Will Insurance Cover Your Adjustable Bed? Here's the Scoop

Navigating the World of Adjustable Bed Insurance Coverage

Adjustable bed insurance coverage is available through Medicare Part B, Medicaid, and some private insurance plans when the bed is deemed medically necessary. Here's what you need to know:

When you're struggling with chronic pain, respiratory issues, or mobility challenges, a good night's sleep can feel impossible. An adjustable bed can make a world of difference—but with prices ranging from $500 to over $30,000, insurance coverage becomes crucial.

"Navigating insurance policies can feel like solving a complex puzzle without a guide," says one retiree who recently went through the process of getting Medicare to cover her hospital-grade adjustable bed.

The good news? Medicare classifies certain adjustable beds as durable medical equipment (DME) and will cover 80% of the approved amount after you meet your annual deductible—but only when they meet specific criteria.

Medicare doesn't cover consumer-grade adjustable beds like Sleep Number or Tempur-Pedic. Instead, they cover hospital-style beds with specific medical features like adjustable head and foot positions and side rails.

Before you start shopping, you'll need to know exactly what's covered, what documentation you need, and how to find suppliers who accept your insurance.

Understanding Adjustable Bed Insurance Coverage

When you're exploring adjustable bed insurance coverage, it helps to know that insurance companies don't see these beds as luxury items. Instead, they view them as medical necessities for people with specific health conditions. These beds fall under Durable Medical Equipment (DME), which Medicare defines as equipment that serves a medical purpose, can withstand repeated use, typically isn't useful to someone who's healthy, is used in your home, and should last at least 3 years.

Medicare Part B covers hospital-grade adjustable beds when prescribed by your doctor for home use. These aren't the same as the adjustable beds you might see in TV commercials. They're medical-grade beds with specific therapeutic features like head and foot elevation controls and safety side rails.

"Many people are surprised to learn there's a significant difference between a consumer adjustable bed and a hospital-grade adjustable bed," shares our nursing specialist at ProMed DME. "For insurance to cover it, the bed must serve a specific medical purpose your doctor has prescribed—not just provide better comfort."

Why "Adjustable bed insurance coverage" matters today

The need for adjustable bed insurance coverage has grown tremendously in recent years, and for good reason. As more Americans choose to age in their own homes rather than move to care facilities, proper medical equipment becomes essential for safety and comfort.

Many people with conditions like sleep apnea, COPD, or congestive heart failure need to sleep with their upper body liftd—something only an adjustable bed can provide consistently. For those with chronic pain or recovering from surgery, the ability to adjust positions can make the difference between a night of agony and restful sleep.

Maria, who manages COPD in her Florida home, told us: "My adjustable bed lets me sleep with my upper body raised, which helps me breathe so much better at night. Without Medicare covering most of the cost, there's no way I could afford it."

With prices ranging from $500 for basic models to over $30,000 for beds with advanced features, insurance coverage isn't just helpful—it's often the only way many people can access this essential equipment.

Key insurance terms you must know

Before diving deeper into adjustable bed insurance coverage, let's break down some terms that might otherwise leave you scratching your head:

When a supplier "accepts assignment," they're agreeing to charge you only what Medicare approves—not a penny more. Medicare pays them directly, and you only worry about your portion of the bill.

Your coinsurance is the percentage you pay after meeting your deductible—typically 20% for Medicare Part B DME. If your adjustable bed costs $1,000 and Medicare approves that amount, you'd pay $200 (after meeting your deductible).

Many insurance plans require prior authorization, meaning they need to approve coverage before you get the equipment. Skip this step, and you might end up responsible for the entire bill.

Medical necessity documentation from your doctor explains why you specifically need this equipment for your health condition. This isn't just a preference—it's your doctor saying, "This person needs this equipment for their health."

Your doctor will complete a Certificate of Medical Necessity (CMN) form that officially documents your need for the equipment. This paperwork is crucial for your coverage approval.

