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If you need a mattress, Medicare can cover it, but not always. When medically necessary, Medicare considers mattresses as durable medical equipment (DME). Original Medicare covers these costs. Your mattress may be subject to other conditions even after applying Medicare coverage.
What is Durable Medical Equipment (DME)?
Heavy-duty medical equipment that is meant for use over time is called durable medical equipment (DME). Oxygen equipment, canes, and crutches are examples of durable medical equipment. Medicare considers beds to be DME when they are necessary. Coverage for durable medical equipment is the same, whether it’s a bed or a wheelchair.
Durable medical equipment must have the following qualities:
- You can use it repeatedly
- Serve a direct medical purpose
- Medical provider orders their use
- Can be used at home
- Isn’t useful to patients when their condition or disability is healed
Which Mattresses Will Medicare Cover?
Medicare only covers mattresses if there is medical need. So, they can’t cover a mattress just for comfort. Pressure-reducing mattresses, which are used for some conditions, can be covered by Medicare. These devices can be used to relieve pain and provide other benefits. Medicare covers pressure-reducing beds, mattresses, or mattress overlays.
Medicare can also cover adjustable beds. This equipment is more complex and costs more than pressure-reducing beds. Your doctor may order the use of a hospital bed will as part of a hospital discharge plan.
What About Electric Hospital Beds?
Medicare considers full electric beds as convenience devices. They won’t cover convenience devices, even though ordinary hospital beds will be covered.
Some patients need semi-electric beds, which Medicare covers as rentals. This means that 80% of the rental fee for 13 months of use will be covered by Medicare. After the 13 months are over, you will be able to buy the bed. This is similar to the situation for other DME. However, some other DME may give you a choice to rent or buy. You will need to rent semi-electric hospital beds this way.
Some people need to rent their mattresses. Medicare won’t always let you choose to rent or buy. If you have to rent, then you will own the equipment after 13 months. If you have an item made for your use, you will often have to buy it. It is common to rent full beds but to buy mattresses.
How to Know if the Mattress You Find is Covered
Although Medicare covers a specific type of mattress, that doesn’t mean they’ll cover all. Medicare only covers DME from Medicare-approved sellers. If you don’t buy equipment from approved retailers, or it will cost more. Medicare suppliers should be easy to find, and you can always ask your supplier if they accept assignment from Medicare.
How Much Does Original Medicare Cover?
Part B of Medicare covers mattresses. Part B covers costs in an outpatient setting. 80 percent of the cost of your mattress will be covered. However, the coverage could be lower for various reasons. You will cover the remaining 20 percent, and the deductible will apply. In 2021, the Part B deductible is $203.
What About Medicare Advantage?
Medicare Advantage plans, or Part C plans, offer you a way to get coverage through private insurance companies. All Part C plans must cover the same things as Original Medicare. Part C plans will cover DME just like Original Medicare does.
There are some changes you may notice if you have a Part C plan. One is that you will have a provider network of some kind. This will work just like other private insurance plans. Your network may limit which providers you can get DME from.
Another change is that Part C plans may have copayments, and Original Medicare does not. Usually, a mattress won’t require a copayment, but your plan may vary. Other fees for these plans can also vary from Original Medicare.
Call us at 800-208-4974 to compare Medicare Advantage plan options in your area
Can A Medigap Plan Help?
Yes, it can. You can use Medigap plans to cover fees that Medicare usually leaves as out-of-pocket expenses. If you need extra help with these fees, then many Medigap plans end up being good to buy.
When you need to use a mattress under Medicare coverage, your deductible will apply. After this, you will have to pay a coinsurance. Every Medigap plan except for Plan K and Plan L covers the Part B coinsurance. But, Plan K still covers 50% of your coinsurance, and Plan L covers 75%.
Only Plan F covers the Part B deductible. Plan F is not available for people who become eligible for Medicare in 2020. If you cannot buy Plan F, then you must pay your deductible. Although Plan F isn’t as available, people who already have it can still use it. If you became eligible for Medicare before 2020, you can still use Plan F even if you only chose to do so after 2020 began.
Frequently Asked Questions
Medicare will pay for pressure-reducing mattresses, adjustable beds and air-fluidized beds.
Adjustable beds can’t be fully electric. You must also buy them from a Medicare-approved retailer.
Medicare will replace your mattress at a minimum of every five years.
Final Thoughts: Medicare and Mattresses
It’s also important to keep in mind that there are restrictions on the types of mattresses Medicare covers. Electronic beds and some other equipment will not be covered, and other features may reduce coverage. Because mattresses are DME, Original Medicare will cover them.
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