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You have to satisfy three different conditions if you want Medicare to pay for your new mattress. First, you can only get a Medicare-covered mattress if your doctor prescribes it to you and states that it’s necessary for a medical condition that you have. Second, the mattress has to qualify as being durable medical equipment (DME). There are five different criteria that a new mattress must meet to qualify.
What types of beds and mattresses are covered by Medicare?
Several different types of mattresses qualify and are considered durable medical equipment covered under your Medicare plan. It’s important to understand the guidelines so that you know which mattresses Medicare covers.
Before a mattress can be qualified as durable medical equipment (DME), it has to be considered to be an essential part of the patient’s normal life. A doctor is the only person who can give a mattress this designation after they determine that it has a necessary medical purpose. Qualifying purposes include pressure relief, body aches, pain relief, and more.
Once a doctor qualifies that a mattress is in the durable medical equipment category, it must still meet five additional criteria to qualify for Medicare coverage.
- Medical use only
- Capable of handling repeated use
- Useful to a sick or injured person
- Must be used at home
- Must have a 3-year minimum life expectancy
To sum up, if the new mattress meets the following requirements (according to Medicare.gov) then you can qualify for financial assistance under Medicare for up to 80% of the purchase price:
- Durable medical equipment classification
- Must meet the five qualifying criteria
Pressure-reducing mattresses are the most common type that are covered by Medicare.
What is durable medical equipment?
Durable medical equipment is described by Medicare as equipment that is required by a physician. DME helps Medicare subscribers with care for important health issues. Common items that qualify as durable medical equipment include insulin monitors, ventilators, oxygen equipment, and breath test tubes. This equipment is needed to manage long-term health conditions.
A medical device such as a pressure-relieving mattress must comply with all requirements and regulations in order to be eligible for Medicare coverage.
Does Medicare cover home hospital beds?
Medicare covers home hospital beds if you are registered to Medicare Part B. You will still be responsible for some out-of-pocket costs, however.
Medicare classifies these types of mattresses as durable medical equipment. Make sure that you consult your health care plan to make sure that your pressure-relief mattress qualifies for Medicare coverage. If your doctor or medical provider disagrees on the necessity of the bed, then Medicare will not pay for your claim and they may require you to pay the full cost.
Make sure you follow all of the instructions as described in your health care plan to make sure that your home hospital bed is covered.
How do I know if mattresses covered by Medicare are best for me?
The pressure-relieving mattresses that are covered by Medicare aren’t the best choice for everyone. There are a few questions that you need to answer before determining if a Medicare-approved mattress is right for you.
- Does your medical condition require that your body is positioned in a way that is impossible with a normal mattress?
- Is it not feasible for you to use a regular mattress to reduce pain?
- Does your head need to be elevated 30 degrees or more in a manner that isn’t possible with a pillow or wedge?
If you answered yes to any of those questions, then a Medicare-approved mattress such as a Thevorelief Pressure Relief Mattress, Defend Pressure Relief Mattress, Joerns Prevamatt Defend Pressure Relief, Solace Resolution Glissando Heavy Duty mattress, or other therapeutic 5-zone support mattress may be best for your needs.
It’s important to note that normal memory foam mattresses may cause back pain for some people. If that applies to you, then you may need one of the special mattresses listed above that are covered under your health plan.
If you don’t feel that you qualify for a new bed under your Medicare coverage but you still want to buy a mattress that provides comfort and pressure relief, there are a few options we recommend. Amerisleep’s AS1 is a firm mattress made out of high-density foam (great for back pain). Saatva Classic is the right mattress for you if you need to manage body aches. The foam material used in the Molecule mattress is a phenomenal option for most people as well. Sleepy’s and Comfy are great budget options.
It’s important to note that the best mattress for you will depend on your unique needs. There is no single brand that is best for everyone.
Conclusion
We recommend contacting your Medicare representative if you want to find out if you qualify to save money on a brand new bed. If you’re a Medicare subscriber then you can save up to 80% of the purchase price on a new mattress if you meet certain criteria.
Mattresses are considered to be medical supplies. Bed-related equipment, especially pressure-relief mattresses, qualify under the mattress health insurance provided by Medicare.
Contact your doctor and your Medicare representative to find out which specific beds qualify under your particular health plan.
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He's been involved in the mattress industry for almost a decade and is dedicated to using his expertise to help you choose the right mattress.
Robert's main goal is to give you straightforward info on what works - and what doesn't - so you can spend less time stressing about sleep and more time living your life (that's what we're all here for, right?).
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