Understanding these terms doesn't just help you talk the talk with insurance representatives—it empowers you to advocate for yourself through what can sometimes be a complex process. At ProMed DME, we guide our customers through every step of securing coverage, making what seems overwhelming much more manageable.

How Medicare Pays for Adjustable Beds

When it comes to adjustable bed insurance coverage, Medicare Part B can be your best friend—but like any friendship, it helps to understand the boundaries. Medicare will cover these beds when they're medically necessary, not just because they'd be nice to have.

Here's how the payment works in plain English: Medicare picks up 80% of the tab while you handle the remaining 20% coinsurance. Before that kicks in, you'll need to meet your annual Part B deductible (currently $240 in 2024). And here's an important tip—make sure your supplier accepts "Medicare assignment" or you might face surprise charges above what Medicare approves.

"I was so relieved when I learned Medicare would cover most of my adjustable bed," shares Rita from Michigan. "But I wish someone had explained the rental process to me earlier—it would have saved me some confusion."

Instead of buying your bed outright, Medicare typically starts with a 13-month rental period. Think of it as a "try before you own" approach. Each month, Medicare pays 80% of the rental fee, you pay 20%, and after those 13 months—congratulations!—the bed becomes yours, and Medicare stops paying rental fees.

This rental approach actually has a silver lining. As our team at ProMed DME often explains to customers: "The rental period gives you time to make sure the bed truly meets your needs, and typically includes maintenance during that time—so if anything goes wrong, it's on them, not you."

Eligibility rules & documentation

Getting Medicare to say "yes" to your adjustable bed insurance coverage requires jumping through a few hoops—but they're manageable with the right preparation.

First, you'll need a written order from your doctor that spells out your diagnosis, describes your condition, explains why you need this specific bed, and details which features are necessary (like side rails or electric adjustments).

Medicare also requires a face-to-face examination with your doctor within six months of ordering the bed. This isn't just a quick chat—your doctor needs to thoroughly document your condition.

The heart of your case is the medical necessity documentation. Your doctor must clearly show why an ordinary bed just won't cut it for your specific health needs. Common qualifying conditions include severe arthritis, cardiac issues requiring elevation, chronic respiratory problems like COPD, spinal cord injuries, or conditions causing severe pain that requires frequent repositioning.

"The paperwork seemed overwhelming at first," admits James, who has severe arthritis. "But my doctor was fantastic. She specifically noted how my condition made it impossible to safely get in and out of a regular bed and how an adjustable bed would allow me to change positions to manage my pain. That detailed documentation made all the difference."

Lastly, your equipment must come from a Medicare-enrolled supplier that accepts assignment. At ProMed DME, we handle this paperwork daily and can guide you through the process.

"Adjustable bed insurance coverage" — Costs & out-of-pocket math

Let's talk dollars and cents with some real-world examples of adjustable bed insurance coverage.

Imagine a Medicare-approved adjustable bed with a $1,000 approved amount. Medicare Part B would cover $800 (that's 80%), leaving you with $200 to pay (your 20% coinsurance). If you haven't met your deductible yet, add another $240, bringing your total out-of-pocket to $440.

For higher-end models, these costs can climb quickly. A bed with a $5,000 approved amount means Medicare pays $4,000, but you're on the hook for $1,000 (plus that deductible if you haven't met it yet).

This is where having a Medigap (Medicare Supplement) plan can be a financial lifesaver. These plans can help cover your 20% coinsurance and sometimes even the deductible. For example, Medigap Plan F covers both the Part B deductible and coinsurance—potentially bringing your out-of-pocket costs down to zero.

Sarah from Arizona shares her experience: "When I first calculated my portion, I was worried. But my Medigap Plan G covered all but the deductible, which made the bed affordable for me. I sleep better now, both physically and financially!"

For the most current information on coverage details, check out Medicare's official hospital bed coverage page.

Features Medicare will (and won't) fund

Medicare isn't in the business of funding luxury, but they do cover what's medically necessary. Understanding the difference can save you from disappointment and unexpected expenses.

