Does Medicare Cover Adjustable Beds in 2025? What’s Included and What You'll Pay

Medicare Coverage for Adjustable Beds and Medically Necessary Mattresses

Medicare designates certain mattresses, specifically hospital bed mattresses and pressure-relieving mattresses, as Durable Medical Equipment (DME). These mattresses are designed to help manage specific medical conditions such as sciatica, arthritis, spinal cord injuries, or chronic bedsores.

Key Medicare Coverage Criteria:

• The mattress must qualify as DME.
• It must be prescribed by a physician who provides a medical order explicitly stating the medical necessity based on your condition.
• Coverage is limited to use at home, not for general comfort or preventive reasons.
• The mattress must be bought or rented from a Medicare-approved supplier.

Conditions Typically Covered:

• Arthritis
• Sciatica
• Chronic bedsores or pressure ulcers
• Spinal cord injuries or paralysis

What Medicare Does Not Cover:

• Standard mattresses for general back or hip pain without a medically documented qualifying condition.
• Mattresses purchased from typical retail mattress stores that are not Medicare-approved suppliers.
• Mattresses selected solely for comfort or non-medical pain relief without doctor documentation.

Cost and Coverage Details for 2025

• Medicare Part B generally covers 80% of the approved cost for medically necessary mattresses classified as DME.
• Beneficiaries are responsible for 20% coinsurance plus the 2025 Part B deductible, which is $257.
• If a mattress is purchased from a supplier not approved by Medicare, full payment may be required.
• There is no Medicare plan offering full coverage without cost-sharing for adjustable beds or medically necessary mattresses in 2025.
• Some Medicare Advantage PPO plans (e.g., Aetna Medicare Plan PPO, UnitedHealthcare’s UC Medicare Choice) may include coverage for DME including medically necessary mattresses, but standard cost-sharing typically applies.

How to Obtain Medicare-Covered Adjustable Beds or Mattresses

• Consult your doctor: Obtain a prescription or medical order specifying the mattress is medically required based on your health condition.
• Confirm mattress qualification as DME: The mattress should be a pressure-reducing or hospital bed mattress suited to your documented medical needs.
• Submit documentation: Your doctor’s prescription and relevant medical records may be required for Medicare approval.
• Use Medicare-approved suppliers: Purchase or rent the mattress from suppliers listed on Medicare’s official directory to ensure Medicare billing procedures are followed.
• Prepare for cost-sharing: Expect to pay 20% of the Medicare-approved cost plus the deductible unless you have supplemental insurance.

Considerations for Mattresses Addressing Back and Hip Pain

While various mattresses claim to relieve back and hip pain, Medicare does not cover standard mattresses purchased solely for pain relief unless they meet the DME and medical necessity criteria stated above. Therefore:

• For general back or hip pain without a qualifying medical condition such as sciatica or chronic bedsores, Medicare is unlikely to provide coverage.
• Consumers may consider specialty mattresses designed for back and hip pain relief available at retail stores, recognizing these are generally not reimbursable by Medicare.
• Features such as pressure-relieving materials like memory foam or hybrid designs, and adjustable beds with customizable firmness and positioning, may be useful for pain management.
• Mattress options sometimes include trial periods ranging from 30 to 90 days to help evaluate comfort and suitability before purchase.

Information About Mattress Purchases from Retail Stores and Medicare Coverage

• Medicare coverage requires the use of approved suppliers, which generally excludes most conventional mattress stores.
• Discounts or promotional specials at retail mattress stores (including those in New York, Georgia, Ohio, Texas, Florida, Indiana) do not affect Medicare coverage or claims.
• When considering mattress purchases linked to Medicare coverage, it is crucial to verify supplier approval through the official Medicare website.

Key Points About Medicare Adjustable Bed Coverage in 2025

• Full coverage for adjustable beds is not included in Medicare plans for 2025.
• Medicare typically covers 80% of costs for prescribed hospital or pressure-reducing mattresses classified as DME, with the beneficiary responsible for 20% plus the deductible.
• Coverage depends on specific medical diagnoses and a doctor’s prescription based on medical necessity.
• Mattresses purchased for general back or hip pain without qualifying medical conditions are not covered.
• Always use Medicare-approved suppliers to ensure proper billing.
• Retail mattress store promotions or discounts are separate from Medicare coverage and reimbursement.
• Supplemental insurance may help reduce out-of-pocket expenses but is not standard Medicare coverage.

Practical Suggestions for Medicare Beneficiaries Considering Adjustable Beds or Therapeutic Mattresses

• Obtain a detailed prescription from your healthcare provider that outlines the medical necessity.
• Confirm approved vendors by checking your Medicare plan or the federal Medicare supplier directory.
• Be aware of potential coinsurance and deductible amounts.
• Choose mattress options based on durability, comfort, and alignment with medical needs.
• Understand that retail mattress discounts do not apply to Medicare reimbursements.
• Explore supplemental health insurance or assistance programs to potentially lower your costs.

By reviewing Medicare’s coverage guidelines and supplier requirements for adjustable beds and medically necessary mattresses, beneficiaries can make informed choices suited to their health needs in 2025.

Sources

• Tom’s Guide: What types of mattresses are covered by Medicare?
• 2025 Aetna Medicare Plan (PPO) Evidence of Coverage
• 2025 UC Medicare Choice Plan Evidence of Coverage

[LINK: https://www.tomsguide.com/features/what-types-of-mattresses-are-covered-by-medicare][LINK: https://emeriti.web1.aetnamedicare.com/application/files/4617/2718/7353/2025EOC_PPO_with_RX.pdf][LINK: https://ucnet.universityofcalifornia.edu/wp-content/uploads/forms/pdf/uc-medicare-choice-plan-booklet.pdf]

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