Hospital Beds and Medicare: What You Need to Know

You have just been informed by your doctor you need a hospital bed, and you may be asking yourself questions such as, why do I need a hospital bed and will my insurance cover this type of medical equipment? Cork Medical’s clinical team has outlined key benefits of a hospital bed, various types of hospital beds, how they relate to a patient’s condition, and which ones can be obtained through Medicare insurance.

A hospital bed, commonly referred to as a support surface, is a pressure reducing mattress or mattress overlay that is often used to prevent pressure injuries or assist with the healing of an existing pressure injury.

Pressure injuries are areas of the body with damages to the skin and underlying soft tissue resulting from prolonged pressure or prolonged pressure in combination with shear on the patient’s lower extremities. The injury typically presents itself as intact skin or open ulcers that can be painful. The tolerance of soft tissue for pressure and shear may also be affected by microclimate, nutrition, perfusion, co-morbidities, and conditions of the soft tissue.

Medicare classifies support surfaces as three main groups: group one, two, and three. Insurance coverage is provided to those individuals who obtain a hospital bed falling under one of the three main groups. It’s important to understand each group’s equipment classification and its criteria to receive the appropriate support surface for your unique need. Let’s dive into each group’s specific options below!

Group One

Group one support surfaces are usually mattress replacements or overlays (made from foam, air, water, or gel materials) commonly purchased, rather than rented. Patients who are immobile or partially immobile are highly recommended to take advantage of a group one support surface. Patients who are mobile but suffer from severe pressure injuries AND demonstrate one of the following conditions: impaired nutritional status, incontinence, altered sensory perception, or compromised circulatory status are also encouraged to take advantage of group one support surfaces.

To order a group one support surface from Cork Medical, complete our request form or have your physician send us a referral order so we can help improve your healing outcome.

Group Two

Group two support surfaces are designed to either replace a standard mattress or provide overlay support. Product options to choose from in this category range from powered air flotation beds, powered pressure reducing air mattresses, to non-powered advance pressure reducing mattresses. It’s important to note group two support surfaces are often rented rather than purchased. However, patients have the option to purchase their support surface, at any time, should they wish to keep it for long-term use.

If a patient suffers from a stage II pressure injury located on the trunk or pelvis, has been on a comprehensive pressure injury treatment program (which included the use of an appropriate group one support surface for at least 30 days), and has had worsening injuries or stagnant healing outcomes for longer than 30 days, then they qualify for this group.

Additionally, patients who suffer from large or multiple stage III or IV pressure injuries on the trunk or pelvis, have had a recent mycutaneous flap or skin graft for a pressure injury on the trunk or pelvis and have been on a group two or three support surface previously are qualified for this group.

If you are interested in obtaining a group two support surface, complete our request form or reach out to the Cork Medical team at 866.551.2580 so they can walk you through your options.

Group Three

Group three support surfaces are complete bed systems, known as air-fluidized beds, which use the circulation of filtered air through silicone beads. This group’s products are also rented rather than purchased but the option to purchase, if the patient feels it’s necessary, is available.

If the patient suffers from a stage III or IV pressure injury, is bedridden or chair-bound, would become institutionalized without the use of a group three support surface, is under the close supervision of a treating physician, has undergone conservative treatment for at least 30 days (including the use of a group two support surface), a caregiver is available and willing to assist with patient care, and all other alternative equipment has been considered and ruled out then a group three support surface is the next viable option.

Contact your treating physician to obtain documentation stating the need for a group three support surface, then have them submit a referral order to the Cork Medical team or complete our request form so we can promptly improve your healing outcome.

When achieving improved healing outcomes while under the care of any group’s support surface, you should continue making good nutritional choices and frequently turn or reposition your body to increase blood flow.