Do Lift-Chairs Qualify for Medicare?

Do Lift-Chairs Qualify for Medicare?

A lift chair can be purchased by those who need assistance rising or falling from a sitting or standing posture owing to age, arthritis, or mobility-restricting surgery.

 For Medicare beneficiaries, the high cost of lift chairs might be a considerable expense. However, lift chairs that a doctor prescribes for use in your house and determines to be medically necessary are covered by Medicare Part B. For the cost of your lift chair to be covered by durable medical equipment (DME) coverage, you must meet a few requirements.

Discover the advantages of lift chairs, how Medicare pays for them, and where to get a lift chair that has received Medicare approval.

main points

  • Lift chairs are covered by the durable medical equipment (DME) section of Medicare Part B. This device must be a medical necessity that your doctor has prescribed.
  • Only the lifting device is covered; the chair itself and its components, such as cushions, fabric, or other decorative accents, are not covered.
  • Only lift chairs purchased from suppliers who accept Medicare will be covered by Medicare.

How Do Lift Chairs Work?

A lift chair is a mechanical chair that helps people with limited mobility stand up and sit down. Patients with severe knee or hip arthritis, those with muscular dystrophy, and older adults whose muscular systems are compromised by degenerative joint disease may be prescribed a lift chair by their doctor.

A lift chair hoists a person with restricted mobility from a sitting to a standing position with the push of a button. It also functions in reverse to assist someone in gently assuming a sitting position.

Only lift chairs with smooth operation, effective assistance with standing up and sitting down, and patient control are covered by Medicare.

Will My Lift Chair Be Covered by Medicare?

Your lift chair will be partially covered by Medicare Part B’s durable medical equipment (DME) coverage. Only when your doctor or another healthcare professional recommends a lift chair for use in home health care does Medicare Part B pay for it. Your home does not have to be a nursing home or hospital where you receive Medicare-covered treatment, but it could be a long-term care facility.

Instead of the chair itself, Medicare Part B contributes to the cost of the lifting apparatus. As a result, no cushions, fabric, or other chair accessories will be covered.

How to Get a Lift Chair Covered by Medicare

Prior to 1986, only people with muscular dystrophy, severe knee or hip arthritis, or other neuromuscular illnesses were eligible for Medicare reimbursement for lift chairs. The Health Care Financing Administration (HCFA) revised its policy in 1986 to cover lift chairs based on medical need rather than diagnostic groups. 

The following criteria must be met to be considered a medical necessity:

  •  It must be determined by a doctor that you can take it therapeutically.
  • The lift chair is a component of your doctor’s treatment plan and is likely to aid in the improvement of your condition or lessen its decline.
  • The only option is confinement in a bed or chair because the disease is so severe.
  • Your physician and the vendor of the lift chair must be Medicare-approved. If not, Medicare won’t pay the claim you’ve submitted. You can only be charged the coinsurance and Part B deductible for the DME-approved amount by Medicare-participating vendors.

The amount you can spend on durable medical equipment provided by a non-participating source is unrestricted. Therefore, confirm that your physician and supplier are Medicare-acceptable.

What You Might Pay for a Lift Chair Covered by Medicare

Before approving payment, Medicare carriers must verify that all conditions for medical necessity have been met. The participating supplier, or 80% of the Medicare-approved amount, is frequently paid.

 When your Medicare Part B deductible for the year is satisfied, you must then pay the final 20% coinsurance. For example, if your doctor prescribed a lift chair and you spent $1,050 on one from a reputable vendor, Medicare may pay $840 (80%).If your deductible had previously been satisfied in this instance, you would pay $210 (20 percent).

Due to the fact that Medicare pays for various types of DMEs in various ways, the amount you are expected to pay may change. You can need to rent the equipment, buy it, or have the option to buy or rent it, depending on the equipment. 

If you have signed up for a Medicare Advantage plan and require a lift chair, contact your plan’s primary care physician to inquire about whether the DME is covered by your plan. Like Medicare Part A and Part B, Medicare Advantage plans are required to pay for medically necessary supplies and services.

You have the right to file an appeal and have the denial of coverage for a DME item or service covered by your Medicare Advantage plan reviewed by an impartial third party.

Call your new primary care physician to confirm that your use of DMEs or services will continue to be covered if you have accepted a new Medicare Advantage plan and are currently getting home care or utilizing medical equipment.

How to Cover Your Lift Chair

Your doctor or treating physician must fill out an order saying that the lift chair is required due to a medical condition in order for Medicare to pay for it. A Certificate of Medical Necessity, which comprises questions targeted at proving your medical need for the equipment, is normally filled out by your doctor.

To guarantee that the paperwork is submitted to either Medicare or your Medicare Advantage provider, your supplier follows up with your doctor. If your condition or needs change in the future, your doctor must complete and submit a new, updated order.

Only lift chairs purchased from a Medicare-accepted supplier will be covered by Medicare. A Medicare supplier number and approval from Medicare are requirements for suppliers.

Where to Purchase a Lift Chair with Approval

The Medicare Supplier Directory, which contains details about vendors who offer durable medical equipment in the US, will help you locate an approved lift chair. Enter your ZIP code and select “patient lifts” to locate a certified vendor nearby.

A supplier cannot receive a Medicare supplier number unless they meet certain requirements. When selecting a supplier, you might want to consider the following inquiries:

  • Do you have a supplier number for Medicare?
  • Do you take assignments from Medicare?

Will you charge me Medicare?

As long as it’s a medical necessity, anyone with Medicare Part B can purchase a lift chair. Lift chairs may be covered by Medicare Advantage plans as well; however, in order to obtain DME coverage, you must contact your plan’s primary care provider.

Whether you own or rent the equipment will also affect how often it needs to be repaired and maintained. Your supplier is under no obligation to provide repair services if you own the DME. However, if you’re renting the equipment, your supplier is responsible for repairs and upkeep.

Questions and Answers (FAQs)

What are the lift chair prices?

Lift chairs typically range in price from $600 to $2,000, though costs might differ depending on the source and the type of materials you select, among other characteristics.

Which durable medical equipment is covered by Medicare?

Hospital beds, traction devices, walkers, crutches, blood sugar monitors, and patient lifts are a few of the durable medical equipment items that Medicare will pay for. For a comprehensive list of the durable medical equipment that Medicare covers, go to Medicare.gov.

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