Hospital Beds Coverage: What You Need to Know

Wondering if your health plan will pay for a hospital‑grade bed at home? You’re not alone. Most people think the word “hospital” means big costs, but there are actually several ways to get help. Let’s break down the basics so you can see what’s covered, what you might pay out‑of‑pocket, and how to make the process smoother.

What counts as a covered hospital bed?

A covered bed is usually called a Durable Medical Equipment (DME) item. To qualify, the bed must be prescribed by a doctor, needed for a medical condition, and used at home for at least a month. Typical features that qualify include adjustable height, side rails, and a motorized head or foot section. Simple frames without these medical features are often considered regular furniture and won’t be covered.

How Medicare handles hospital beds

If you have Medicare Part B, you may be eligible for a hospital bed when a doctor’s order meets the criteria above. Medicare will cover 80 % of the allowable cost after your deductible, leaving you responsible for the remaining 20 %. Keep in mind that the equipment supplier must be enrolled in Medicare and the bill must include a proper HCPCS code (usually E0250‑E0299 for different bed types).

When you apply, Medicare will ask for a justification letter from your doctor. It should explain why a motorized bed is essential for your condition—think things like severe arthritis, chronic lung disease, or recovering from major surgery. The clearer the medical need, the smoother the approval.

Private insurance and other options

Many private health plans follow Medicare’s rules, but they often have their own limits on the brand, features, or rental periods. Call your insurer’s DME department, give them the doctor’s order, and ask for a pre‑authorization. Some plans will let you rent a bed for a set time, which can be cheaper than buying outright.

If insurance won’t cover the full cost, look into charitable programs, local council assistance, or community health grants. Organizations like the NHS Charities or Age UK sometimes have schemes for low‑income patients needing a hospital bed.

Choosing the right bed without breaking the bank

Start by listing the features you truly need. A simple electric height adjustment may be enough; you might not need a full 5‑position feature set. Compare prices from several suppliers—online retailers often list DME‑approved models at lower rates than hospital stores.

Ask the supplier if they offer a second‑hand or refurbished unit. These are inspected, repaired, and come with a warranty, yet cost 30‑50 % less. Just verify the unit still meets the required HCPCS code and is covered by your plan.

Tips for a hassle‑free claim

1. Get a written prescription that includes the exact HCPCS code.
2. Confirm the supplier is Medicare‑approved or in‑network for your private insurer.
3. Keep all invoices, delivery receipts, and the doctor’s note together.

When you submit the claim, attach a brief cover letter summarizing the medical need and quoting the relevant policy sections. A well‑organized packet reduces back‑and‑forth with the payer.

What to do if your claim is denied

Denials happen most often because of missing paperwork or a perceived lack of medical necessity. Contact the insurer, ask for the exact reason, and then ask what additional docs they need. Often a second note from your doctor or a clarification about how the bed improves your daily living is all that’s required.

If the insurer still says no, you can file an appeal. Use the Medicare appeals guide or your private plan’s grievance process—most have a 60‑day window. Stay polite, stick to the facts, and include any new supporting information.

Getting a hospital bed covered isn’t magic; it’s about matching the right medical need with the correct paperwork and choosing a supplier who knows the rules. Follow these steps, keep your records tidy, and you’ll increase the odds of a successful claim while keeping costs manageable.