Medicare covers a hospital bed once every five years if your doctor says you need it for a medical reason

Medicare Part B pays 80 percent of the cost of a hospital bed after you meet your yearly deductible. The bed must be medically necessary — meaning your doctor has to write an order saying you cannot get in and out of a regular bed safely, or that you have a condition where the adjustable height or rails matter to your treatment. Medicare will not pay for a bed you want for comfort alone.

The five-year rule is the hard limit. Once Medicare pays for a hospital bed, you cannot get another one covered until five years have passed from the date of delivery. If your first bed was delivered in January 2022, Medicare will not cover a replacement until January 2027, even if the first one breaks or wears out.

You pay the remaining 20 percent of the approved amount, plus anything the supplier charges above what Medicare allows. If the supplier is not a Medicare-approved vendor, you may owe the full cost.

Key Takeaways

  • Your doctor must write a written order stating the bed is medically necessary before Medicare will consider paying for it.
  • Medicare covers one hospital bed per five-year period, paying 80 percent of the approved cost after your Part B deductible.
  • You are responsible for 20 percent coinsurance, plus any amount the supplier charges above Medicare's approved price.
  • The bed must come from a Medicare-approved durable medical equipment supplier, or you will owe the full bill.
  • If your bed breaks within the five-year window, Medicare will not pay for a replacement — repairs may be covered instead.

What counts as medically necessary for a hospital bed

Medicare uses a specific definition. Your doctor must document that you have a condition where a regular bed puts you at risk or makes your medical care harder. Common reasons Medicare approves beds include severe arthritis that makes it impossible to get up without motorized help, spinal cord injury, paralysis, or a condition where you spend most of your day in bed and need the head or foot to adjust for breathing or circulation.

Conditions that usually do not may have access to include general weakness from age, minor back pain, or a preference for a bed that is easier to get out of. Your doctor's order has to say why the bed is necessary for your specific condition, not just that you are elderly or recovering from surgery.

The order must come from a doctor, nurse practitioner, or physician assistant — not from a hospital discharge planner or a medical equipment supplier. The supplier cannot write the order for you, and Medicare will reject any order that does not come from a licensed provider.

How to start the process and what documents you need

Step one is talking to your doctor. Tell them you are having trouble getting in and out of bed, or that your condition makes a regular bed unsafe. Ask them to write a written order for a hospital bed and send it to a Medicare-approved supplier. The order should include your diagnosis, why the bed is medically necessary, and the date.

Step two is choosing a supplier. You can find Medicare-approved suppliers by searching the Medicare Supplier Directory on Medicare.gov, or by calling 1-800-MEDICARE. The supplier will verify that your doctor's order is on file and will check your coverage before delivery. Ask the supplier upfront what your 20 percent coinsurance will cost, because approved amounts vary.

Step three is delivery and setup. The supplier delivers the bed, sets it up, and shows you how to use it. Keep the delivery receipt and any paperwork the supplier gives you. You will need these if Medicare later questions the claim.

The five-year replacement rule and what happens if your bed breaks

Once Medicare pays for your hospital bed, the five-year clock starts on the delivery date. You cannot get a second bed covered until five years have passed, even if the first one stops working. This is a strict rule with no exceptions for equipment failure.

If your bed breaks before five years are up, you have two options. First, you can ask the supplier to repair it — Medicare may cover repairs at 80 percent, though you will still owe 20 percent coinsurance. Second, you can pay out of pocket for a replacement bed and wait until the five-year mark to ask Medicare to cover the next one.

Some suppliers offer rental instead of purchase. If you rent a hospital bed, the five-year rule still applies to the rental payments Medicare covers. Once Medicare has paid for 60 months of rental, coverage stops.

What you pay and how to estimate your out-of-pocket cost

Your cost depends on three things: your Part B deductible, the Medicare-approved amount for the bed, and what the supplier charges above that amount.

First, you pay your yearly Part B deductible if you have not met it yet in that calendar year. For 2024, the Part B deductible is $240, though this amount changes yearly. Once you have paid the deductible, Medicare pays 80 percent of the approved amount and you pay 20 percent.

The Medicare-approved amount varies by region and by the type of bed. A basic adjustable bed might be approved at $800 to $1,200, while a more complex model could be approved at $1,500 or more. Call the supplier and ask what the approved amount is in your area before you commit.

If the supplier charges more than the approved amount, you owe the difference in full. For example, if Medicare approves $1,000 and the supplier charges $1,300, you pay 20 percent of $1,000 (which is $200) plus the full $300 overage, for a total of $500 out of pocket.

When Medicare will not cover a hospital bed

Medicare will not pay if your doctor does not write an order, or if the order does not explain why the bed is medically necessary for your condition. It will not pay if you buy or rent the bed before getting the order in writing — you have to have the order first.

Medicare will not pay if you use a non-approved supplier. Always check the Medicare Supplier Directory before placing an order. If you use a supplier who is not approved, you owe the full cost.

Medicare will not pay for a second bed within five years of the first delivery, even if you have moved, changed doctors, or your condition has worsened. You also cannot get coverage for a bed that is purely for comfort, convenience, or preference.

If you have Medicaid in addition to Medicare, Medicaid may cover a replacement bed during the five-year window. Contact your state Medicaid office to ask whether they cover hospital beds and what their rules are.

Medigap and Medicare Advantage coverage for hospital beds

Medigap plans do not cover hospital beds. They only cover the coinsurance and deductibles that Original Medicare leaves you responsible for. Since Medicare covers 80 percent of the approved amount, Medigap will cover 20 percent of that approved amount — but not any amount the supplier charges above Medicare's approval.

Medicare Advantage plans (Part C) set their own rules for durable medical equipment. Some Advantage plans cover hospital beds on the same terms as Original Medicare — 80 percent after deductible. Others may have different approval processes or may require you to use specific suppliers. Call your Advantage plan before ordering to find out what they cover.

If you are switching from Original Medicare to an Advantage plan, or vice versa, the five-year rule still applies. The clock does not reset when you change plans.

Frequently Asked Questions

Can I get Medicare to pay for a hospital bed if I am in a nursing home or assisted living?

No. Medicare does not cover hospital beds for people living in nursing homes or assisted living facilities. The facility is responsible for providing the bed. If you need a special bed, ask the facility's social worker or administrator whether they have one available or can provide one.

What if my doctor says I need a hospital bed but Medicare denies it?

You have the right to appeal. Ask your doctor's office to send a detailed letter explaining why the bed is medically necessary for your specific condition. Submit this letter along with your appeal to Medicare within 120 days of the denial. You can also ask your doctor to call Medicare to discuss the case directly.

Does Medicare cover mattresses or bed rails separately from the bed frame?

Medicare may cover a pressure-relief mattress if your doctor orders it for a medical reason, such as pressure ulcer prevention. Bed rails are usually covered as a separate item. Both follow the same rules as the bed itself — your doctor must order them, and Medicare pays 80 percent of the approved amount after your deductible.

Can I buy a hospital bed myself and ask Medicare to reimburse me?

No. You must have your doctor's order in place before you purchase or rent the bed. If you buy one without an order, Medicare will not pay you back. Always get the written order from your doctor and give it to a Medicare-approved supplier before any money changes hands.

What happens to my hospital bed after five years — can I keep using it?

Yes, you can keep using the bed you own. The five-year rule only prevents Medicare from paying for a new one. If your original bed still works, you can use it as long as you want. If it breaks and you want a replacement covered by Medicare, you have to wait until five years have passed since the first delivery.