Can A Mattress Purchase Be Covered by Insurance?

When you’re struggling with chronic pain or other health issues, getting a good night’s sleep can feel like an impossible dream. You might have tried countless mattresses, pillows, and sleeping positions, only to wake up feeling tired and sore.

But what if the key to better sleep was a specialized mattress for your medical needs?

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Such specialized mattresses often incorporate features like adjustable firmness and pressure-relieving foam to provide targeted support and comfort for various health conditions, aiming to improve sleep quality.

But with great technology comes a higher price tag, making affordability a concern for many. However, insurance coverage may provide a solution.

Let’s get into the details of how your insurance might be able to help you get the mattress you need for a better night’s sleep.

Exploring Medicare Coverage for Your Mattress

If you’re a Medicare subscriber and need a special mattress for a medical condition, Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source you might be wondering if your insurance will cover the cost. The good news is that Medicare Part B can help pay for a variety of mattresses.

For example, two types of orthopedic mattresses that may be covered by insurance include the 5-zone support orthopedic mattress and the spinal alignment orthopedic mattress, if prescribed by a doctor for the treatment of orthopedic conditions and used in the patient’s home.

However, to qualify for Medicare coverage, you must meet the following requirements:

• Your doctor must provide a prescription confirming that the mattress is medically necessary for your condition, treatment, and recovery.
• The bed must be classified as durable medical equipment (DME) to be eligible for coverage.
• The mattress itself must satisfy five specific criteria set by Medicare.

To determine if your mattress qualifies for Medicare coverage, consult with your healthcare provider and review Medicare’s guidelines. By understanding these requirements upfront, you can make informed decisions about your mattress purchase and maximize your insurance benefits.

Who Can Get a Medicare-Covered Mattress?

Medicare Part B coverage for mattresses depends on meeting these five criteria:

Medical Necessity

Your doctor must prescribe the mattress as medically necessary for treating or managing a chronic condition. Common conditions that may warrant a specialized mattress include:

• Bad pressure ulcers Verified Source Medline Plus Online resource offered by the National Library of Medicine and part of the National Institutes of Health. View source
• Arthritis Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Sciatica Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Chronic pain Verified Source National Library of Medicine (NIH) World’s largest medical library, making biomedical data and information more accessible. View source
• Back problems or injuries that make getting in and out of bed challenging

Exclusive Use

The new mattress must be used only by the sick or injured person for whom it was prescribed. It cannot be shared with other household members who do not have a medical need for the specialized mattress.

Doctor’s Specification

The mattress must be used for the specific medical reasons outlined by your doctor in the prescription. This ensures that the mattress addresses your particular health needs and challenges.

Durability

The bed must be durable enough to withstand repeated use for at least three years in your home. This criterion helps ensure that Medicare is investing in a long-lasting solution for your medical needs.

Home Use

The mattress must be intended for use in your home rather than a hospital or skilled nursing facility.

Medicaid Coverage for Adjustable Beds

Medicaid might pay for an adjustable bed if you have a condition like a broken hip or paraplegia. The bed must be considered durable medical equipment and have certain features, such as:

• The ability to raise or lower the head and foot
• Side rails that can move up and down

Medicaid can also cover special changes to the bed, like:

• Making it extra wide
• Adding electric controls
• Including a built-in scale
• Using special mattress pads

To get Medicaid to pay, your doctor must say the bed is needed to:

• Help you breathe better
• Ease pain or improve body position
• Attach special devices that won’t work on a regular bed

Some health problems that might require an adjustable bed are serious leg injuries, paraplegia, and lung diseases.

In addition to insurance coverage, financial assistance programs such as Medicaid Services, Department of Veteran Affairs, and philanthropic organizations like the Muscular Dystrophy Association may help cover the cost of an adjustable bed for those who qualify.

Out-of-Pocket Costs for Medicare-Covered Mattresses

The cost of special medical mattresses can range from $200 to $30,000 without insurance. In most cases, Medicare Part B covers 80% of the cost, with the remaining 20% and the yearly Part B deductible being the responsibility of the beneficiary.