Medicare typically covers basic hospital-style adjustable beds with electric head and foot controls when medically needed. They'll also pay for side rails when prescribed for safety and pressure-relief mattresses if you're at risk for pressure ulcers. If you need heavy-duty or extra-wide beds due to weight requirements, those are usually covered too, along with mattress pads and covers when medically necessary.

What won't make Medicare's approved list? Those consumer brand adjustable beds you see advertised on TV, like Sleep Number or Tempur-Pedic. Medicare also says "no thanks" to luxury features like massage functions, built-in speakers, USB ports, or designer headboards. Even programmable position memory settings aren't covered unless they're part of a medical-grade bed, and you can forget about warming features or cooling technology.

"I had my heart set on a beautiful adjustable bed I saw in a magazine," Marjorie from Tampa tells us with a laugh. "My doctor gently explained that Medicare would only cover a hospital-grade model. It doesn't match my bedroom decor, but it gives me the medical support I need, and Medicare covered most of the cost. I've dressed it up with a pretty quilt, and now I hardly notice the difference."

Medicaid, Private Insurance & Financial Aid Options

While Medicare is the primary insurance provider for many seniors needing adjustable beds, it's definitely not your only option for adjustable bed insurance coverage. Let's explore some alternatives that might help you sleep better—both physically and financially!

"I was so focused on Medicare that I nearly missed out on my state's Medicaid waiver program," shares Elaine from Michigan. "That program covered my adjustable bed completely, which was such a blessing for my limited budget."

Medicaid often steps in where Medicare leaves gaps, particularly for those with lower incomes. Unlike Medicare's standard 80% coverage, Medicaid frequently covers up to 100% of approved medical equipment—including adjustable beds—when properly prescribed by your doctor and obtained through a Medicaid-enrolled supplier.

Medicaid waiver programs by state

Each state runs its own version of Medicaid with unique Home and Community-Based Services (HCBS) waivers designed to help people receive care at home rather than in nursing facilities.

Florida residents might qualify for the Home Care for the Elderly (HCE) program, which provides subsidies for home equipment for seniors at risk of nursing home placement. Meanwhile, Californians can look into In-Home Supportive Services (IHSS), and New Yorkers have the Medicaid Managed Long Term Care (MLTC) program.

"The Texas STAR+PLUS Waiver was my lifeline," explains Carlos from Houston. "Not only did they cover my adjustable bed, but they also helped with other home modifications that made aging in place possible."

Income limits vary by state, so don't assume you won't qualify. A quick call to your state's Medicaid office can help determine your eligibility and guide you through the application process.

Other ways to lower costs

Beyond government programs, several other avenues can help make your adjustable bed more affordable:

Veterans Benefits can be a godsend for those who served. The VA Aid & Attendance benefit often covers medically necessary beds when prescribed by VA physicians. As James, a Vietnam veteran, told us: "The VA covered nearly everything. I just wish I'd known about the benefit sooner instead of struggling for months."

Private insurance policies vary widely, but many follow Medicare-like guidelines for DME coverage. They typically require prior authorization and thorough documentation of medical necessity. Coverage percentages usually range from 50% to 80% of approved amounts, and staying in-network almost always results in lower out-of-pocket costs.

Medicare Advantage Plans (Part C) might offer more generous coverage than Original Medicare. Some plans feature lower coinsurance percentages or additional covered features, though they may have stricter supplier networks.

Nonprofit assistance can be found through organizations like the ALS Association, Multiple Sclerosis Foundation, and Muscular Dystrophy Association, which offer equipment grants for qualifying individuals.

Don't overlook tax deductions either. When prescribed by a doctor, medical equipment can often be claimed as a medical expense if you itemize deductions on your tax return.

Many manufacturers offer discount programs for those with financial need. Some provide payment plans or seasonal sales that can significantly reduce upfront costs.

