Medicare will cover some of the costs for medical equipment, including a lift chair. These are special chairs that help lift you from a sitting position to a standing position. They can be extremely helpful when you have mobility issues and difficulty standing up from a seated position.
Let’s answer your questions about Medicare coverage for lift chairs and how to make sure you’re reimbursed the maximum amount for your purchase.
Medicare does provide some coverage for lift chairs, provided a doctor prescribes it for a medical reason. However, Medicare does not cover the entire cost for the chair. The motorized lifting mechanism is considered durable medical equipment (DME), which is covered under Part B.
The other parts of the chair (frame, cushioning, and upholstery) are not covered, and you’ll pay out of pocket for this portion of the chair’s cost.
To meet Medicare reimbursement criteria, DME must meet the following criteria:
- durable (you can use it repeatedly)
- needed for a medical purpose
- used in the home
- will usually last at least 3 years
- is usually useful to a person who is ill or injured
The chair portion of the lift chair is not considered medically necessary, and that’s why it’s not covered.
You are eligible for coverage of a lift chair if you’re enrolled in Medicare Part B. To qualify for Medicare, you must be at least 65 years old or have other qualifying medical conditions. These conditions may include a severe disability, end stage renal disease, or ALS (amyotrophic lateral sclerosis).
If you have Medicare Advantage, you are still eligible to receive a lift chair. Medicare Advantage or Medicare Part C is when you choose a private insurance company to cover your Medicare benefits.
Because Medicare Advantage companies must cover all aspects that original Medicare does, you should get at least the same amount of coverage, if not additional benefits.
You also need to be evaluated by a doctor to get a prescription for the chair. Here are some of the things your doctor will assess when considering if a lift chair is medically necessary:
- if you have severe arthritis in your knees or hips
- your ability to operate the chair
- your ability to stand up from the chair without assistance
- your ability to walk, even with assistance from a walker, after the chair has lifted you (if you depend on a scooter or walker for most of your mobility, this may make you ineligible)
- you can walk once you are standing
- you have tried other treatments (such as physical therapy) to help you go from sitting to standing without success
If you’re an inpatient at a hospital or resident at a nursing facility, you won’t qualify for coverage of a lift chair. You must live in a residential home to qualify for this benefit.
Medicare Part B costs
Medicare Part B is the portion of Medicare that pays for the lifting mechanism of the lift chair. With Part B, you’ll first need to meet your deductible, which is $203 in 2021.
Once you’ve met the deductible, you’ll pay 20 percent of the Medicare-approved amount for the lift mechanism. You will also pay 100 percent of the remaining cost of the chair.
Medicare-enrolled physicians and suppliers
Medicare will only pay for a lift chair if the doctor who prescribes it is a Medicare provider. Medicare also requires the supplier to be enrolled in Medicare.
When you search for lift chairs, it’s important to ask the company if they are enrolled in Medicare and accept assignment. If the chair company doesn’t participate in Medicare, you may be charged more than the accepted Medicare amount, and it will be up to you to cover the difference.
How reimbursement works
If you buy your lift chair from a Medicare supplier, you’ll likely pay for the total cost of the chair upfront and can then seek partial reimbursement from Medicare.
As long as the supplier participates in Medicare, it will usually file a claim on your behalf. If, for any reason, the supplier doesn’t file the claim, you can fill out a claim online. To submit the claim, you will need the following items:
- the claim form
- an itemized bill
- a letter explaining the reason for submitting the claim
- supporting documents related to the claim, like your doctor’s prescription
The supplier or you must file the claim within 12 months of purchasing the lift chair.
Some companies may also allow you to rent a lift chair. This may affect your costs under Medicare. In this instance, it’s best to ask the company you are renting from for an explanation of your monthly costs under Medicare.
If you have a Medigap policy (also known as Medicare supplement insurance), the policy may help you pay for the costs of the copayments on the chair. Check with your plan for specific coverage details.
A lift chair helps a person go from a sitting to standing position. The chair usually looks like a reclining chair, but it has the ability to rise or lift on an incline when you push a button.
Sometimes, lift chairs have additional features, such as heat or massage. Some chairs may even transform to a completely flat position, which would allow you to sleep in the chair as well.
With many additional features or upgraded upholstery materials available, the costs of lift chairs are also highly variable. Most chairs range from several hundred dollars to a thousand dollars.
It’s important to note that a lift chair is not the same as a stair lift, which is a seat that takes you from the bottom to the top of a staircase by pushing a button. It’s also not a patient lift, which helps caregivers transition you from a wheelchair to a bed or vice versa.
Medicare considers a lift chair to be durable medical equipment (DME) and will pay for some of the costs for the chair. You must have a doctor’s prescription for the chair and purchase it from a Medicare-approved supplier.
You’ll likely pay for the full cost of the chair at the time of purchase, and then Medicare will reimburse you for 80 percent of the approved cost of the motorized lifting component of the chair; you’ll pay 100 percent of the cost for the rest of the chair.