Will Medicare Pay for a Lift Chair? Medicare covers quite a lot of services. There are two types of Medicare, Medicare Advantage and Original Medicare. Each has different Parts to them. For example, original Medicare has Part A and Part B. In contrast, Medicare Advantage has Part C. There is also Part D that stands alone, and this covers prescription medication but can also be added to an existing plan.
Medicare Part A deals in Hospital Insurance, inpatient care in a hospital, hospice care, home health care, nursing home care, and skilled nursing facility care. Whereas Part B deals in Medical Insurance consisting of outpatient care, home health care, durable medical equipment (DME), services from doctors and other healthcare providers, and some preventive services.
Durable Medical Equipment can be from blood sugar test strips to wheelchairs and scooters. This is where you will find lift chairs and have Medicare cover them.
What is a Lift Chair?
A lift chair, sometimes also known as a riser armchair, is a recliner-style chair with a powered lifting mechanism that can push the entire chair up from its base. This is to assist the user in getting to a standing position.
These chairs possess an internal lifting system powered by a standard electrical wall outlet. They have 2 to 3 position chairs and, like normal recliners, come in different styles and different sizes.
Lift chairs are mainly used by those with arthritis, difficulty standing up usually due to age, recovery from lower-body injuries or upper body injuries, and cardiovascular and open-heart surgeries.
Where can I Find a Lift Chair and What are The Costs?
Lift chairs are considered to be a piece of durable medical equipment. Therefore they will be provided or covered by Medicare and Insurance if ordered by a doctor. You can find lift chairs in most HME showrooms and many furniture stores as well as online.
The cost of a lift chair depends on the make, model, and features that you desire. A relatively low-end lift chair will typically cost around $300, and for a deluxe high-end chair, it could be about $2000. On average, the cost for a quality lift chair can be around $600 to $800.
Will Medicare Cover All Lift Chair Costs?
Medicare Part B, although stating that it has lift chair coverage, does not cover the cost of the entire chair more so it covers the cost of the lift mechanism that enables the chair to rise.
Medicare will first need patients to have a visit with their physician to discuss the need of this particular DME before they can consider the coverage. The Lift Chair provider will then request a certificate of medical necessity (CMN) and a prescription. The certificate of a medical condition will usually have five questions that the physician will need to answer before the DME is provided. These questions typically are;
- Does the patient have severe arthritis?
- Does the patient have a neuromuscular disease?
- Is the patient incapable of getting up a regular chair in their home?
- Can the patient walk once standing?
- Have all other therapeutic measures been taken?
If any of the above questions have been answered with a no, then it is highly likely that they will deny the request for the lift chair as they see it unnecessary.
If accepted, you will have to pay 20% of the Medicare-Approved Amount, and the Part B deductible will apply. Depending on the Durable Medical Equipment needed, Medicare will pay in different ways depending on the type of equipment.
Medicare will only cover your DME if your doctors and DME suppliers are enrolled in Medicare. So be sure to find out if they are registered before getting the DME.
How do I enroll in Medicare Lift Chair Coverage?
Firstly you will need to be evaluated by a doctor who will prescribe a lift chair. They must state that the chair is medically necessary, and if you don’t have one, you will most likely be confined to a non-lift chair or bed.
The doctor must then fill out a certificate of medical necessity for a seat lift mechanism. This form is referred to as CMS-849. This will be needed to qualify for Medicare reimbursement.
To qualify for partial reimbursement from Medicare, some requirements must be met, and these are what needs to be elaborated on the CMS-849 form. Some of the conditions that will qualify you are;
- Severe arthritis of the hip or knee.
- Severe neuromuscular disease.
- Can’t stand up on your own from a regular chair.
- Without the lift chair, you will be stuck to a bed or chair.
- Once standing, you are able to walk independently, even with the assistance of a walker or cane.
- You do not stay in a skilled nursing facility, nursing home, or hospice.
If you decide to buy a lift chair from a Medicare supplier, then you will have to pay out-of-pocket and seek partial reimbursement from Medicare for the motor. If, however, the supplier participates in Medicare, they will usually file a claim on your behalf. If they do not file a claim, you can download and print a request for payment online.
Lift Me Up
Medicare does not fully cover the expense of a lift chair but will pay the cost of the mechanism or motor. Specific requirements need to be met before the request for one will be accepted, and coverage is supplied. Medicare does aid in partial coverage, which can help quite a bit. There are many different types sizes and even supply different upholstery so you can choose which one will suit your home the best. You don’t have to go specifically to a place that sells DME because regular furniture stores also supply these chairs. It is good to know that if or when you need assistance in getting up off a chair, there is a mechanism that can help you.