DME recycling programs exist in many communities, offering gently used equipment at reduced prices or sometimes even for free. These programs not only save money but also promote sustainability.

"After trying everywhere else, I finded a local DME recycling program," shares Martha from Oregon. "I found a hospital-grade adjustable bed that was barely used for just $300. It was exactly what my doctor prescribed at a fraction of the cost."

At ProMed DME, we understand navigating these options can feel overwhelming. That's why our team specializes in helping you identify which programs you might qualify for and assisting with the necessary paperwork. We believe everyone deserves a good night's sleep—regardless of their financial situation.

Step-by-Step Guide to Secure Coverage

Securing adjustable bed insurance coverage doesn't have to feel like solving a complex puzzle. With the right approach and documentation, you can steer the process with confidence. Let's walk through exactly what you need to do to get your adjustable bed covered.

"Adjustable bed insurance coverage" Step-by-Step checklist

The journey to getting your adjustable bed covered starts with your doctor and ends with delivery to your home. Each step matters, so let's break it down.

Start by having an honest conversation with your healthcare provider about your needs. This isn't just a quick visit—you need to explain how your condition affects your sleep and mobility, and why an adjustable bed would make a meaningful difference in your care. Your doctor needs to be convinced the bed is truly necessary, not just convenient.

"I was nervous about asking my doctor for an adjustable bed," shares Maria from Palm Beach. "But when I explained how I couldn't breathe lying flat and hadn't slept more than two hours straight in months, she immediately understood the medical necessity."

Once your doctor agrees, they'll write a detailed prescription. This isn't a simple slip of paper—it needs to include your specific diagnosis, what features you need (like electric adjustments or side rails), and most importantly, why a regular bed won't work for your condition. Make sure this prescription is dated within the last 6 months, or insurance may reject it.

Your doctor will also need to complete a Certificate of Medical Necessity (CMN). This form provides the detailed justification Medicare or other insurers need to approve coverage. Sometimes your doctor might attach clinical notes or test results to strengthen your case.

Next comes selecting a supplier. This step can make or break your experience. Choose a Medicare-approved supplier who accepts assignment—this means they've agreed to accept the Medicare-approved amount as payment in full. At ProMed DME, we not only accept assignment but also handle all the paperwork for you, taking a huge burden off your shoulders during an already stressful time.

Before submitting everything, make copies of all your documents. Insurance paperwork has been known to go missing, and having backups can save weeks of delays. After submission, follow up regularly until you receive written confirmation of approval.

Once approved, verify your financial responsibility before delivery. Get clear answers about what portion you'll pay and when payment is due. When your bed arrives, ensure proper setup and training on how to use all features safely. Keep all delivery receipts and warranty information in a safe place.

"The documentation is everything," notes our Medicare specialist at ProMed DME. "We've seen many claims denied simply because the prescription wasn't specific enough about why the adjustable features were medically necessary."

Finding an approved supplier

Finding the right supplier might be the most important decision you make in this process. The right partner will guide you through the insurance maze, while the wrong one could leave you with unexpected bills or subpar equipment.

Medicare makes finding suppliers relatively straightforward through their online "Find a Supplier" tool on Medicare.gov. Simply enter your ZIP code and search for DME suppliers. But finding a supplier is just the beginning—you need to verify they accept assignment, which means they agree to charge only what Medicare approves.

You can also verify a supplier's credentials by asking for their National Provider Identifier (NPI) number and checking it on the NPPES NPI Registry website. This extra step ensures they're in good standing with Medicare.

When calling potential suppliers, ask these critical questions: Do you accept my insurance? What's your experience specifically with adjustable bed claims? Will you handle all the paperwork? How long does approval typically take? Do you provide delivery and setup? What happens if I need repairs? Is there any kind of trial period?

Good suppliers like ProMed DME will take time to answer all your questions without rushing you. They'll explain what documentation they need, handle the insurance verification, and communicate clearly throughout the process. They should feel like partners in your healthcare, not just vendors.

