Medicare's Capped Rental Program Explained
Under Original Medicare Part B, hospital beds fall under the category of Durable Medical Equipment (DME) and are subject to the capped rental program. This program dictates the process for obtaining and paying for certain types of equipment, including hospital beds. Instead of a direct purchase, the beneficiary first rents the equipment from a Medicare-approved supplier.
The 13-Month Rule for Ownership
For a hospital bed, the capped rental period lasts for 13 months of continuous use. During this time, Medicare pays its share of the monthly rental fee, and the beneficiary is responsible for their coinsurance. After the 13th month of rental payments, the ownership of the hospital bed is transferred from the supplier to the beneficiary. After 13 months, you are no longer responsible for rental payments. You become responsible for routine maintenance, though Medicare will cover major repairs and replacement parts if the bed is within its “reasonable useful lifetime” (typically five years).
The Choice to Rent or Buy
Medicare may give you the choice to rent or buy some DME. However, for hospital beds, the capped rental program leading to ownership after 13 months is standard. Always confirm specifics with your doctor and supplier.
How Ownership is Affected if you Stop Needing the Bed
If your medical condition improves and you no longer need the hospital bed before the 13-month capped rental period ends, rental payments stop, and the supplier reclaims the bed. If you complete the 13 months and own the bed, you keep it even if your medical need ends.
Qualifying for Medicare Coverage of a Hospital Bed
To receive coverage, both you and the equipment must meet specific requirements under Medicare Part B.
Medical Necessity Documentation
A doctor must certify that a hospital bed is medically necessary for your home use and provide documentation explaining why it is required. Reasons include needing specific positioning for pain or respiratory issues, requiring attachments not possible with a regular bed, or having conditions like severe arthritis or bedsores.
The Importance of Medicare-Approved Suppliers
It is crucial to obtain your hospital bed from a supplier that is enrolled in Medicare and accepts assignment. A Medicare-enrolled supplier can bill Medicare, and one who accepts assignment agrees to the Medicare-approved amount as full payment, limiting your out-of-pocket costs to the 20% coinsurance and any unmet deductible.
Comparison Table: Rental vs. Purchase via Capped Rental
| Feature | Hospital Bed Rental (Months 1-13) | Hospital Bed After Ownership Transfer (Month 14+) |
|---|---|---|
| Payments | Monthly rental payments | No further rental payments |
| Ownership | Owned by the supplier | Owned by the beneficiary |
| Maintenance/Repair | Supplier's responsibility | Beneficiary's responsibility for routine care; Medicare may cover major repairs |
| Medicare Payment | Medicare covers 80% (after deductible); beneficiary pays 20% coinsurance | No further payments from Medicare for the bed itself, only for medically necessary repairs |
| Medical Necessity | Must remain medically necessary during the rental period | Continues to be covered as long as medically necessary, even if condition improves after ownership transfer |
Special Circumstances for Different Beds
Medicare typically covers manual and semi-electric beds. Coverage for fully electric or specialty beds requires more specific medical justification. Without this, you may pay the cost difference.
Potential Costs and Coverage Details
Out-of-pocket costs include the Part B deductible and coinsurance. You must first meet your annual Part B deductible (in 2025, $257). Afterward, you pay 20% of the Medicare-approved amount for monthly rentals and future repairs. Medigap or Medicare Advantage (Part C) plans can help with these costs.
Conclusion
Medicare covers medically necessary hospital beds through a 13-month capped rental program, requiring a doctor's prescription. After meeting the Part B deductible, beneficiaries pay 20% coinsurance, with Medicare covering 80%. Ownership transfers after 13 months, but if medical need ceases sooner, payments stop and the bed is returned. Using a Medicare-approved supplier who accepts assignment is essential. It is recommended to consult your doctor and supplier for specific details. {Link: Medicare.gov https://www.medicare.gov/coverage/hospital-beds}
What to Know Before Getting a Hospital Bed
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Medicare requires a doctor's prescription for a hospital bed to be covered.
A physician must document the medical necessity of the bed in your medical records for Medicare to approve coverage.
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The standard Medicare coverage model is a 13-month rental that leads to ownership.
Under Medicare's capped rental program, you rent the equipment for 13 continuous months before ownership transfers to you.
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You must use a Medicare-enrolled supplier who accepts assignment.
For coverage, the hospital bed must come from a Medicare-approved supplier who agrees to charge only the Medicare-approved amount.
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Your financial responsibility includes the Part B deductible and 20% coinsurance.
After meeting your annual Part B deductible, you pay 20% of the Medicare-approved amount.
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Coverage for specialty features requires additional medical justification.
While manual and semi-electric beds are typically covered, fully electric or bariatric beds may need more specific medical documentation.
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If you no longer need the rental bed before 13 months, payments and coverage will stop.
If medical necessity ends during the rental period, payments stop, and the supplier retrieves the bed.
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Once you own the bed, Medicare will still cover medically necessary repairs.
After the 13-month rental, Medicare may cover 80% for major repairs if the bed is within its useful lifetime.
FAQs
Does Medicare pay for a hospital bed to be used at home?
Yes, Medicare Part B covers medically necessary hospital beds for home use with a doctor's prescription and from a Medicare-approved supplier who accepts assignment.
How does the capped rental program for hospital beds work?
Medicare pays 80% of the monthly rental for 13 months, and the beneficiary pays 20% coinsurance after the Part B deductible. Ownership transfers after 13 months.
Do I have to rent the hospital bed for the full 13 months?
You only rent as long as it's medically necessary. If you no longer need the bed before 13 months, payments stop, and the equipment is returned.
What if I need a hospital bed after a prolonged hospital stay?
Coverage for a home hospital bed is under Medicare Part B, requiring a separate doctor's order and following DME rules for home use.
What type of hospital beds does Medicare cover?
Medicare typically covers manual and semi-electric beds. Fully electric or specialty beds require additional medical justification or you may pay the difference.
What is the difference between renting and buying a hospital bed with Medicare?
The standard process involves renting first, with ownership transferring after 13 months. A direct purchase option may not always be available from the start.
Will Medicare cover accessories like trapeze bars or special mattresses?
Yes, if medically necessary as determined by your doctor, Medicare can cover accessories.
What are my out-of-pocket costs for a Medicare-covered hospital bed?
After meeting the Part B deductible, you generally pay a 20% coinsurance for monthly rentals and future covered repairs.
How do I find a Medicare-approved supplier for a hospital bed?
Medicare-approved suppliers can be found on the official Medicare website or by calling 1-800-MEDICARE. Confirm they accept assignment.
Does a Medicare Advantage plan cover hospital beds?
Yes, Medicare Advantage plans cover Original Medicare benefits like hospital beds, though costs and network rules may vary by plan.
What happens if my medical need for the bed changes?
If your medical condition changes requiring a different bed, a new prescription outlining the updated medical necessity is needed.
What if the bed I own breaks down?
Once you own the bed, Medicare may cover 80% for major repairs if it's within the equipment's useful lifetime.
