What Diagnosis Qualifies for a Hospital Bed Through Medicare?

If you or your loved one is recovering from an illness or living with a long-term health condition, a hospital bed at home can be essential for comfort, safety, and care.

Fortunately, Medicare Part B may help cover the cost if specific criteria are met, and having a qualifying diagnosis for a hospital bed under Medicare is part of that process.

In this guide, we explain how to qualify for a hospital bed, what medical conditions are typically covered, and what durable medical equipment Medicare pays for as part of its home care benefits.

Summarized: the key points

1. Medicare Part B may cover hospital beds at home if they're considered medically necessary.

2. A qualifying diagnosis and a written prescription from a healthcare provider are required.

3. Conditions like spinal cord injuries, severe arthritis, chronic obstructive pulmonary disease, ALS, or recent hospital discharge may meet the eligibility criteria.

4. Beds must be prescribed as a safer or medically required alternative to an ordinary bed.

5. Medicare generally covers fixed height, variable height, semi-electric, and some total electric hospital beds.

6. Accessories like side rails, bed cradles, and pressure relief mattresses may also be covered.

7. Medicare pays 80% of the approved cost after the annual deductible is met.

8. The bed must be sourced through a Medicare-approved supplier.

9. Proper documentation of the medical necessity is crucial for approval.

10. Speak with a healthcare professional to determine your eligibility and start the process.

Diagnoses that commonly qualify for a hospital bed

There’s no set list of diagnoses, but the following conditions often meet Medicare’s requirements for a home hospital bed:

1. Neurological or musculoskeletal disorders

• Spinal cord injuries or spinal disorders

• Severe arthritis or joint degeneration

• Multiple sclerosis

• Muscular dystrophy

• Parkinson’s disease

• ALS (Amyotrophic Lateral Sclerosis)

• Dementia (if the patient is considered homebound and has trouble leaving their home without the help of another person or an assistive device, like a wheelchair)

2. Cardiac, respiratory, or chronic conditions

• Severe cardiac conditions

• Chronic obstructive pulmonary disease (COPD)

• Chronic pain requiring therapeutic positioning

• Congestive heart failure

3. Post-surgical and recovery cases

• Recent hospital discharge after surgery

• Bone fractures in elderly patients

• Recovery from major orthopedic procedures

4. Mobility impairments

• Partial or complete paralysis

• Weakness from long-term illness

• Bedbound individuals needing healthcare professional assistance at home

In each case, the key is to demonstrate that a hospital bed is medically necessary and prescribed by a healthcare provider.

What is the definition of medically necessary?

'Medical necessity' is a term health insurance companies use to define services and supplies needed to diagnose or treat medical conditions.

According to the National Association of Insurance Commissioners, there is no set definition of 'medical necessity'. Instead, health insurance plans will provide a definition, and, in some cases, state laws may define the term, too.

Understanding Medicare coverage for hospital beds

Hospital beds are classified as durable medical equipment (DME) and are eligible for Medicare coverage under Part B when they’re considered medically necessary. To be approved, the following criteria for a hospital bed at home must be met:

• Your healthcare provider must prescribe a hospital bed for use in your home.

• Your condition must be a documented medical condition that makes an ordinary bed unsafe or insufficient.

• The prescription must specify why an adjustable bed is required for medical treatment.

Once approved, Medicare covers 80% of the cost of the home hospital bed, with the remaining 20% typically paid by the patient or supplemental insurance. Beds must be obtained from a Medicare-approved supplier.

Read more about coverage requirements, including rental and purchase criteria, in our guide: Does Medicare Pay for Hospital Beds?

What is durable medical equipment (DME)?

According to the Medicare website, DME includes, but isn't limited to:

• Canes

• Commode chairs

• Continuous passive motion machines, devices & accessories

• Continuous Positive Airway Pressure (CPAP) machines

• Crutches

• Diabetes supplies, such as

• Blood sugar monitors

• Blood sugar test strips

• Blood sugar control solutions

• Lancets & lancet holders

• Hospital beds

• Infusion pumps & supplies

• Nebulizers & nebulizer medications

• Oxygen equipment & accessories

• Patient lifts

• Pressure-reducing support surfaces

• Suction pumps

• Traction equipment

• Walkers

Explore Opera Hospital Beds

What are the criteria for getting a hospital bed?

Medicare’s decision is based on a combination of your diagnosis and how it impacts your daily life. To qualify, your provider must show that:

• You need to change body position frequently to relieve pain, avoid pressure sores, or improve circulation.

• You have a medical condition that requires your head or feet to be elevated above the level of your heart.

• You cannot safely sleep in or rise from a standard bed.

These requirements form the basic criteria for a hospital bed at home. Ultimately, the goal is to ensure that the bed improves your health and safety in a home setting.

How do you qualify for a hospital bed at home?

To qualify:

1. Speak with a healthcare professional (doctor, nurse practitioner, or occupational therapist) about your condition.

2. Request a written prescription with detailed notes on your condition and medical necessity.

3. Use a Medicare-approved DME supplier to begin the approval and delivery process.

If you don't meet Medicare's criteria for a hospital bed, there are other ways you can get one. Discover how in our blog, How to Get a Hospital Bed for Free.

What sort of hospital beds does Medicare cover?

Medicare Part B generally covers the following types of hospital beds if they’re prescribed:

• Fixed-height hospital beds – basic models with a set height.

• Variable height hospital beds allow height adjustments to assist with transfers or mobility.

• Semi-electric hospital beds which offer electric adjustment of head and foot sections, but the height is adjusted manually.

• Fully electric adjustable hospital beds electronically adjust the head, foot, and height. They are usually only covered if manual use is not possible due to physical limitations.

• Extra-wide hospital or bariatric beds are covered only when medically necessary and prescribed for larger patients.

Each bed type must meet the medical necessity criteria, and the documentation must clearly state why a specific model (like a total electric hospital bed) is required.

What other bed accessories and bedding does Medicare consider durable medical equipment?

In addition to the bed itself, Medicare may also cover specific accessories and bedding classified as durable medical equipment:

• Side rails: Included for safety, especially if there’s a risk of falls.

• Bed cradle: Keeps bedding off sensitive skin, useful for certain conditions.

• Pressure relief mattresses (non-powered): Covered for individuals at risk of pressure sores.

• Mattress overlays or gel cushions: May be covered if standard bedding causes discomfort or skin issues.

It's important to note that memory foam mattresses and luxury items, like hospital bedding and care bed accessories are not generally covered unless proven medically necessary and authorized by a healthcare provider.

More from Opera Beds

Having a hospital-grade bed in your home can drastically improve safety, comfort, and healing. Whether it’s to assist with post-surgery recovery, a spinal cord injury, or chronic conditions, Medicare Part B may help cover the cost if the right steps are followed.

If you need help finding the right bed for home use, try our Bed Selector Tool or contact our friendly team of experts - we’re here to help you navigate every step of the process.

Explore our range for more details about how they work and the medical problems they can alleviate:

• Rotating chair beds

• Hospital beds

We even stock a wide range of hospital bed mattresses and hospital bed accessories, to maximize your comfort and ensure a quality night's sleep. 

For further information on our range and tips on how to manage medical conditions, explore our blog. Here, you’ll find guides on how adjustable beds provide relief from common back pain, how to get a better night’s sleep with chronic pain, and more.