After your bed is delivered, understand who's responsible for maintenance. During the rental period (typically the first 13 months with Medicare), the supplier usually handles repairs and maintenance. After ownership transfers to you, the responsibility may shift. Ask about extended warranties and what they cover—sometimes paying a little more upfront saves significant money down the road.

At ProMed DME, we've streamlined this entire process. Our team handles all insurance paperwork, verifies coverage before delivery, and provides complete setup and training when your bed arrives. Plus, with our dedicated nurse on staff, we can help ensure your documentation meets all requirements for coverage, significantly improving your chances of approval.

This isn't just about getting a bed—it's about improving your quality of life through better sleep and mobility. Taking the time to follow these steps properly means you'll get the equipment you need with minimal stress and expense.

Appeals, Maintenance & FAQs

When it comes to adjustable bed insurance coverage, even the most carefully prepared claims sometimes face problems. Don't worry—you have options if things don't go smoothly.

What if my claim is denied?

Take a deep breath if you receive a denial letter—this happens more often than you might think, and many initially rejected claims get approved on appeal.

"I was devastated when Medicare first denied my claim," shares Eleanor from Palm Beach. "But my supplier helped me appeal, and we got it approved on the second try. The key was adding more detailed notes from my pulmonologist."

The Medicare appeals process follows these timeframes:

First, request a Redetermination within 120 days by submitting form CMS-20027 along with any additional supporting documentation from your doctor. Expect a decision in about 60 days.

If that's unsuccessful, you can move to a Reconsideration by a Qualified Independent Contractor within 180 days using form CMS-20033. Again, expect about a 60-day wait.

For claims worth at least $180 (in 2024), the third level involves requesting an Administrative Law Judge hearing within 60 days. These can be conducted by phone, video, or in person, with decisions typically taking about 90 days.

If needed, you can escalate to the Medicare Appeals Council using form DAB-101 within 60 days, and ultimately to Federal District Court for claims of at least $1,800.

"In our experience at ProMed DME, most successful appeals come down to stronger documentation," our claims specialist explains. "We often help clients obtain more specific letters from their doctors explaining exactly why the adjustable features are medically necessary for their condition."

Who pays for repairs after the warranty?

Understanding who handles repairs helps you plan for the long haul with your adjustable bed.

During the 13-month rental period that Medicare typically follows, your supplier must handle all repairs and maintenance at no extra cost to you. If something breaks, they're responsible for fixing or replacing it promptly.

The situation changes after ownership transfers to you:

Medicare may cover 80% of the cost for necessary repairs to keep the equipment working properly, with you responsible for the remaining 20% coinsurance. However, these repairs must be performed by a Medicare-approved supplier using approved parts.

Routine maintenance—like tightening screws or lubricating moving parts—typically becomes your responsibility once you own the bed. Some suppliers offer extended service plans that are worth considering, especially for beds with complex electronic components.

"I keep a maintenance log for my adjustable bed," suggests Tom from Naples. "It's helped me track when things need attention and document everything for insurance purposes."

For specialized features like pressure-relief surfaces, Medicare has specific coverage policies. You can learn more about these in Medicare's coverage of air-fluidized beds.

Frequently Asked Questions about Adjustable Bed Insurance

Does Medicare cover both rental and purchase?

Yes, but you usually don't get to choose which approach is used. Medicare typically prefers the 13-month rental pathway for most adjustable beds, which actually works in your favor.

"The rental approach gives you a test drive," explains our Medicare specialist at ProMed DME. "If the bed doesn't meet your needs or your condition changes, adjustments can be made more easily during the rental period."

During those 13 months, Medicare pays 80% of the monthly rental fee while you pay 20% (after meeting your deductible). After that period, you own the bed outright with no further rental payments.

For highly specialized or customized equipment, Medicare occasionally approves an outright purchase instead, but this decision ultimately rests with your supplier based on Medicare guidelines.

Are consumer luxury beds ever covered?

