Medicare coverage – knowledge Mentors

Durable Medical Equipment Coverage (DME Coverage)

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Though getting a new mattress through Medicare is not something that every enrollee will qualify for, through Medicare Part B, and more specifically Durable Medical Equipment Coverage, you could use your insurance to help you sleep better at night. Durable medical equipment is equipment that helps patients with tasks, activities, or functions necessary for everyday life. To get Medicare coverage for your new mattress, it first must qualify as DME. That requires a prescription from your doctor. Moreover, you have to meet the requirements that Medicare has set forth.

To qualify, there are several requirements you must follow. The mattress can only be in your own home. You will not qualify if you do not have an injury, sickness, or medical reason for the mattress. Finally, you need to select a durable mattress for repeated use because it should last for at least three years.

Types Of Mattresses That May Be Covered

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Not all mattresses will meet the stringent requirements that Medicare will cover. It’s imperative to know what kind of bed may or may not be covered before you start shopping. For Medicare to pay for them, they must be useful in your daily functions and serve medical functionality. A Google search for Medicare-approved sellers will display many retailers that specialize in medical equipment. Purchasing your new bed or equipment through one of these suppliers can reduce your overall costs.

Three major kinds of mattresses and beds will qualify through Medicare: pressure-reducing overlays, pressure-reducing beds, and pressure-reducing mattresses. Once your claim for DME is approved, you will be responsible for 20% of the total Medicare-approved cost of the equipment; your Medicare Part B deductible will apply to this cost, and you will then pay the rest of the expense.

Shopping For Adjustable Beds and Mattresses

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Once you’re ready to shop, you need to decide between an adjustable bed and an adjustable mattress. An adjustable mattress is one where you can control the softness or firmness of the mattress itself. On the other hand, an adjustable bed is one where you can adjust the base into different positions from both the head and foot of the bed. Whether you’re looking to shift your support level or to manipulate your positioning in bed will determine which type of bed frame and mattress is right for you.

Below is a list of the best adjustable beds and mattresses available on the market. Regardless of which you go with, if you need any help or clarification on whether or not you could qualify for DME coverage for a new mattress or bed through Medicare, you can review your plan and contact your doctor. You can find more information by visiting Medicare.gov.

Amerisleep Adjustable Bed Gold Package – Highest Overall Rating
Nectar Adjustable Bed – Second-highest Overall Rating
Legget & Platt ShipShape base – Best for Durability
Classic Brands Adjustable Bed – Money-Saver
Legget & Platt New Split S-Cape Adjustable Bed – Best in Luxury
Serta Motion Essentials II Adjustable Bed – Best for Ease of Install
PragmaBed Simple – Best for Design
Reverie 7S Adjustable bed – Best for Bluetooth Capabilities

When you turn 65, you’re eligible to enroll for Medicare coverage. Medicare is health insurance for older adults on behalf of the federal government. It’s critical to do your research about Medicare before open enrollment every year.

The internet has a plethora of resources about Medicare and all of its options. While researching, you should make a list of what your specific needs are. That will help you ensure that your Medicare plan covers what you need. Read on to learn about six vital factors you should consider when choosing Medicare coverage.

Determine the Type of Coverage You Need

Your Medicare coverage decides essential factors that impact your healthcare. The options you select will determine everything from which doctors are covered under your plan to your out-of-pocket costs. That’s why it’s vital to enroll in coverage that includes the services you need most. Medicare has two types of coverage. The first is Original Medicare or Medicare Parts A and B. The second type is Medicare Advantage, or Part C. Medicare Advantage offers all of the services in Original Medicare with some additional coverage. Research what each of these plans covers.

Do You Plan to Travel?

Individuals over 65 years old who plan to travel outside of the United States may want to review their options and coverage under Medicare. Both Original Medicare and Medicare Advantage plans typically do not cover any medical care received outside of the United States. If this is your scenario, you may be able to purchase additional coverage or a different plan that does cover international healthcare costs. Yet be sure to read the fine print to be aware of precisely what’s covered.

Review Who Accepts Medicare In Your Area

Never assume a doctor accepts Medicare. Every doctor varies on the types of health insurance and policies or plans they receive. While some welcome Medicare, others do not. Before choosing your coverage and enrolling, check with your doctors to see if they will take Medicare. Original Medicare allows people to see any doctor who accepts Medicare, whereas Medicare Advantage may require you to see doctors or go to hospitals that participate in the plan’s network. Get the details from your doctor before making any changes to ensure you can continue seeing your current doctor.

Adding Supplemental Coverage

You also have the option to increase your Medicare coverage by adding supplemental insurance. You can purchase supplemental insurance, or Medigap, from a private insurance company. Some of these gaps can include extra costs to you, such as copayments, coinsurance, and deductibles. The purpose of the Medigap plan is to help eliminate some of these additional costs or a portion of them. Keep in mind that you can only get a Medigap plan if you are enrolled in Original Medicare. It’s also important to note that a supplemental plan requires a monthly premium, and you may still have additional healthcare costs that you’ll be required to pay out of pocket.

Do You Need Prescription Drug Coverage?

When determining your coverage needs, it’s important to assess prescription needs. Medicare plans don’t usually cover all prescription costs. If you have many prescriptions, you should be aware that Medicare limitations may leave you with high out-of-pocket costs. If this is your scenario, you can join a Medicare Prescription Drug Plan or Part D. This additional plan will cover many medications and lower out-of-pocket costs. Be sure to review all of the details of your prescription drug coverage before making any changes. There are sometimes limitations or exclusions that people are unaware of. Review your regular prescriptions to ensure you are covered under your current plan, Part D, or Medicare Advantage plan.

Figure Out-of-Pocket Costs

Finally, research and determine how much your Medicare choices will cost you. Many individuals over 65 years old live on a fixed income. Although it is crucial to ensure that all of your health needs are covered, it’s vital to know the amount you will pay out-of-pocket. Medicare is more complicated than just the premium costs. Although some premium rates are $0, there may be other costs you are responsible for. When researching potential costs, consider the monthly premium, copayments, annual deductible, prescription drug copayments, and yearly limits on out-of-pocket costs. Make sure to check your plan closely as each is different.