Medicare Part B covers nonhospital-related medical costs for services and needed durable medical equipment, such as an adjustable bed or a wheelchair. Many private insurers, such as Fidelis, provide Medicare Part B coverage to Medicare beneficiaries. Whether or not a sleep adjustable bed is covered under a Fidelis Medicare plan depends upon the beneficiary meeting the medical necessity guidelines set by Medicare.
Medicare Benefits
Medicare is a government medical insurance program primarily for persons 65 and older. Medicare is divided into four parts, A through D, with beneficiaries receiving hospital coverage under Part A and coverage for outpatient services and durable medical equipment under Part B. A Medicare beneficiary can opt to receive his Part A and B benefits from a qualified private insurer under Part C. Fidelis is one of many private health insurers that provides Part C coverage for Medicare beneficiaries. Medicare Part D provides a prescription drug benefit only.
Fidelis Medicare Advantage Plans
Health insurance plans offered as part of Medicare Part C are often referred to as Medicare Advantage Plans, like the one offered through Fidelis. For Medicare Part B coverage, a monthly premium payment is required along with a 20 percent co-payment for medical services and durable medical equipment received by a beneficiary. The Fidelis Medicare Advantage Plan, like most Part C plans, have a higher premium payment, but also cover the all or a portion of the 20 percent co-payments.
Medical Necessity
Medicare requirements for durable medical equipment like an adjustable bed are based upon a medical necessity for the equipment. Coverage for an adjustable bed through a Fidelis Medical Advantage Plan will follow these same requirements. The Medicare National Coverage Determinations Manual updated July 2010 states that a doctor's prescription is required for an adjustable bed. The prescription must specify the beneficiary's condition that requires positioning of the body in a way that is not feasible in a normal bed or that the condition requires attachments to the bed that cannot be made to a normal bed. Medicare provides a Certificate of Medical Necessity form that is specifically designed for use when prescribing an adjustable bed.
Capped Rental Item
Medicare classifies certain durable medical equipment, such as adjustable beds, as a capped rental item. Medicare's payment policy for such items differs from its policy for other Part B items. The policy provides for choosing between a rental option or purchase option, both of which cover 10 months of continuous rental payments for an adjustable bed. Under the rental option, Medicare will pay for five additional months after which it makes a payment for the lifetime use of the bed, with maintenance assessments paid every six months. The company that supplied the bed continues to own the bed. Under the purchase option, Medicare will pay for three additional months after which is will make a payment of 80 percent of the cost of the bed, which will become the property of the beneficiary. Medicare will also pay for future maintenance on the bed.
Misconceptions
Medicare policy for coverage of an adjustable bed will only be for a semi-electric twin bed. A full-size deluxe or luxury bed will not be covered under Medicare guidelines nor through a Part C plan, such as a Fidelis Medicare advantage Plan.
