Will Medicare Pay for a Lift Chair?

For years, I watched my parents struggle to get in and out of their easy chairs. So my siblings and I got each of them a lift chair as a wedding anniversary gift.

One question I hear a lot is, “Will Medicare cover a lift chair?” I get it. These chairs offer a level of independence that many folks rely on. However, the financial side can be a bit murky.

Let me clarify things for you. Understanding the nuances of Medicare lift chair coverage can be a game-changer. This knowledge can save you stress, time, and potentially a significant chunk of money.

What Is Medicare Lift Chair Coverage?

In the simplest terms, Medicare lift chair coverage means Medicare might pay for part of a lift chair’s cost, specifically the seat-lift mechanisms form. It’s not automatic though. Medicare views this part as “durable medical equipment” or DME.

You see, Medicare isn’t going to pay for a fancy lift recliner just because you think it’d look nice in your living room. There’s a process and specific criteria to meet before they’ll even consider chipping in.

Understanding What Medicare Considers Medically Necessary

Think of “medically necessary” as the magic phrase when it comes to Medicare lift chair coverage. Medicare primarily focuses on ensuring you get crucial medical care, not necessarily comfort items. They need to see a real medical need for that lifting mechanism.

Now, I know this can sound confusing. That’s why I always tell people to picture it like this: imagine trying to stand up from a chair, but your joints are screaming in protest or your muscles just won’t cooperate. If you need significant assistance to get out of a regular chair due to a medical condition, then a lift chair becomes more than just a comfy place to watch TV – it becomes a medical necessity.

Here’s a rundown of conditions that often make the cut:

Severe arthritis of the hip or knee: When painful joints make it almost impossible to get up from a seated position, that’s where a lift chair’s seat lift mechanism comes into play.
Severe neuromuscular diseases: Conditions like muscular dystrophy or ALS can make it difficult to control muscles. In such cases, a lift chair mechanism provides much-needed assistance and improves daily living.
Other mobility limitations: Medicare lift chair coverage might extend to situations beyond severe arthritis and neuromuscular diseases. Coverage can be provided if your physician believes the mechanism is medically necessary to improve or slow the deterioration of your condition.

Do You Qualify for Medicare Lift Chair Coverage?

So, you’re thinking, “This sounds like my situation. Does this mean Medicare will definitely cover my lift chair?” Not so fast. There are certain boxes you (and your doctor.) need to tick for Medicare to consider covering the seat-lift mechanisms. Let’s break it down step-by-step:

Medicare Enrollment: You have to be enrolled in either Medicare Part B (Medical Insurance) or a Medicare Advantage Plan (Part C). If you have a Medicare Advantage plan, you’ll need to check with your specific plan provider. Coverage rules, costs, and even which suppliers they work with can vary from plan to plan.
Doctor’s Order: First and foremost, a simple doctor’s note saying, “Needs a lift chair,” won’t cut it. Medicare needs official documentation. Your physician must fill out what’s called a “Certificate of Medical Necessity for Seat Lift Mechanisms,” also known as the “Medicare form CMS-849.”
Supplier Matters: Here’s the catch – not just any supplier will do. Medicare has a network of participating suppliers that they prefer you work with. Be sure to check with Medicare to make sure the supplier you’re thinking about is actually in their network. Otherwise, you could be stuck footing the entire bill yourself.

Navigating Medicare Lift Chair Costs

Alright, now to the part I know everyone is waiting for—the cost. I’ll be frank; while Medicare may pitch in for the seat lift mechanism, don’t expect them to cover the entire chair’s cost.

The average reimbursement you can anticipate is about $300, but that can fluctuate depending on your location. You are responsible for the rest of the cost. But hey, look at the bright side. You’re still saving a considerable amount, considering some of these chairs can cost more than a used car.

Remember that 20% coinsurance most Medicare Part B items have? It applies to the Medicare-approved amount for that lift chair. Don’t worry. I’ll walk you through that process, too, so you understand everything involved.

Finding a Medicare-Approved Lift Chair Supplier

Remember what I said earlier about not all lift chair suppliers being created equal in the eyes of Medicare? This is where your homework comes in. You want to find DME suppliers enrolled in Medicare that also sell lift chairs. This will ensure the supplier you pick plays by Medicare’s rules and accepts assignment.

In simple terms, assignment means they agree to accept Medicare’s approved amount as full payment. This will help you avoid sneaky hidden charges or surprise bills. I can’t stress this enough: do your research to save yourself a major headache.

Hop on over to Medicare.gov, enter your zip code, and search for “Seat Lift Mechanisms.” Then, keep your eyes peeled for the magic “M” symbol beside a supplier. The “M” is your golden ticket. It means they accept Medicare assignment, so you won’t have to shell out more than your portion. Easy peasy, right?

Frequently Asked Questions

Will Medicare Pay for a Lift Chair for My Elderly Parent?

Medicare might pay for a lift chair for your elderly parent under certain conditions. To qualify, your parent must have a medical condition that makes it difficult to get in and out of a regular chair without assistance.

A doctor needs to determine if the patient’s lift is medically necessary and provide a prescription for a lift chair. The supplier and lift chair must also meet Medicare’s requirements. The patient must be enrolled in either Original Medicare Part B or a Medicare Advantage plan that includes this benefit.

Does Medicare Cover Lift Chairs for Seniors After a Stroke?

Medicare may cover lift chairs for seniors after a stroke if certain criteria are met. A doctor must deem the chair medically necessary because of stroke-related mobility issues, meaning the senior cannot stand from a seated position or sit down without assistance.

Furthermore, the chair’s lifting mechanism is the part Medicare considers for coverage, not the entire chair. Only suppliers enrolled with Medicare can provide covered lift chairs. The senior must also meet Medicare’s eligibility requirements for this type of DME.

Does Medicare Cover Power Lift Recliners?

While Medicare does not specifically use the term “power lift recliners,” they might partially cover lift chairs with a powered lifting mechanism. Medicare considers the powered lift mechanism as durable medical equipment (DME) when prescribed by a doctor for a qualifying medical condition that significantly impairs mobility.

The lift mechanism must be essential for the individual to stand up or sit down in the chair. Coverage depends on various factors, including the beneficiary’s specific Medicare plan (Original Medicare or Medicare Advantage), the supplier’s enrollment status with Medicare, and meeting all necessary documentation requirements.

Conclusion

Navigating Medicare lift chair coverage doesn’t have to feel like deciphering a foreign language. By arming yourself with knowledge, you’ll feel empowered. More importantly, this knowledge will increase your chances of getting your Medicare benefits.

And remember, getting help from your doctor or a Medicare representative is a smart move. Their expertise can help make the process less stressful.