Can A Mattress Purchase Be Covered by Insurance?

If you suffer from chronic pain or other health issues, getting a good night’s sleep can seem like a pipe dream. You’ve tried every mattress, pillow and sleeping position under the sun and still wake up feeling tired and sore. What if the answer to better sleep was a mattress specifically designed for your medical needs? These mattresses often have advanced technology and features to provide targeted support and comfort for different health conditions to improve sleep. But with great technology comes a higher price tag and affordability is a concern for many. So can a mattress purchase be covered by insurance? The good news is that for some people, the answer is yes.

Medicare Coverage for Your Mattress

If you’re a Medicare subscriber and need a special mattress for a medical condition, you might be wondering if your insurance will cover the cost. Medicare Part B can pay for many mattresses, such as orthopaedic mattresses to alleviate aches and pains, pressure-reducing mattresses for a medical condition, adjustable beds that can be raised and tilted to help with sleep, hospital beds and air-fluidized beds to prevent ulcers. But to qualify for Medicare coverage you must meet certain requirements. Your doctor must write a prescription stating the mattress is medically necessary for your condition, treatment and recovery.

The bed must be deemed Durable Medical Equipment (DME), and the mattress must meet five requirements. These requirements are that you use the bed for medical purposes for at least 3 years, the new mattress can only be used by the sick or injured person, it’s used for medical reasons as prescribed by the doctor, the bed is durable and withstands repeated use and it’s used at home. Where Medicare approves your new mattress or hospital bed as DME, you’ll pay 20% of the Medicare-approved amount and the deductible, and Part B will pay the rest.

Who Can Get a Medicare Covered Mattress?

Medicare Part B coverage for mattresses depends on these five requirements:

• Medical Necessity: Your doctor must prescribe the mattress as medically necessary for treating or managing a chronic condition. Common conditions that may require a special mattress are bed sores, arthritis, sciatica, chronic pain, back problems or injuries that make getting in and out of bed difficult.
• Exclusive Use: The new mattress can only be used by the sick or injured person for whom it was prescribed. It can’t be shared with other household members who don’t have a medical need for the special mattress.
• Doctor’s Specification: The mattress must be used for the specific medical reasons stated by your doctor in the prescription. This ensures the mattress addresses your specific health needs and challenges.
• Durability: The bed must be durable enough to withstand repeated use for at least 3 years in your home. This requirement helps ensure Medicare is investing in a long term solution for your medical needs.
• Home Use: The mattress must be used in your home, not a hospital or skilled nursing facility.

Does Insurance Cover Orthopedic Mattresses for Back Pain?

If you have arthritis or sciatica, your doctor might recommend an Orthopedic bed. This can help with back pain and discomfort. Medicare or private insurance might cover the cost of such a mattress. Two types of Orthopedic mattresses are covered: the 5-zone support and the spinal alignment. Insurance will pay if the mattress is needed for treatment and prescribed by a doctor. It must be used at home. Medicare might also cover the mattress if it’s deemed DME. This means it’s essential for the patient’s life.

Does Medicare Cover a Pressure Relief Mattress?

Pressure relief mattresses are prescribed for immobile patients and those bedridden due to injuries. Some patients may develop pressure ulcers or sores as the pressure increases on the skin and joints during long periods of immobility. Seniors can try pressure-reducing Medicare-approved mattresses to improve their sleep. A pressure relief mattress is covered under Medicare, Medicaid, Aetna, and BCBS insurance. To get the Medicare-approved amount, you must provide proof of immobility or injury that makes you bedridden.

Will Medicaid Cover Adjustable Beds?

Patients with conditions like paraplegia or a broken hip can get Medicaid coverage for an adjustable bed if it’s necessary to provide more comfort and reduce injury risk. To be covered, the adjustable bed must be classified as a DME. An adjustable bed can be a DME when the bed can adjust head or foot, the patient can elevate and lower different parts of the bed and the bed has side rails that the patient can raise or lower. Medicare will cover the cost of the necessary modifications on an adjustable bed to reduce pressure. Some of the modifications covered under Medicare are an extra wide hospital bed, electrical power adjustments, built-in weight scale, gel-like pressure mattress pads and lambswool or sheepskin pads.

To be eligible for Medicare coverage, the adjustable bed must be prescribed by the doctor’s office to treat the condition. An adjustable bed is considered necessary when it requires positioning to improve respiratory function, relieve pain or improve body alignment, and attach special devices like traction devices that can’t be attached to a regular bed. A person may need an adjustable bed with medical conditions like severe leg injuries, paraplegia and chronic obstructive pulmonary diseases.

Does Medicare Cover Hospital Beds?

You can get a hospital bed for yourself or your loved one and get insurance coverage if it’s medically necessary. If you rent a hospital bed the rent can be covered in case of a medical emergency. A hospital bed is classified as DME and covered under Medicare and Medicaid if you meet their eligibility criteria. Medicare-approved beds and mattresses can cost between $500 to $30,000 and above.

The cost of the bed depends on the type of bed needed, the deductible, and whether you buy or rent the mattress. To get the required coverage, you must either buy or rent a Medicare-approved mattress from a supplier who is enrolled in Medicare. If you buy from any other supplier, you may have to pay the full price as Medicare won’t approve the purchase. If you rent a bed, Medicare will cover the rent for 13 months of continuous use, and after that, the supplier must transfer the ownership of the bed to the user.

FAQs about Can A Mattress Purchase Be Covered by Insurance?

What diagnosis will cover a hospital bed?

A doctor must say a hospital bed is needed for your health. This is true for severe arthritis, spinal cord injuries, and other mobility issues. They need to explain why a hospital bed is necessary in your case.

What conditions might need a special mattress?

Special mattresses are for conditions like pressure ulcers and back problems. They help by supporting your body and easing pain. Your doctor will decide if you need one based on your health.

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

Medicare Part A covers mattresses in hospitals or skilled nursing facilities. Part B covers mattresses for home use. If your doctor prescribes one, Part B will pay 80% of the cost.

Can a doctor write a prescription for an adjustable bed?

Yes, a doctor can prescribe an adjustable bed if it’s needed for your health. They’ll write a prescription explaining how it will help you. Then, you can send it to your insurance for coverage.

Why would someone need an at-home hospital bed?

At-home hospital beds are for those recovering or with mobility issues. They have adjustable parts to ease pain and improve circulation. They also help caregivers with daily tasks.

Conclusion

If you have a chronic condition or medical issue that’s affecting your sleep a special mattress may be the answer to better sleep and quality of life. These mattresses can be expensive, but Medicare and other insurance providers may cover them if criteria are met, like a doctor’s prescription and the mattress is considered DME. It’s important to work with your healthcare provider to determine if a special mattress is medically necessary for your condition and to navigate the insurance coverage process. By knowing your options and advocating for your health, you can start sleeping more comfortably tonight. Sleep is an investment in you. Try a special mattress and insurance today.