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Medicare identifies hospital beds as durable medical equipment (DME) and includes them under Medicare Part B. It is essential to understand the eligibility criteria and potential out-of-pocket expenses involved.
Under specific conditions deemed medically necessary and prescribed by a healthcare provider, Medicare may cover either the purchase or rental of a hospital bed, provided it is sourced from a Medicare-approved supplier.
Medicare considers hospital beds as durable medical equipment (DME), and they fall under the purview of Medicare Part B. However, to qualify for this coverage, several stipulations must be fulfilled.
Even with Medicare's coverage for your hospital bed, you might incur certain out-of-pocket expenses. Familiarize yourself with your coverage details.
Does Medicare Cover Hospital Beds?
Medicare Coverage for Hospital Beds
Definitely, Medicare will cover the expenses associated with hospital beds, given that you meet specific eligibility criteria. Medicare will address the costs for either renting or purchasing a hospital bed for home usage if:
- You are registered in Medicare Part B
- A physician has marked the bed as medically necessary
- The bed is supplied by a Medicare-approved medical equipment distributor
Per Medicare.gov, "Doctors and suppliers must adhere to rigorous standards to enroll and remain in Medicare. If your healthcare providers or suppliers are not enrolled, claims submitted by them will not be compensated by Medicare."1
Cost Implications for Hospital Beds with Medicare
Should your request to rent or purchase a hospital bed be sanctioned for Medicare coverage, the cost responsibility falls on you to pay 20 percent of the Medicare-recognized amount, while Medicare will handle the remaining 80 percent.
Before Medicare disburses its share, you will have to meet your Part B deductible. In , the standard Medicare Part B deductible is $240 annually.
Medicare does provide coverage for both the rental and purchase of hospital beds. After a duration of 13 months in rental, you will officially own the bed following Medicare's rules. The specific costs associated with your hospital bed may be influenced by factors such as:
- Physician fees
- Your geographical area
- Other existing insurance coverage
Your healthcare provider can provide further insights regarding the anticipated expenses you might incur under Medicare for your hospital bed.
Competitive Bidding Program of Medicare
As part of Medicare's Competitive Bidding Program, DME suppliers put forth bids to supply equipment to recipients residing in or visiting designated competitive bidding zones. If you are on Original Medicare and are located in or temporarily in a competitive bidding area, you must acquire your DME from a supplier that has a contract.
Check Medicare.gov to determine whether you reside in a competitive bidding region.
Does Medicare Cover Hospital Stays?
Medicare Part A encompasses inpatient hospital stays, skilled nursing care, hospice services, and limited home healthcare services.
When you are admitted to a hospital under Medicare Part A, your coverage includes:
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Semi-private accommodations
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Meals
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General nursing services
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Prescription medications administered during your stay
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Care as part of a qualifying clinical research trial
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Additional hospital services and supplies
However, not covered are costs for private nursing services, most private rooms, personal items, and entertainment services.
Hospital Stay Expenses with Medicare
Before Medicare Part A will contribute to the costs of a hospital stay, you need to meet your Medicare Part A deductible, which is ' $1,632 per benefit period (in ).
For extended hospitalizations, coinurance might apply based on the duration of your stay (all amounts listed pertain to the current year):
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Days 1-60: $0 coinsurance
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Days 61-90: $408 per day as coinsurance
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Days 91 and further: $816 for each "lifetime reserve day;" you have a total of 60 lifetime reserve days.
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After lifetime reserve days: You are responsible for all costs.
Medigap Plans for Hospital Stay or Bed Costs
Medicare Supplement Insurance plans (Medigap) can assist in covering the out-of-pocket expenses correlated with a hospital stay.
Additional resources:Neusoft Medical Systems : Quotes, Address, Contact
Are you curious about procuring electric hospital beds for sale? Get in touch with us today for an expert consultation!
All Medigap plans cover various hospital benefits, including:
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Medicare Part A coinsurance and related hospital fees
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First three pints of blood required for transfusions
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Part A hospice care coinsurance or copayment
Select Medigap plans might also encompass coverage for:
With 10 standardized Medigap options available in most states, you can discover one that aligns with your needs. Reach out today to speak with a licensed insurance agent who can aid in comparing Medigap plans accessible in your locality.
Important: Plan F and Plan C accessibility may be limited for beneficiaries who became eligible for Medicare on or after January 1, .
Medicare Supplement Insurance can help mitigate your out-of-pocket hospital bed expenses.
Find a plan
Or call
1-800-995-
to connect with a licensed insurance agent.
LCD - Hospital Beds and Accessories (L)
To qualify for Medicare coverage, an item must 1) fit within a defined Medicare benefit category, 2) be judged necessary and reasonable for diagnosing or treating an illness or injury, or improving a malformed body part's functionality, and 3) comply with all other pertinent Medicare statutory and regulatory requisites.
