The 80-20 guideline encourages seniors to save money for “durable medical equipment” (DME), which includes lift chairs. If seniors are eligible, the 80-20 rule states that Medicare will pay 80% of the cost of a lift chair, leaving you to pay the remaining 20%.
However, when it comes to lifting chairs, Medicare coverage and eligibility is a complex issue. You’ll need to be aware of a wide range of coverage exclusions and limitations. The Medicare rules explain how to get a lift chair for medical and mobility needs as well as which characteristics disqualify you and how your unique medical scenario qualifies.
Lift chairs are considered durable medical equipment under the rules of Original Medicare, but they may need additional characteristics depending on your mobility and health.
How Do Lift Chairs Work?
You might not notice the difference between a lift chair and a large loveseat until you learn that the one-seater has a remote control or a few built-in buttons. Although this seater resembles a recliner and may recline, its main and most crucial function is to raise the user from a sitting to a standing position utilizing an integrated mechanical hydraulic system.
The chair smoothly glides forward and slowly raises the user without any effort or needless movement on their part. There is little probability that the user will feel queasy because there is no momentum involved.
The chair requires some more space when installed in a living area because of its forward-springing motion. The lift chair is intended to be medically supportive of mobility concerns and important for recovery after surgery, therefore users don’t appear to worry.
Numerous advantages are offered by lift chairs, including:
- Assisting elderly people with osteoarthritis to maintain their independence and mobility without running the risk of a possible slip and fall
- Use various seating postures throughout the day to promote good posture
- Enabling older adults with chronic weariness to move more freely and with fewer energy demands
- Permitting comfortable sit-to-stand transfers while relieving pressure and tension on joints and muscles
- Elevating the legs will help fluid decrease
According to studies, the lift chair is a very practical and efficient at-home solution to eliminate bedsores and gradually improve weak muscles when used as a therapy tool or an assistive mobility device.
Since a lift chair has so many advantages, Original Medicare provides reimbursement for what they classify as durable medical equipment. Medicare plans do differ slightly in terms of which features are and aren’t covered, though.
What Elements Are Included?
Your Medicare plan will determine your level of coverage. The raising mechanism of the chair is both its most important component and the benefit that Medicare will pay for.
Many lift chairs come with additional functions that can prevent them from being regarded as medically necessary. On the other hand, despite not being essential to the lifting function, these characteristics can improve user friendliness, expand its use, and foster user happiness.
You might have to pay out of pocket or choose a more adaptable plan that would include the extras you require.
Patient lifts are defined as medical devices having lift mechanisms. Since it is designed for use in your house, medical equipment with lifting capabilities is considered durable medical equipment. Medicare must approve the chair in order for you to use it, but there are several ways to do it, including:
- Purchase of the chair in full
- Renting the furniture
Deciding whether renting or buying best meets your needs
The model you select must, at the very least, feature a lifting mechanism. As long as this condition is satisfied, along with a few others regarding supplier and physician eligibility, Medicare will pay for the chair in full.
Mechanism for Reclining
Since only the motorized or lifting mechanism of your chair is covered by original or conventional Medicare, many seniors must pay out of pocket for the lift chair’s other functions, like its reclining mechanism.
Many lift chairs have zero gravity or infinite positioning, allowing you to stretch out the seat and recline the backrest. You can gain from the enhanced circulation brought on by keeping your legs elevated just above your heart if you can discover a lift chair with an integrated reclining position.
However, part of the strain can be relieved even by chairs that just recline to a 45-degree angle. Even while your chair still qualifies as a DME, you will be able to choose from two, three, or even infinite positions.
Many senior citizens and people in their later years choose for a Medicare Supplement Plan in order to benefit from the lift chair’s rest’s reclining characteristics. Medicare Supplement Plans can pay for co-insurance, copayments, deductibles, and other out-of-pocket medical expenses as a supplemental insurance policy designed to supplement your Original Medicare coverage.
Massage therapy and heat
Some chairs come equipped with built-in massage and heated backrests. However, because these accessories are not deemed medically necessary, your coverage, which may not cover the whole cost of your lift chair purchase, may not also cover them.
Make sure your Medicare plan will cover the full cost of treatment if you are aware of how vital heat and massage therapy are to you. The money you would have otherwise saved may then be directed toward these features.
The good news is that there are no restrictions on a chair’s materials for Medicare coverage. You won’t necessarily lose Medicare coverage for your purchase because of your preferred upholstery.
The catch is that you’ll have to pay for any materials that aren’t included in the price of your purchase but would be considered upgrades. For instance, you are responsible for paying for leather if your preferred lift chair model offers it as an expensive premium upgrade. Once more, you can reduce these additional costs by combining your supplemental insurance with Medicare Plan B (Original Medicare).
Supplemental plans are practical because they let you tailor the purchase of a lift chair to your specific needs. While each user’s circumstances are unique, Medicare has a set of requirements that all users must meet.
