Can a Mattress Purchase Be Covered by Insurance

Key Takeaways

  • Health insurance might cover mattresses deemed medically necessary: Coverage applies to specific medical conditions like chronic back pain, arthritis, or pressure ulcers, often requiring a doctor’s prescription and meeting the criteria for durable medical equipment (DME).
  • Specialty mattresses are typically eligible: Orthopedic, pressure-relief, or air mattresses designed for medical use are commonly covered, provided they align with your insurer’s guidelines and approved vendor list.
  • Proper documentation and insurance verification are essential: A doctor’s letter of medical necessity, a compliant insurance policy review, and accurate claims submission significantly improve the likelihood of coverage approval.

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When you think about health insurance, you likely imagine coverage for doctor visits, medications, or surgeries.

But did you know that, in certain situations, health insurance might also help you purchase a mattress?

While it’s not a common benefit, there are cases where insurance companies cover the cost of a mattress if it’s deemed medically necessary.

Let’s discuss the details.

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When Does Insurance Cover a Mattress Purchase?

Insurance coverage for a mattress depends on specific circumstances, including the medical need for the item and your insurance policy.

a. Prescribed for a Medical Condition

A mattress may qualify for coverage if your doctor determines it is essential for treating or managing a medical condition. Common conditions where mattresses may be medically necessary include:

In such cases, the mattress is considered durable medical equipment (DME), which is often covered under insurance plans when medically prescribed.

b. Specific Types of Mattresses

Not all mattresses are eligible for coverage. Typically, insurance may cover specialty mattresses designed for medical use, such as:

  • Orthopedic mattresses: Provide support for spinal alignment.
  • Pressure-relief mattresses: Reduce pressure points for individuals with mobility issues.
  • Air mattresses for medical use: Adjustable air pressure to prevent bedsores.

Steps to Get Insurance Coverage for a Mattress

To determine if your mattress purchase can be covered by insurance, follow these steps:

1. Consult with Your Doctor

Begin by discussing your condition with your physician.

If they determine that a specialized mattress is essential for your health, they will provide you with a prescription or a letter of medical necessity.

This document should clearly explain the medical reasons why you require the mattress, detailing how it supports your treatment or alleviates your condition.

2. Review Your Insurance Policy

Carefully examine your insurance policy to understand its coverage provisions.

If you’re unsure, contact your insurance provider directly to inquire about the inclusion of durable medical equipment (DME) in your plan.

Specifically, ask if mattresses qualify as DME, and confirm any conditions or restrictions, such as pre-authorization requirements, copayments, or approved vendor stipulations.

3. Select a Qualifying Mattress

Collaborate with your doctor and insurance provider to identify a mattress that meets their requirements.

Most insurance plans have specific guidelines, such as:

  • Approved types of mattresses (e.g., orthopedic, pressure-relieving, or adjustable models)
  • Vendor restrictions (e.g., purchases must be made through authorized suppliers) Ensure the chosen mattress aligns with both your medical needs and the insurance company’s criteria to avoid claim denials.

4. Prepare and Submit Necessary Documentation

Gather all required paperwork to submit your claim effectively. This typically includes:

  • Doctor’s Prescription or Letter of Medical Necessity: A detailed explanation of why the mattress is essential for your treatment.
  • Quote or Receipt from an Approved Vendor: Proof of purchase or a cost estimate from a supplier recognized by your insurance provider.
  • Additional Forms Required by Your Insurance Plan: Any specific documentation requested by your insurer, such as claim forms or prior authorization requests.

Ensure all documents are complete and accurate to minimize delays in the claims process.

5. Await Insurance Approval

Once your claim is submitted, the approval process may take some time. During this period:

  • Be prepared to respond promptly if your insurance company requests further documentation or clarifications.
  • Keep copies of all submitted forms and correspondence for your records.
  • Follow up with your insurance provider periodically to check the status of your claim and address any issues promptly.

