Dear Marci,
I need a hospital bed in my home. How can I get it covered by Medicare?
Jack (Portland, ME)
Dear Jack,
Hospital beds are covered by Medicare as Durable Medical Equipment (DME). In order to get Medicare to cover your DME, whether you have Original Medicare or a Medicare Advantage Plan, you must meet the following two conditions:
- Your doctor or primary care provider (PCP) must sign an order, prescription, or certificate after a face-to-face visit.
- In this document, your PCP must state that the required office visit occurred, that you need the hospital bed to help a medical condition or injury, and that the equipment is for home use.
- Your face-to-face visit must take place no more than six months before the prescription is written.
- Once you have your doctor or PCP’s order or prescription, you must take it to the right supplier to get coverage. Be sure to only use suppliers with approval from Original Medicare or your Medicare Advantage Plan.
If you have Original Medicare, the type of supplier you use depends on where you live and the type of equipment you need.
- If you live in a competitive bidding area, Original Medicare only covers certain DME items from a select group of suppliers, known as contract supplier. Competitive bidding is a program designed to lower DME costs and improve DME quality in certain parts of the country.
- If you do not live in a competitive bidding area, or the item you need is not part of the program, you should get your DME from a Medicare-approved supplier that takes assignment. Taking assignment means that the provider accepts Medicare’s approved amount as full payment. For many Medicare-covered services, providers can only charge up to 15% above the Medicare-approved amount—this is known as the limiting charge. DME is not subject to a limiting charge, so if you get your hospital bed from a supplier who does not take assignment, the supplier could bill you for the entire balance of your item in excess of Medicare’s approved amount.
You can call 1-800-MEDICARE to learn if you are affected by the competitive bidding program and to find a contract supplier or supplier who takes assignment.
If you have a Medicare Advantage Plan, you must follow the plan’s rules for getting DME. Your plan may require that you:
- Receive approval from the plan before getting your hospital bed
- Use a supplier in the plan’s network of suppliers
- You may get little or no coverage if you use an out-of-network supplier.
- Use a preferred brand
- You may pay a higher cost when using a non-preferred brand.
People with Medicare Advantage Plans are not affected by competitive bidding. Contact your plan to learn more about its DME coverage rules before ordering your DME.
-Marci
