For many people, a mattress can affect their health in good or bad ways. Sometimes, doctors recommend that a person get a new mattress or bed because of a specific medical condition. But many of these special beds and mattresses can be expensive and may not fit your budget. Learn more about how Medicare may factor into your mattress purchasing decisions. 

Does Medicare pay for mattresses? 

In some circumstances, Medicare Part B may cover most of your mattress or bed cost. However, you must meet certain criteria to get most of the expenses covered. In addition, Medicare may only cover the rental of some equipment. It is essential to discuss mattresses and beds with your doctor first.  

In which cases does Medicare cover mattresses? Here are the eligibility guidelines

Medicare Part B will only cover your mattress or bed if it meets specific criteria.

First and foremost, your doctor must declare it medically necessary for you to have a mattress. In other words, a mattress should serve as a tool to ease a certain medical condition; Medicare will not cover a mattress if there’s no medical reason for you to have one.

Secondly, a mattress needs to qualify as Durable Medical Equipment or DME. Here are the requirements that should be met for the mattress to qualify as DME:

• Your doctor must declare it a medical necessity;
• Expected that you will use it for at least three years;
• Only useful for sick or injured people; 
• It will be used for medical reasons; 
• It is durable and can withstand repeated use; 
• It can be used in the home; 

There are additional factors to consider regarding a Medicare-approved mattress or bed. For instance, Medicare may specify whether you must rent or buy the item, and in some cases, it gives you a choice.

Additionally, you must get it only through Medicare-approved mattress and bed suppliers in your area. Your doctor may have a list of such suppliers, so make sure to double-check at the doctor’s office. You can also search for a supplier in your zip code here.

What mattress is covered by Medicare? 

Medicare Part B does not cover every kind of mattress, but there are many types of mattresses and beds that Medicare typically approves. Hospital beds and pressure-reducing mattresses are some of the most common options. If you are struggling with pressure ulcers, then you may be able to get an air-fluidized bed.  

Are pressure-reducing mattresses covered by Medicare? 

Yes, pressure-reducing and orthopedic mattresses and adjustable beds are actually some of the most common Medicare mattresses for seniors. 

There are many types of pressure-reducing mattresses for seniors that Medicare Part B will cover. Some of the most popular include: 

• Joerns PrevaMatt Pressure Relief Series Mattress — Doctors often recommend this mattress to prevent and treat up to Stage II pressure ulcers. 
• Drive Medical Therapeutic 5-Zone Support Mattress —These mattresses redistribute pressure over five zones and can reduce friction. 
• Solace Resolution Glissando Heavy Duty Mattress — In addition to reduced friction, this mattress has sidewalls that can make it easier for you to get in and out of bed. 

Does a pressure-reducing mattress require prior authorization?

Yes, if you need a pressure relief mattress, then Medicare requires you to get approval first (also known as “prior authorization”).

Your mattress supplier will send a prior authorization request and required documents to Medicare for approval before delivering a pressure-reducing support surface for use in your home. Medicare will review the information to make sure you’re eligible and meet all requirements for the item.

These 5 types of pressure-reducing support surfaces require “prior authorization”:

• Powered air flotation bed (low air loss therapy)
• Powered pressure-reducing air mattress
• Non-powered advanced pressure-reducing overlay for mattress, standard mattress length and width
• Powered air overlay for mattress, standard mattress length and width
• Non-powered advanced pressure-reducing mattress

Does Medicare cover mattresses for back pain? 

If you need an orthopedic mattress designed to alleviate back pain, Medicare Part B will cover most of the cost as long if your back pain is caused by a certain medical condition and therefore a mattress is a medical necessity for you. You may need this type of mattress if you are suffering from any of the following conditions: 

• Arthritis; 
• Sciatica; 

There may be other reasons why you need an orthopedic mattress. You may also be able to choose a firmness level that is more comfortable for you. Orthopedic mattresses are often much more expensive than regular mattresses, so getting coverage through Medicare can be a big help.

Does Medicare cover adjustable beds? 

If getting in and out of bed is challenging, then an adjustable bed might be a good option. However, these types of beds are often expensive. Medicare Part B will help pay the cost if you need an adjustable bed. But Medicare may determine that you must rent the adjustable bed rather than buy it, depending on your condition and the vendors in your area. It is also important to know that Medicare may not cover all types of adjustable or hospital bed additions, such as side rails or an electric-powered bed. 

Medicare mattress prices 

Medicare-approved mattresses and beds can range in price from around $500 to more than $30,000. While Medicare may pay most of the cost (80% of the cost), you may still have to pay a significant amount (remaining 20%) depending on the type of bed you need, including the deductible, which is $240 in 2024. Some beds are only available to rent, and you may be able to rent or purchase a refurbished bed for less.  

Many people have Medicare Advantage (Part C) or Medigap. Many Medigap and Medicare Advantage plans help you cover some or all of your coinsurance and even the deductible. It’s possible your plan can help you get your new mattress or bed with little to no out-of-pocket cost. When selecting your plans, consider whether you will need to replace your old mattress or if you have a condition that will qualify you for a Medicare-approved mattress. 

How to get a new mattress from Medicare? 

To obtain a Medicare-approved mattress, you would generally need to follow these steps:

1. Talk to your doctor about your mattress and bed options. A new mattress can relieve the chronic pain of your condition or may be vital to your recovery and healing process. The doctor will evaluate your specific needs and determine whether an adjustable bed or hospital bed is medically necessary. Your doctor may also recommend the specific type or brand of mattress you need and will recommend Medicare-approved suppliers.

2. Your doctor will provide you with a prescription or a Certificate of Medical Necessity (CMN) stating the need for the equipment. The prescription should include detailed information about the specific type of bed or mattress required.
3. Contact Medicare directly or a Medicare-approved durable medical equipment (DME) supplier to inquire about their coverage policies and find a supplier that can provide the approved mattress or bed. You can also check the Medicare Supplier Directory or contact your Medicare Advantage plan for a list of approved suppliers.
4. Submit Documentation. Work with the supplier to complete any necessary paperwork, including the prescription or CMN from your healthcare provider. The supplier will often handle the documentation and billing process on your behalf.
5. Medicare Approval and Coverage Determination: The supplier will submit the documentation to Medicare for review and coverage determination. Medicare will assess whether the equipment meets its coverage criteria and if it is deemed medically necessary for your condition. They will inform the supplier and you of their decision.
6. Then, purchase your bed or mattress, and enjoy a more restful night. If Medicare approves the coverage, they will pay a portion of the cost for the bed frame, and you will be responsible for any applicable deductibles, co-payments, or co-insurance. It’s important to review your specific Medicare plan’s coverage details to understand your financial responsibility.

Find a plan that works for you

If you want to switch, join or drop your Medicare plan during this Open Enrollment (Oct 15 -Dec 7), you can use a Plan Finder to help you find a plan that works for you. Many people who review their plans yearly can save money or find better coverage.

If you need help feel free contact us at medicare@hihella.com

Article updated on December 19, 2023