Medicare Coverage for Pressure Relief Mattresses

Pressure relief mattresses are designed for individuals who are immobile or bedridden, often due to injuries or chronic conditions.

These mattresses help prevent pressure ulcers by redistributing weight and reducing stress on vulnerable areas like the skin and joints.

Medicare, Medicaid, Aetna, and BCBS insurance may cover pressure relief mattresses if they are deemed medically necessary.

To qualify for Medicare coverage, patients must provide documentation, typically from a physician, proving their condition or immobility that justifies the need for the mattress.

Hospital Beds and Medicare

Hospital beds are another type of DME that Medicare and Medicaid may cover if medically necessary.

These beds are especially beneficial for patients requiring specific positioning for therapeutic purposes or who need attachments like traction devices. Costs for Medicare-approved hospital beds range from $500 to over $30,000, depending on the type and features.

To receive Medicare coverage:

  1. The patient must procure the bed through a Medicare-enrolled supplier.
  2. For rentals, Medicare will cover monthly payments for up to 13 months, after which the ownership of the bed is transferred to the patient.
  3. The patient must meet eligibility criteria, including a medical prescription and proof of need.

Medicaid and Adjustable Beds

Adjustable beds can also be covered under Medicaid for patients with specific medical conditions such as paraplegia, severe hip injuries, or chronic illnesses that require enhanced comfort or reduced risk of injury.

For coverage, the adjustable bed must qualify as Durable Medical Equipment (DME) and meet specific criteria, including the ability to adjust the head and foot sections, support patient mobility with side rails, or accommodate additional features like gel mattress pads or sheepskin overlays.

Medicare may also fund certain modifications to adjustable beds, such as:

  • Extra-wide hospital beds
  • Electric adjustment capabilities
  • Built-in weight scales
  • Pressure-relieving mattress pads

To secure coverage, a physician must prescribe the bed and document its necessity for the patient’s treatment, such as improving respiratory function, alleviating pain, or enhancing body alignment.

Medicare Advantage and Mattress Coverage

For individuals enrolled in a Medicare Advantage (MA) plan, the coverage for a medically necessary mattress may differ from Original Medicare. While Medicare Advantage plans are required to provide at least the same benefits as Original Medicare, including coverage for Durable Medical Equipment (DME) like pressure relief mattresses, specific costs and coverage requirements vary between plans.

Some MA plans may cover the full cost of a prescribed mattress, while others might impose higher deductibles or coinsurance. The extent of coverage depends on your specific plan details.

One significant difference with Medicare Advantage is the requirement to use in-network suppliers. Most MA plans operate within a defined network, meaning the mattress must be purchased or rented from an approved supplier to qualify for coverage.

Additionally, many plans require pre-authorization for equipment like a pressure relief mattress, making it essential to have clear documentation from your physician that outlines the medical necessity of the equipment.

To understand your coverage fully, it’s important to contact your Medicare Advantage plan provider directly. They can provide details about your plan’s deductible, coinsurance, and any out-of-pocket costs related to obtaining a prescribed mattress.

By coordinating with both your doctor and your insurance company, you can ensure you receive the mattress that meets your medical needs while avoiding unnecessary expenses.

Take the time to verify that your supplier is approved under your plan and confirm that all necessary approvals are in place before proceeding with your purchase.

Out-of-Pocket Costs and Alternatives

Even with insurance coverage, patients may still need to pay certain out-of-pocket expenses for a medically necessary mattress. These expenses can include:

  • Deductibles: The amount you must pay before your insurance begins covering the cost. For Medicare Part B, this is a yearly amount that resets every calendar year.
  • Co-payments: After meeting your deductible, you typically pay 20% of the Medicare-approved amount for the mattress or hospital bed.
  • Limits on Reimbursement: Insurance may only cover up to a certain amount for specific types of mattresses, leaving you responsible for any difference.

