Sleeping in a Recliner? Medicare Covers 'Hospital Beds' for Home Use. Here Is the 'Medical Necessity' Wording Doctors Must Use

Sleeping in a Recliner?

Walk into the living room of many seniors, and you will see a familiar, sad sight: A loved one sleeping in a La-Z-Boy recliner, surrounded by pillows.

They don't sleep there because they want to. They sleep there because they cannot lie flat. Whether it's due to congestive heart failure (CHF), severe acid reflux (GERD), or chronic back pain, a flat mattress is torture.

Family members often think, "We should buy one of those fancy adjustable beds from TV." But those cost $3,000. What they don't know is that Medicare Part B will pay for a hospital bed in your home—if you know how to ask.

Today, we explain the strict criteria Medicare uses to approve beds in 2026 and how to get your doctor to write the perfect prescription.

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It's Not Furniture, It's "DME"

First, a critical distinction. Medicare does NOT cover "Adjustable Bases" (like Sleep Number or Tempur-Pedic). Those are considered "Comfort Items."

Medicare covers "Hospital Beds." These are classified as Durable Medical Equipment (DME). They look medical, they have side rails, and they are designed for treatment, not just sleep.

🏥 The "Cost" Breakdown (2026)

If approved, Medicare Part B pays 80% of the cost. You (or your Medigap plan) pay the remaining 20%.

• Deductible: You must first meet the $283 Part B Deductible (2026 standard) before coverage kicks in.
• Ownership: Just like oxygen, you usually "rent" the bed for 13 months. After the 13th payment, you own it.

The Criteria: Do You Qualify?

You cannot get a bed just because "it's more comfortable." Medicare requires proof that your current bed makes your condition worse. To qualify, you must meet at least one of the following four conditions:

1. Positioning for Pain: Your condition requires you to be positioned in a way that is not possible in an ordinary bed to alleviate pain (e.g., severe arthritis, spinal injuries).
2. Head Elevation (> 30 Degrees): You require the head of the bed to be elevated more than 30 degrees due to conditions like CHF, COPD, or aspiration risks. (Note: Pillows or wedges must have been tried and failed).
3. Traction Equipment: You require traction equipment that can only be attached to a hospital bed frame.
4. Transfer Issues: You struggle to get in or out of a regular bed, and the adjustable height allows you to transfer safely.

The Magic Wording for the Prescription

Doctors are busy. If they just scribble "Hospital Bed for Back Pain" on a prescription pad, Medicare will deny it. You need to guide them.

To get the Semi-Electric Bed (where the head/feet move with a remote), your doctor's Standard Written Order (SWO) and clinical notes must explicitly state a need for "frequent repositioning." Ask them to use this language:

"Patient has a diagnosis of [Severe GERD / COPD / CHF]. Patient has attempted to use wedges and pillows to elevate the head, but these methods fail to maintain the necessary 30-degree elevation required to prevent aspiration/breathlessness. Crucially, the patient's condition requires frequent repositioning to prevent decubitus ulcers (bedsores) and alleviate pain, which requires the semi-electric feature to be managed independently. Therefore, a semi-electric hospital bed (E0260) is medically necessary."

Semi-Electric vs. Fully Electric: Don't Get Tricked

When the medical supply company arrives, watch out. There are two main types of beds:

• Semi-Electric (Covered): The head and foot sections move with a remote control, but the height of the entire bed is adjusted with a manual hand crank. Medicare covers this if you document the need for "frequent repositioning."
• Fully Electric (Not Fully Covered): The height of the bed also moves with the remote. Medicare views this height feature as a "convenience." If you want this, you have to pay the price difference (called an ABN upgrade) out of pocket.

The "Mattress" Warning

The standard mattress that comes with a Medicare bed is... terrible. It is a thin, vinyl-covered foam pad. It is easy to clean, but uncomfortable.

Pro Tip: If the patient is completely immobile or has existing bedsores, ask the doctor to also prescribe a "Group 1 Support Surface" (a gel or air overlay). Medicare pays for this separately (Code E0185) if there is a documented risk of skin breakdown.

Action Plan: Get Mom Off the Couch

1. Document the Struggle: Before the doctor visit, keep a log. "Mom tried sleeping with 3 pillows but still coughed all night." This proves "pillows failed."
2. Visit the Doctor: Bring the criteria list. Politely ask, "Can we document that she needs 30-degree elevation and frequent repositioning?"
3. Choose a Supplier: Contact a local Medicare-approved DME supplier. Ask, "Do you have a semi-electric bed (E0260) in stock?"
4. Clear the Room: These beds are Twin XL size but bulky. You will need to move the old furniture out before the delivery truck arrives.

(Disclaimer: Medicare rules (NCD 280.7) are strict. This article is for educational purposes based on 2026 guidelines. Coverage depends on individual medical diagnosis and documentation.)

Sleep is Medicine

A good night's sleep is the best medicine. If a standard bed is hurting you, the government has a program to fix it. Use it.