part A

Medicare Part A covers inpatient care in hospitals, hospice care, and some home health care. If the patient is in a hospice program, Medicare Part A may cover the cost of a hospital bed. The hospice provider will typically provide the bed and other necessary equipment. Medicare Part A will only cover the cost of a hospital bed if the patient is enrolled in a hospice program and not for general home use.

Medicare part B

Medicare Part B covers medically necessary services and supplies, including doctors' services, outpatient care, preventive services, and medical equipment. If a patient meets the medical criteria for the bed and has a prescription, Medicare Part B may cover the cost of a hospital bed. In this case, Medicare will cover 80% of the price of the bed provided the deductible has been met. The patient may be eligible for other payment assistance through local and state programs and charitable organizations. Veterans may be covered under their Department of Veterans Affairs (VA) insurance and supplemental insurance such as Tricare for Life.

Medicare part C (Medicare Advantage Plans)

Medicare Advantage Plans, also known as Medicare Part C, provide all the benefits of Medicare Part A and Part B and may offer additional benefits, such as coverage for home hospital beds. However, the specifics of the coverage vary from plan to plan. Since these plans are obtained through private insurance companies, check with your plan to understand the coverage details, cost-sharing requirements, limitations, and restrictions.

What is the price of a hospital bed with Medicare?

The cost of a hospital bed with Medicare coverage depends on the plan and supplier. Under Medicare Part B, the patient typically pays 20% of the Medicare approved fee allowed for the bed, while Medicare covers the remaining 80%. For example, if a hospital bed costs $5,000, the patient's out-of-pocket cost would be $1,000, and Medicare would cover the remaining $4,000. On average, hospital beds can cost anywhere from $500 to $5,000, with more advanced models costing upward of $10,000 depending on the bed's features and the supplier. To determine the exact cost and coverage for a specific bed, it's best to check with Medicare and the supplier.

How much is a hospital bed without insurance?

The cost of a hospital bed without insurance can vary depending on the supplier and the specific features of the bed. Without insurance, a hospital bed can cost anywhere from $500 to over $10,000 out of pocket. Patients without insurance can negotiate a lower cost with suppliers or may be eligible for financial assistance programs. However, it's always best to compare prices and explore all options before purchasing a bed with cash.

Does Medicare cover the cost of bedsheets?

While Medicare may cover the cost of a hospital bed, it does not cover the cost of bedsheets. Patients or their caregivers will need to purchase or provide sheets. However, some suppliers may offer packages that include sheets and other accessories as part of the overall bed cost. Check with your supplier to understand what is included in the package deal and what additional fees may be associated with purchasing the bed.

Alternatives to hospital beds

Should Medicare not cover the cost of a hospital bed, alternative options are available, including:

• Adjustable beds. These beds are similar to hospital beds but are designed for home use.
• Lift chairs. Lift chairs can help individuals with mobility issues get in and out of a seated position.
• Recliners. Recliners can help the individual with mobility issues get in and out of a seated position and provide some of the same benefits as an adjustable bed.

In the absence of a physician's prescription or insurance coverage, hospital bed alternatives can provide comfort and safety. If you're uncertain what will work for the patient, ask your healthcare provider for recommendations. You should also check how each alternative is covered under Medicare.