If your insurance denies coverage or you face significant costs, there are alternative options to consider:

Health Savings Accounts (HSA) or Flexible Spending Accounts (FSA):

These accounts allow you to set aside pre-tax income to pay for eligible medical expenses, including certain mattresses. Using HSA or FSA funds can significantly reduce the financial burden by lowering your taxable income.

Check with your plan administrator to ensure the mattress qualifies as an eligible expense.

Payment Plans or Discounts:

Many suppliers of medical mattresses or hospital beds offer flexible payment plans to make the purchase more manageable. These plans let you spread the cost over several months.

Additionally, some suppliers provide discounts for patients who pay upfront or are paying out of pocket. Be sure to inquire about these options when shopping for your mattress.

Non-Profit or Community Assistance Programs:

Some local organizations, charities, or community health programs may provide financial assistance or free medical equipment to individuals in need. Researching these resources can be especially helpful if insurance does not cover your required mattress.

FAQs

What features are included in a Medicare-covered hospital bed?

Medicare-covered hospital beds may include adjustable height and positioning, side rails, or special mattress pads for pressure relief. Advanced features like built-in weight scales or electric adjustments may also be covered if medically necessary.

Are rental options available for hospital beds or mattresses under Medicare?

Yes, Medicare often covers the rental of hospital beds and mattresses for up to 13 months if they are medically necessary. After this period, ownership is typically transferred to the patient. Renting can be a cost-effective solution for short-term needs or trial use.

What medical conditions require a special mattress?

Special mattresses, like pressure-relief mattresses, are often prescribed for conditions such as chronic pain, pressure ulcers, severe arthritis, or immobility. These mattresses help prevent bedsores and reduce discomfort for individuals who are bedridden or have limited mobility.

How can I qualify for a mattress covered by insurance?

To qualify for a mattress covered by insurance, you must have a medical condition that requires it, such as pressure ulcers, severe arthritis, or immobility. You will also need a doctor’s prescription and, in many cases, approval from your insurance provider.

Why might someone need an at-home hospital bed?

At-home hospital beds are essential for individuals who need special positioning to alleviate pain, improve breathing, or aid recovery. They are also beneficial for patients requiring attachments like traction devices or frequent caregiver assistance.

How does Medicare Part A differ from Part B for mattress coverage?

Medicare Part A covers mattresses and beds only if used in an inpatient or hospice setting, while Part B provides coverage for durable medical equipment (DME) like mattresses and beds for home use, as long as they are medically necessary and prescribed.

How much will I pay for a Medicare-covered mattress?

Under Medicare Part B, patients typically pay 20% of the Medicare-approved amount after meeting the deductible. Additional costs may apply if the supplier does not accept Medicare assignment or if you have a Medicare Advantage plan.

Can Medicare cover adjustable beds?

Yes, Medicare can cover adjustable beds if they qualify as DME and are medically necessary. Conditions like chronic pain, paraplegia, or respiratory issues often justify coverage. The bed must be prescribed by a doctor and obtained from a Medicare-enrolled supplier.

Final Thoughts

While it’s not common for insurance to cover a mattress purchase, it’s possible under the right circumstances.

If you or a loved one is facing a medical condition that requires a specialized mattress, start by consulting your doctor and checking your insurance policy.

With the right steps, you might find financial relief for what could otherwise be a significant expense.

This article is for informational purposes and should not replace advice from your doctor or other medical professional.

Sarah Anderson, Certified Sleep Science Coach Sarah Anderson

Sarah Anderson is a sleep, health, and wellness writer and product reviewer. She has written articles on changing and improving your sleep schedule, choosing the right mattress for chronic pain conditions, and finding the best pillow for you. Sarah Anderson has her Bachelor of Arts degree from Arizona State University in Journalism and Mass Communications. Prior to working for Zoma, she wrote for a variety of news publications. Sarah's work has been featured on Bustle, PureWow, and other publications.

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