The exact amount you’ll owe depends on a few factors:

• What kind of mattress it is
• If Medicare says you have to rent or buy it
• Which mattress suppliers in your area Medicare approves
• If you have Original Medicare or Medicare Advantage

As a side note, Medicare Part A typically doesn’t provide coverage for mattresses you can use at home. However, it will cover the cost of your bedding and other necessary equipment while you’re an inpatient at a hospital or skilled nursing facility.

What About Medicare Advantage?

If you have a Medicare Advantage plan, your costs for a covered mattress will depend on the same factors as Original Medicare, as well as the specifics of your plan. Some Medicare Advantage plans might charge you more than Original Medicare, while others could cover the full cost of your prescribed mattress or have more lenient coverage requirements.

To know exactly what you’ll pay, contact your Medicare Advantage provider for details on your plan’s deductible, coinsurance, and any other costs related to a doctor-prescribed mattress. Work closely with your doctor and insurance company to ensure you get the mattress you need while understanding your financial responsibility.

Frequently Asked Questions

What conditions might require a special mattress?

Special mattresses are often prescribed for conditions such as stage II pressure ulcers, arthritis, sciatica, chronic pain, and mobility issues related to back problems or injuries. These mattresses are designed to provide targeted support, redistribute pressure, and improve spinal alignment, helping to alleviate pain and discomfort.

Your doctor will assess your specific health needs and determine if a special mattress is medically necessary for your condition.

What diagnosis will cover a hospital bed?

A hospital bed may be covered by insurance if a doctor determines that it is medically necessary for the patient’s condition. Some diagnoses that may qualify for hospital bed coverage include severe arthritis, spinal cord injuries, multiple sclerosis, and other conditions that limit mobility or require specific positioning for treatment or comfort.

The physician must provide detailed documentation of the patient’s diagnosis, symptoms, and how a hospital bed would benefit their health and meet the insurance provider’s specific criteria.

Can a doctor write a prescription for an adjustable bed?

Yes, a doctor can prescribe an adjustable bed if they determine it is medically necessary for the patient’s condition. The prescription should include the patient’s diagnosis, symptoms, and a detailed explanation of how an adjustable bed would improve their health and quality of life.

This prescription and any required documentation can then be submitted to the patient’s insurance provider for potential coverage.

Why would someone need an at-home hospital bed?

At-home hospital beds are often required for patients recovering from surgery, managing chronic conditions, or dealing with limited mobility. These beds offer adjustable head and foot sections, which can help reduce pain, alleviate pressure points, and improve circulation.

They also make it easier for caregivers to assist with patient transfers and daily care tasks, and can be equipped with specialized mattresses to prevent pressure ulcers in bedridden patients. While you may technically be able to use a regular mattress with a hospital bed, it’s rarely the most comfy setup.

What’s the difference between Medicare Part A and Part B coverage for mattresses?

Medicare Part A covers bedding during inpatient hospital or skilled nursing facility stays, while Part B classifies mattresses as durable medical equipment for home use.

When a mattress is prescribed by a Medicare-assigned doctor and purchased from an approved supplier, Part B covers 80% of the cost. The beneficiary is responsible for the remaining 20% and the Part B deductible.

How much will I have to pay for a Medicare-covered mattress?

With Original Medicare, you’ll typically owe a 20% coinsurance and the annual Part B deductible for a covered mattress. The exact amount depends on the mattress cost and whether you’ve met your deductible for the year.

For instance, if the mattress costs $1,000 and you’ve already met your deductible, you’ll be responsible for paying $200.

Conclusion

If you’re struggling with a chronic condition or medical issue that affects your sleep, a specialized mattress may be the key to better rest and improved quality of life. While these mattresses can be expensive, Medicare and other insurance providers may offer coverage if certain criteria are met, such as a doctor’s prescription and the mattress being considered durable medical equipment.

It’s essential to work closely with your healthcare provider to determine if a specialized mattress is medically necessary for your specific condition and to navigate the insurance coverage process. By understanding your options and advocating for your health needs, you can take steps towards a more comfortable and restorative night’s sleep.

Remember, investing in your sleep is investing in your overall health and well-being. Don’t hesitate to explore the possibility of a specialized mattress and insurance coverage if you believe it could make a difference in your life.