A Local Coverage Determination (LCD) aims to clarify the "reasonable and necessary" standards as delineated by Social Security Act § (a)(1)(A).
Supplemental to the "reasonable and essential" benchmarks specified in this LCD, additional payment rules must be adhered to prior to Medicare compensation:
- Refer to the LCD-related Standard Documentation Requirements Article at the bottom of this policy under the Related Local Coverage Documents section.
- Refer to the LCD-related Policy Article at the bottom of this policy under the Related Local Coverage Documents section.
- Check the Supplier Manual for further details regarding documentation necessities.
- Visit the DME MAC websites for supplementary articles and publications associated with this LCD.
For the items discussed in this LCD, the "reasonable and necessary" benchmarks defined by Social Security Act § (a)(1)(A) include the following coverage indications, limitations and medical essentials:
A fixed height hospital bed (E, E, E, E, and E) is eligible for coverage if one or more of the criteria below (1-4) are satisfied:
- The individual has a medical condition that necessitates body positioning that cannot be accomplished with a standard bed. Elevating the head/upper body by less than 30 degrees generally does not necessitate a hospital bed.
- The individual requires positioning in ways not achievable with an ordinary bed to alleviate discomfort.
- The individual needs the head of the bed elevated by more than 30 degrees consistently due to congestive heart failure, chronic pulmonary conditions, or aspiration issues.
- The individual requires traction apparatus that can only be secured to a hospital bed.
A variable height hospital bed (E, E, E, and E) qualifies for coverage if the individual meets the evaluation criteria for a fixed height hospital bed and necessitates a bed height that differs from a static height bed to support transitions to a chair, wheelchair, or standing position.
A semi-electric hospital bed (E, E, E, E, and E) is qualified for coverage if the individual meets one of the criteria for a fixed height bed and has a pressing need for frequent body positioning adjustments.
A heavy-duty extra-wide hospital bed (E, E) is covered if the individual meets one of the evaluation criteria for a fixed height hospital bed and their weight exceeds 350 pounds but is less than 600 pounds.
An extra heavy-duty hospital bed (E, E) is covered if the individual meets one of the evaluation criteria and their weight exceeds 600 pounds.
A total electric hospital bed (E, E, E, and E) is not covered, as the height adjustment functionality is classified as a convenience. Total electric beds will be rejected as not necessary medically.
For the aforementioned hospital beds (including those coded E - see Policy Article Coding Guidelines), claims that lack appropriate documentation validating the medical need of the bed type billed will face denial as not reasonable and necessary.
Any individual that does not fulfill any of the coverage standards for any hospital bed type will see their claim denied as not warranted or necessary.
ACCESSORIES:
Trapeze equipment (E, E) is covered if it is essential for the individual to sit up due to a respiratory illness, to alter body position for medical purposes, or to shift in or out of bed.
Heavy-duty trapeze equipment (E, E) is covered if it meets the standards for regular trapeze equipment and the individual's weight exceeds 250 pounds.
A bed cradle (E) is covered when necessary to prevent contact with bed linens.
Side rails (E, E) or safety enclosures (E) are covered when required by the individual's medical condition and are integral to or an accessory of a covered hospital bed.
If a patient requires a replacement innerspring mattress (E) or foam rubber mattress (E), it shall be covered for a hospital bed owned by the beneficiary.
GENERAL
A Standard Written Order (SWO) must be forwarded to the provider prior to submitting a claim. If the provider bills for an item described in this policy without having received a completed SWO first, the claim will be denied as neither reasonable nor necessary.
For Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) base items that require a Written Order Prior to Delivery (WOPD), a signed SWO must be received by the provider before the DMEPOS item is delivered to the beneficiary. Claims will be denied as not reasonable or necessary if the provider dispatches a DMEPOS item without previously acquiring a WOPD. Refer to the LCD-related Policy Article, found at the bottom of this policy under Related Local Coverage Documents section.
For DMEPOS base items under WOPD that also necessitate separately billed related options, accessories, and/or supplies, a WOPD outlining the base item and potentially all the associated options, accessories, and/or supplies that will incur separate billing must be received before delivering the items. In such scenarios, if the provider separately bills for adjunct options, accessories, and/or supplies without first acquiring a completed and signed WOPD for the base item, the claims will be rejected as not reasonable and necessary.
In conclusion, a service/item is accurately coded when it conforms to all listed coding principles per CMS HCPCS guidelines, LCDs, LCD-related Policy Articles, or DME MAC articles. Claims that do not adhere to coding standards will be denied as incorrect or not appropriate based on medical necessity.
Documentation of delivery (POD) is essential and DMEPOS suppliers are mandated to keep POD records available upon request by the Medicare contractor. All services lacking sufficient proof of delivery from the provider will be rejected as not reasonable or necessary.
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