If you need a hospital bed at home, you’re likely wondering how Medicare fits into the picture. Will they cover the cost? What expenses will you have to handle? Whether you’re prepping for surgery, managing ongoing health issues, or assisting a family member, knowing the ins and outs of Medicare’s hospital bed coverage can save you both stress and money. Keep reading to get a clear grasp of Medicare’s coverage policies, what you’ll owe out-of-pocket, and how supplemental insurance can further benefit you.
When Does Medicare Cover Hospital Beds?
The first thing you should know is that hospital beds fall under the category of durable medical equipment (DME) and are covered by Medicare Part B. However, certain conditions need to be met for Medicare to cover the expense. Specifically, you must be enrolled in Medicare Part B and have a prescription from a doctor stating that the bed is medically necessary for your condition. This means that the bed must be deemed essential for the diagnosis or treatment of your illness or injury, or to improve the functionality of a malformed body part.
Additionally, the hospital bed must be supplied by a medical equipment provider that is approved by Medicare. This is very important because Medicare won’t pay the claims for DME if they are submitted by suppliers that are not enrolled in Medicare. So, even if you meet all the medical qualifications, you’ll want to confirm that the supplier you’re considering is enrolled and approved by Medicare. Doing so ensures that you’re not left holding the bag for the full cost of the hospital bed, which can be quite expensive.
What’s Your Share of the Cost?
After you’ve jumped through the initial hoops of eligibility and supplier requirements, you’ll want to get a handle on what portion of the bill you’ll be personally responsible for. Medicare operates on a cost-sharing model for most services, and hospital beds are no exception. You’ll first need to satisfy your annual Part B deductible, which stands at $240 for 2024. Once that’s done, Medicare will cover 80% of the approved cost of the hospital bed, and you’ll be responsible for the remaining 20%.
But keep in mind, the “Medicare-approved amount” may not necessarily cover the full retail price of the hospital bed. The specific amount you’ll end up paying can be influenced by several factors. Your doctor’s charges, your geographic location, and any other insurance coverage you might have can all come into play. Therefore, it’s a good idea to consult with your healthcare provider or a licensed agent to get an estimate of what your out-of-pocket costs might look like. This can help you budget and plan accordingly, eliminating any unwelcome financial surprises. For immediate assistance, please give us a call at 866-633-4427.
Rent or Buy? Medicare Gives You Options
When it comes to acquiring a hospital bed through Medicare, you have some flexibility. You can either rent or purchase the equipment. Medicare has specific rules that allow for both options, depending on your unique medical needs and circumstances. If you need the bed for a short-term recovery, for instance, renting might be the most cost-effective route. Medicare will cover the rental costs under their DME benefits, and after 13 months of renting, you become the owner of the bed.
However, there are scenarios where purchasing the bed outright could be more advantageous. For example, if you anticipate a long-term need for the hospital bed due to chronic health conditions, it might be more economical in the long run to purchase it from the get-go. Medicare will still cover 80% of the approved cost if you’ve met your Part B deductible, just as with renting. It’s important to weigh the pros and cons and possibly consult with your healthcare provider to decide which option is best suited for your needs.
Hospital Stays vs. Hospital Beds at Home
When discussing Medicare coverage for hospital stays and hospital beds at home, it’s essential to understand that these are two distinct types of coverage. Medicare Part A covers inpatient hospital stays, including aspects like semi-private rooms, meals, general nursing, inpatient treatment drugs, and other hospital services and supplies. If you’re admitted to a hospital as an inpatient, Part A kicks in. You’ll need to meet a deductible of $1,632 per benefit period for 2024 before Medicare covers its share of the costs.
On the other hand, hospital beds for home use fall under Medicare Part B as durable medical equipment. As discussed earlier, this comes with its own set of requirements, including enrollment in Part B, a doctor’s prescription, and an approved supplier. The financial structure is also different. Once you’ve met your Part B deductible, Medicare will cover 80% of the approved cost, whether you choose to rent or buy. So, while both hospital stays and home-based hospital beds are covered under Medicare, the guidelines, requirements, and financial responsibilities vary significantly between the two.
A Helping Hand from Medigap
While Medicare provides substantial coverage for hospital beds and inpatient stays, there are still gaps that can strain your finances. That’s where Medicare Supplement Insurance, commonly known as Medigap, comes in. Medigap plans are designed to pick up where Medicare leaves off, covering additional out-of-pocket costs like coinsurance and deductibles. For example, if you’re burdened by the 20% of the approved amount that Medicare doesn’t cover for your hospital bed, a Medigap plan can ease that financial pressure.
Beyond hospital beds, Medigap plans also offer broader benefits that complement your Medicare coverage. They can cover your Medicare Part A coinsurance and hospital costs, the first three pints of blood if you need a transfusion, and even Part A hospice care coinsurance or copayments. Some Medigap plans may also include coverage for skilled nursing facility stays and the Part A deductible. With ten standardized Medigap plans available in most states, you have a good chance of finding one that meets your specific needs, making it a worthwhile consideration for a more comprehensive healthcare financial strategy. For more information on Medigap plans, please call us at 866-633-4427.
Understanding the specifics of Medicare Part A and Part B can make a world of difference. Part A is your go-to for inpatient hospital care, covering essential services like semi-private rooms and general nursing. However, be prepared for deductibles and potential coinsurance costs for longer stays. Part B steps in when you need a hospital bed at home, categorizing it as durable medical equipment and covering 80% of the costs after your deductible. Knowing these details allows you to make smarter healthcare decisions without unnecessary financial strain. Armed with this knowledge, you can better focus on your well-being and recovery.
If you have any questions about Medicare coverage for hospital beds, please speak with a Senior Healthcare Solutions Medicare expert today at 866-633-4427. A licensed agent will be happy to answer all your questions and explain how you can reduce your Medicare out-of-pocket expenses with a supplemental Medigap policy. Regardless of if you’re new to Medicare or a long time Medicare beneficiary, our team is here to guide you through every step of your Medicare journey.