Does Medicare Cover Lift Chairs?
Medicare will cover the cost of your lift chair for specific medical conditions. Also, there are guidelines when buying lift chairs, and out-of-pocket costs apply too.
A lift chair is like a reclining armchair, but it uses an electronic mechanism to gently move you from a seated position to a standing one or vice versa.
Lift chairs are DME (durable medical equipment), and Medicare categorizes them as medically necessary products expected to last for several years.
In this review, we’ll look at the eligibility requirements for a lift chair, the parts of Medicare that cover lift chairs, and where to get a Medicare-approved lift chair.
DME Eligibility Requirements
As per DME guidelines, before Medicare pays for your lift chair’s motorized mechanism, your healthcare provider must fill and submit a certificate of medical necessity.
The following are the eligibility requirements you need to satisfy:
- You should have severe arthritis of the hip or knee or have muscular dystrophy or any other eligible neuromuscular condition.
- Your physician must confirm that the motorized lift chair is medically necessary to improve your current state or prevent it from worsening. Also, they should include it as part of your documented treatment plan.
- Your physician must confirm you’re incapable of standing without a lift chair.
- You must be able to operate the chair and use it to sit or stand without any help.
Only a physician can prescribe durable medical equipment, and the product should:
- Be able to withstand repeated use
- Be operational for at least three years
- Be suitable for use at home
Medicare Part B
Medicare Part B is the part of the original Medicare that pays for the motorized mechanism of your lift chair. However, you must meet your part B deductible, which was $203 in 2021.
Once you’ve settled the deductible, you’ll only need to pay 20% of the Medicare-approved cost of the lift mechanism.
For instance, if the chair’s lifting mechanism is $1000, Medicare will pay $800 (80%), assuming you’ve already paid your 20% ($200) deductible.
Keep in mind that Medicare doesn’t pay for anything else; you’ll have to pay 100% of the remaining cost of the lift chair, including the chair itself.
Medicare Part C
If you have a Medicare Advantage (Part C) plan and need a lift chair, contact your plan’s primary care provider to determine if your plan covers DME.
If your Medicare Part C plan doesn’t cover DME products or services you deem necessary, you can file for a denial of coverage and have your appeal reviewed by an independent party.
If you’re using medical equipment or receiving home care and have a new Medicare Advantage Plan, contact your primary care provider to confirm coverage will continue for the DME product you have and the services you’re getting.
How Much Does It Cost to Get a Lift Chair?
If you’re eligible for a lift chair, Medicare usually covers the chair’s lifting motorized mechanism but not the entire chair.
Depending on the state you reside in, the reimbursement amount could be about $300, but you will have to pay the remainder.
Like all Medicare Part B items, you’ll pay 20% of Medicare’s approved costs after paying your deductible if you get the lift chair from a supplier that accepts Medicare coverage.
Where Can You Get a Medicare Approved Lift Chair
You can find an approved lift chair by searching Medicare’s Supplier Directory, which contains info about suppliers who offer DME (durable medical equipment) in the US.
Open the directory to find an approved supplier, enter your ZIP code, and click on ‘patient lifts.’
Suppliers must satisfy strict eligibility requirements to get a Medicare supplier number. Some of the questions you should ask a supplier include:
- Can they bill Medicare on your behalf?
- Do they accept Medicare coverage?
- Do they have a Medicare supplier number?
As indicated above, if you have original Medicare, you can get the lift chair’s lifting mechanism covered as a medical necessity.
If you have Medicare Advantage, you should contact your provider to access DME coverage.
Repairs and maintenance for DME (durable medical equipment) vary depending on whether you’re leasing or you own the equipment.
The DME supplier isn’t mandated to offer repair services if you own the equipment. However, if you’re leasing the equipment from the supplier, they must repair and maintain the equipment.
To sum it all up, Medicare will cover medically necessary DMEs such as lift chairs under original Medicare.
However, part B will only cover 80% once you’ve settled your deductible. Note that Medicare doesn’t pay for the chair itself, massage functions, or reclining features.