Choosing the best mattress is particularly important as you get older as it can help reduce aches and pains, as well as ensure you get a good night’s rest. It’s for this reason that many older people, or those with certain medical conditions, prefer to invest in a specialist mattress that can offer more tailored support.
The downside is that these mattresses can be expensive, so it’s worth knowing that Medicare will cover most of the cost for certain mattresses. Unsure what types of mattresses are covered by Medicare? We’ve done the research for you here...
What types of mattresses are covered by Medicare?
Medicare has certain guidelines that must be met before the cost of your mattress can be covered. For a start, the mattress needs to qualify as Durable Medical Equipment, or DME.
DME is medically necessary equipment prescribed by a doctor to help patients function in their everyday lives. DME items can include crutches, walkers, blood sugar monitors and hospital beds. Certain mattresses are also included, but a doctor is the only person who can give a mattress this designation.
To qualify, the mattress must meet the below conditions:
- Be durable and able to withstand repeated use
- Used for medical reasons only
- Only useful to a sick or injured person
- For use in a person’s home
- Have a predicted life expectancy of at least three years
Pressure-reducing mattresses, which are used for certain conditions such as sciatica and arthritis, are usually the only type of mattress covered by Medicare. Some of the top pressure-reducing mattresses that are approved by Medicare are outlined below:
- Solace Resolution Glissando Heavy Duty Mattress: This mattress is designed to prevent friction and shear which can help prevent ulcers from forming. It features high-density foam for comfort, and built-in sidewalls.
- Joerns PrevaMatt Defend Pressure Relief Mattress: Constructed for even pressure redistribution, this mattress can help prevent a range of issues, including pressure ulcers. Buyers can choose between flat or sidewalls and each mattress comes with a two-way stretch, nylon mattress cover.
- Drive Medical Therapeutic 5-Zone Support Mattress: This therapeutic mattress provides a comfortable sleep surface by using a convoluted top later to distribute weight evenly across five zones or areas. Its water-resistant and anti-microbial cover is designed for easy cleaning.
- ThevoRelief Pressure Relief Mattress: Specifically designed for those with arthrosis, body aches and other discomforts, this mattress features unique wing suspensions that create a soft and comfortable sleeping surface. It gently stimulates the body’s nerve tracts while you sleep, helping relieve soreness.
- Drive Medical Alternating Pressure Low Air Loss Mattress System: This mattress can operate in either an alternating or static pressure mode, and is designed to be used to help prevent, treat and manage pressure ulcers. There are different settings to meet a person’s comfort level.
What types of mattresses are not covered by Medicare?
While a number of mattresses will be covered by Medicare, many more mattresses won’t be. If the mattress you’re buying is for non-medical use and if it is not used for specific health care issues like sciatica and arthritis, you won’t be able to get any financial help from Medicare.
Remember that Medicare will only cover the costs of mattresses that qualify for DME designation and meet the conditions mentioned above. If you can't get Medicare to help pay for your mattress, browse this year's Labor Day mattress sales for ways to keep some extra cash in your pocket.
How much of the mattress purchase will Medicare cover?
You will need to check your specific Medicare coverage to work out how much Medicare will pay and how much you will need to contribute. However, as mattresses are covered under Medicare Part B, in most cases Medicare will cover 80% of the cost of your new mattress and you will need to pay for the remaining 20%. The deductible will also apply, which is $233 in 2022.
Who is eligible for a mattress covered by Medicare?
To be eligible for Medicare help, you will need to get a doctor’s recommendation stating that you have a medical condition that requires you to buy a pressure-reducing mattress to ease discomfort. The note will need to explain what condition you have and how the mattress could improve your health.
Once you’ve received the doctor’s note you will need to submit it to Medicare for consideration. If Medicare approves the request and agrees that you’re eligible, you can go ahead and make your purchase. One further condition is that the mattress must be bought from a Medicare-approved mattress retailer. If it’s not, you won’t receive your funds. You can search for approved suppliers on the Medicare website.
Types of mattresses covered by Medicare: Summary
To summarize, if your mattress meets the following three criteria, Medicare will cover the cost of up to 80% of the mattress price:
- DME classification
- Meets the five qualifying criteria mentioned above
- Pressure-reducing mattress
You must also have a note from your doctor explaining why you need the mattress, and you must purchase the mattress from a Medicare-approved supplier.
If you do not qualify for financial help from Medicare, it is still possible to find an affordable mattress for your needs. As a first step, make sure you shop around and compare retail options carefully. It is also well worth checking out the latest mattress sales.
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And, I have my quarterly appointment with my pain management doctor in just a few days, so we will be having this conversation then! I have already been looking for a hospital style bed, with his prescription that does not address some of these issues, in order to help me with my mobility and motion issues, but haven't really considered the mattress being a separate issue. The only ones that apparently are supplied or offered with the beds at the most local DME store are just slabs, more or less, and I have issues they won't address. Now I know how to handle this issue, and I have already paid up my annual Medicare deductible. So theres $233.00 I won't have to pay!
Thanks very much for this very informative and well researched article! It just might help change my life!