In nearly all cases, the answer is no. That Sleep Number or Tempur-Pedic adjustable base you've seen advertised simply doesn't meet Medicare's definition of durable medical equipment.

Consumer beds typically include non-medical "comfort" features like massage functions, heating elements, or programmable positions. They're designed with aesthetics and comfort in mind, not specific medical needs.

Medicare and most insurance plans specifically cover hospital-style adjustable beds that have medically necessary features like side rails, Trendelenburg positioning, or heavy-duty frames for patients with weight considerations.

There are rare exceptions where a doctor might convince Medicare that only a specific consumer model will address a unique medical need, but you'd likely need to pay the difference between the approved amount and the actual cost.

How long does coverage last?

For the typical rental scenario, Medicare covers monthly payments for 13 consecutive months. After that, the bed belongs to you, but Medicare stops paying rental fees.

If you purchased the bed outright (less common), Medicare makes a one-time payment for their share of the approved amount.

What about replacement? Medicare may cover a replacement bed if yours is lost, stolen, or damaged beyond repair in an accident or disaster. For normal wear and tear, replacements are typically covered only after the "reasonable useful lifetime" of the equipment—usually 5 years—and you'll need to establish medical necessity all over again.

"Many people don't realize that coverage for the bed itself is separate from coverage for accessories," notes our equipment specialist. "Even after you own the bed, Medicare may still cover related supplies like special mattress overlays or pressure pads if they're medically necessary."

At ProMed DME, we've guided thousands of customers through these complex processes. Our team handles all the paperwork, helps with appeals if needed, and makes sure you understand your coverage every step of the way.

Conclusion

Navigating adjustable bed insurance coverage might feel like finding your way through a maze, but the journey is well worth it. When you consider the financial savings and quality-of-life improvements, taking the time to understand this process pays dividends for years to come.

After helping countless customers secure the medical beds they need, we've learned that success comes down to a few essential points:

First, Medicare Part B typically covers 80% of the approved amount for medically necessary adjustable beds after you meet your deductible. This can translate to thousands of dollars in savings, especially for higher-end models with features that address specific medical conditions.

Documentation is absolutely crucial in this process. Your paperwork tells the story of your medical need, so work hand-in-hand with your healthcare provider to ensure your prescription and medical records clearly demonstrate why an adjustable bed isn't just helpful—it's necessary for your condition.

"The difference between approval and denial often comes down to how well your medical need is documented," shares one of our customer service specialists. "We've seen countless claims initially denied that were later approved with the right paperwork."

Always choose Medicare-approved suppliers that accept assignment. This simple step can save you from unexpected costs and billing headaches down the road. At ProMed DME, we accept assignment on all Medicare claims, ensuring you never pay more than your required share.

Don't overlook supplemental coverage options. A good Medigap or Medicare Advantage plan can help cover that 20% coinsurance, potentially reducing your out-of-pocket costs to nearly nothing for qualifying equipment.

And if your claim is denied—take a deep breath and appeal. Many initially denied claims are approved during the appeals process when additional documentation is provided. Persistence often pays off.

At ProMed DME, we understand this process can feel overwhelming. That's why we handle all the heavy lifting for you—from insurance paperwork and verification to claims submission and appeals if needed. Our nationwide shipping means you can access quality medical equipment no matter where you live, and our dedicated nurse on staff helps ensure your documentation meets all requirements for coverage.

We work with most insurance plans to minimize your expenses because we believe that financial concerns shouldn't stand between you and the equipment you need for better health and comfort.

Whether you're in our hometown of Stuart, Florida or anywhere else across the country, we're committed to making your experience as smooth as possible. Our team is just a phone call away, ready to answer questions and guide you through every step of securing coverage for your adjustable bed.

For more information about our selection of adjustable beds and personalized help with your insurance coverage, visit our adjustable beds information page or reach out to our friendly team.

Investing in proper sleep equipment isn't just about comfort—it's about improving your health, independence, and quality of life. And with the right approach to insurance coverage, it can be more affordable than you might think.