When recovering from a planned surgical procedure, or after a hospital stay for an unexpected medical event, a hospital bed, lift recliner, patient lift, or powered mobility device might be beneficial to aid recovery. How do you leverage your insurance benefits? How do you know what is and isn’t covered?

Here is a guide to help you make informed choices should the need arise!

Definitions: Medical equipment provided through insurance companies is referred to as DME (Durable Medical Equipment). Items provided through a local, private-pay dealer are referred to as HME (Home Medical Equipment).

Hospital Beds: Medicare, Medicaid and most insurance plans cover a semi-electric bed. This means that the head and foot portions are electric and operated by remote control, but that the deck (the part on which the mattress rests) is controlled with a hand crank. You will want to assess the ability of the caregiver to effectively grasp the crank, and operate it multiple times a day to lift the bed deck up and down. These basic beds have no additional clinical features, and typically have a max lifting height of 23” and a max lowering range of 10”-15” from the floor. This is something important to consider if your loved one is under 5’5” as their feet may not touch the floor when the bed is in the lowest position. You will also want to determine if the longer timeline that insurance companies require fits your needs.

HME beds are almost always fully electric. Cranks might be present as part of an emergency safety system in case of a power outage, but all of the features on an HME bed would be operated with a remote. Features such as Trendelenberg (tilts the bed on a flat plane to position feet above the heart) or Reverse Trendelenberg (tilts the opposite way to position feet below the heart) can aid in lymphatic drainage, blood circulation, and re-positioning. These advanced beds can go as high as 37” and as low as 3” from the floor. This wide range of lifting heights can significantly reduce caregiver strain, and mitigate fall risk for more petite users. Local dealers usually try to work with a very short timeline when possible!

We highly recommend researching your medicare plan coverage for DME so that you know exactly what your options are BEFORE the need arises!

Mobility Equipment: Medicare and Medicaid provide both powered mobility devices such as scooters and power wheelchairs, along with manual mobility equipment like wheelchairs and transport chairs. One advantage to using insurance-provided benefits in this area would be that the equipment can be custom, or semi-custom in fit. This is an important consideration if one is above or below average height. If transporting the equipment is desired then working with a local HME dealer could be beneficial. Typically, wheelchairs, scooters, and power wheelchairs provided through insurance are meant to be used in the home and as a result they are not lightweight and transportable. If taking your mobility scooter, power wheelchair, or manual wheelchair in the car, on errands, or to visit family is a priority then you might consider comparing lightweight HME options.

Excluded Items: Medicare and Medicaid do not cover stair lifts, lift recliners (insurance will often reimburse about $150-$300 for the lift motor, however), transport chairs (a type of folding, lightweight wheelchair w/four small wheels), vehicle lifts, shower chairs or wheelchair ramp systems. You will want to research your plan to confirm these exclusions.

Prescriptions: The state of Georgia allows for a sales tax exemption when a prescription is provided at the point of purchase for a Class II medical device. There are specific guidelines as to what qualifies as a Class II medical device, and who is eligible to write a prescription for the device, but your local mobility dealer can explain the Pharmacy Board regulations outlined by your state.

Service and Repair: Whether you are sourcing DME through an insurance-participating provider, or HME through a local dealer, you will want to explicitly ask who handles service and repair. Additionally, ask about warranty registration, and whether the individual responsible for repairing the item is an authorized dealer for the manufacturer of the item you are receiving. Being an authorized dealer ensures that your repair technician is knowledgeable, credible, and able to source original parts when necessary.

At Mobility Plus Alpharetta, we are authorized dealers for 26 different suppliers. We maintain training certifications required by both the state of Georgia, and our suppliers, and we repair everything that we sell! We prioritize the customer experience and hope to become a long-term partner on the aging or recovery journey.

We hope that this equipment guide will make decision-making during a difficult time a little easier!