Medicare covers the cost of a lift chair for people with certain medical conditions. There are rules when purchasing lift chairs, and out-of-pocket costs apply.
Lift chairs look like a reclining armchair. They use an electronic system to gently move a person from a seated position to standing, or from a standing position to seated.
When a person is seated, the seat and back of the chair slowly rise and move forward until a person is almost entirely in a standing position.
Medicare classes durable medical equipment (DME) as medically necessary items expected to last for many years, such as canes and wheelchairs.
Lift chairs fall under the DME category, and Medicare Part B covers some of these costs.
This article discusses when Medicare considers a lift chair medically necessary, coverage, and possible out-of-pocket costs.
We may use a few terms in this piece that can be helpful to understand when selecting the best insurance plan:
- Deductible: This is an annual amount that a person must spend out of pocket within a certain time period before an insurer starts to fund their treatments.
- Coinsurance: This is a percentage of a treatment cost that a person will need to self-fund. For Medicare Part B, this comes to 20%.
- Copayment: This is a fixed dollar amount that an insured person pays when receiving certain treatments. For Medicare, this usually applies to prescription drugs.
Medicare has rules surrounding the classification of DME.
Rules
To qualify as medically necessary, a product or service must:
- be provided or prescribed by a doctor
- prevent, diagnose, treat, or improve the function of a medical condition
- agree with generally accepted medical practice
Only a doctor can prescribe the medical equipment, and the item must:
- be expected to last at least 3 years
- be able to withstand repeated use (durable)
- be required for medical purposes
- be suitable for use at home
Coverage
For lift chairs, Medicare covers costs associated with the part of the chair considered medically necessary. This means they cover the electrical device that moves the chair, but not the chair itself.
Usually, an individual will be required to pay for their lift chair upfront and then submit a claim to Medicare for reimbursement.
Once a person meets their annual deductible, which in 2020 is $198, Medicare Part B will cover up to 80% of eligible costs. An individual must pay the 20% coinsurance out of pocket.
Medicare Advantage plans must have at least the same coverage as original Medicare, so the same rules apply, but out-of-pocket costs may vary between plan providers.
Prescription and forms
For Medicare to consider covering a lift chair’s costs, a prescription from a doctor is needed. There may be further out-of-pocket costs, including a coinsurance or copayment for these visits.
When the doctor gives a prescription for the chair mechanism, they should also complete the Certificate of Medical Necessity CMS-849 — Seat Lift Mechanisms form.
Medicare supplement insurance, also called Medigap, may help pay for some out-of-pocket costs.
The plans work alongside original Medicare and can help with expenses such as coinsurance and copayments. Current Medigap plans are unable to assist with the Part B deductible.
If a person has questions about their Medigap plan coverage, it may be useful to contact the private insurance company that administers the policy.
A lift chair can assist those who do not have enough strength to stand, unassisted, from a seated position.
Some medical conditions that may cause a person to lose strength in their legs and hips are:
- arthritis in the knees or hips
- muscular dystrophy
- other neuromuscular diseases
A person must be able to operate the chair by themselves. Medicare does not pay for a lift chair for people who live in assisted living facilities, skilled nursing facilities, or nursing homes.
Chairs that move smoothly and help a person sit down and stand up without assistance may be covered. Medicare does not cover chairs that are spring operated and released with a sudden motion.
When considering the medical necessity for a lift chair, there must be evidence the doctor prescribed the chair. The chair must also be able to improve or stop the condition from getting worse.
A doctor may be required to show that a person may not have the strength to live independently without the lift chair.
General costs
The general cost of the whole chair depends on several factors:
- Is the chair reclining?
- Who makes the chair?
- Does the chair offer massage or heated massage?
How much Medicare will reimburse for a seat lift mechanism depends on which state a person lives in and the company that supplies the chair.
Medicare has a supplier directory where a person can search for a DME supplier in their zip code. Individuals can type in their zip code and then choose up to five types of DME.
To find DME providers who take Medicare assignment for a lift chair, a person should choose “seat lift mechanism.” Search results will then display containing supplier contact information.
Medicare will only reimburse people who buy a chair through a supplier who accepts Medicare assignment. If the company does not accept Medicare assignment, people may pay more for their lift chair.
Most DME companies accept Medicare assignment, but a person may wish to check with the company before making any final decisions.
Other stores that sell lift chairs, such as department stores, do not take assignment. A person can choose to buy their chair through these stores, but they will pay 100% of the cost.
A lift chair is a piece of durable medical equipment. People with arthritis in the knees and hips or people with neuromuscular disease may benefit from using lift chairs. They assist a person moving from a seated position to standing.
Medicare Part B covers medically necessary DME, including lift chair mechanisms. Part B covers 80% of the lift mechanism after a person has paid their deductible. Medicare does not pay for the cost of the chair itself, a reclining feature, or massage function.
A person must buy a lift chair from a provider who accepts Medicare assignment, and a prescription from a doctor is required.
The Medicare supplier directory can help find a DME provider in a specific zip code.