Qualifications for a Lift Chair
You must prove a medical necessity in accordance with Medicare’s own guidelines in order to be eligible for a lift chair. Medicare will only keep its word and pay for the chair’s seat lift mechanism if you can satisfy their predetermined requirements.
A Medicare Part B or Medicare Advantage (Part C) plan must first be selected for you, and you must be enrolled in it. When purchasing your lift chair, you should confirm that there aren’t any additional coverage requirements, charges, or providers because the latter is covered by a private insurance provider’s policy.
Medical Necessity Certificate
You must first have a face-to-face meeting with your doctor in order to demonstrate your medical requirement. You will receive a prescription from your doctor stating that you need to use an at-home lift chair due to a medical issue.
The formal Certificate of Medical Necessity for Seat Lift Mechanisms form, commonly known as Medicare Form CMS-849, requires your doctor to complete sections B and D.
Make sure you’re buying from a Medicare-participating supplier who accepts assignment by checking this pro tip. If not, Medicare won’t pay the expenses.
Send this data to your provider as soon as you’ve finished the necessary documentation. Your clinician must first show that you are physically and medically eligible before they can submit the claim to Medicare for your preferred chair.
Will a Lift Chair Be Covered by Medicare?
Your doctor and the manufacturer of your lift chair must both be active Medicare beneficiaries in order to accept Original Medicare benefits. Make sure your doctor and supplier are enrolled in Medicare because it has its own requirements that these individuals must follow.
Pro-Tip: Even though a supplier is registered with Medicare, they could not be an accepting assignment or an active participant. They can decide not to accept your request if this is the case and they are not actively engaging, and they are free to impose any fees they see fit for your DME.
As long as you meet the eligibility requirements, Medicare will cover the cost of your lift chair. Your doctor must evaluate you in accordance with these standards since Medicare views their verification as a seal of approval. It informs Medicare that your requirement is valid.
How to Determine Your Lift Chair Eligibility
Your physical and medical health determines your eligibility. You need to show, specifically, that:
- Your knee or hip is affected by severe osteoarthritis or a neuromuscular condition.
- You require assistance to get out of a conventional chair.
- Your primary care doctor is prescribing the lift chair as an essential component of your treatment plan because it will help you feel better or prevent your existing condition from getting worse, as specified and advised by your doctor.
- You don’t use a wheelchair or scooter, but you may require a cane or walker for support.
- The attending or consulting physician for the condition’s treatment is your doctor.
Pro-Tip: Consider your decision carefully before submitting your Medicare claim for a manual wheelchair, power wheelchair, or scooter. You are automatically ineligible for a subsequent (or ongoing!) lift chair claim to Medicare as a result of this claim.
You, your doctor, and the provider of your choice must all adhere to a preset set of requirements for Medicare purposes. Your lift chair must, however, also:
- Be resilient to frequent use
- Be created with a medical issue in mind.
- Be utilized for therapeutic purposes at home
- A minimum of three years of use
Once your purchase satisfies all four requirements set forth by Medicare, your Medicare Part B benefits become effective and will pay for up to 80% of your purchase. The remaining 20% will be your responsibility if you don’t have any other supplemental insurance.
A Part B Deductible is what?
Your Part B deductible is the amount you must initially pay out of pocket before your Medicare insurance coverage begins, a concept that many people find confusing. This amount increased by $2 from the previous year to $185 in 2019.
The 20% co-insurance, which is the balance from the chair’s actual cost, is also your responsibility.
Plans that supplement Medicare
There are alternatives if the thought of paying the 20% co-insurance seems too much for you. You can pick from a variety of Medicare Supplement Plans.
Medicare Supplement Plan F: It exempts you from paying any excess fees, the 20% co-insurance, or the Part B deductible.
Medicare Supplement Plan G: It exempts you from paying excess fees and the 20% co-insurance, but the Part B deductible is still your responsibility.
Medicare Supplement Plan N: You are still responsible for paying the Part B deductible and excess costs even though you don’t have to pay the 20% coinsurance.
Medicare Advantage (Part C), Medicare Prescription Drug (Part D), and Medigap are additional terms you might be familiar with. Before selecting the best Medicare Supplement Plan for you, it’s a good idea to compare all of them.
2019 Medicare Advantage Changes
Similar to your HMO or PPO, Medicare Advantage Plans extend your coverage. As of 2019, modifications to these plans’ terms may classify lift chairs as a permissible additional health benefit.
With these modifications, it’s now simpler than ever for those with a particular ailment or physical requirement to access lift chairs affordably.
Tax Breaks and Lift Chairs
The lack of a Medicare Supplemental Plan does not put you at a complete disadvantage. The 20% co-insurance you must pay, the extra fees for features like heat and massage or zero-gravity reclining, or both, may be tax deductible.
Although it’s wise to speak with a tax expert, the IRS generally states that a lift chair falls under capital expenses and that you can write off a number of qualified medical expenses. Have a prescription from your doctor demonstrating medical necessity if you wish to deduct the cost of your lift chair from your taxes.
Is Medicare’s Competitive Bidding Program Affecting You?
You should be aware that the Medicare Competitive Bidding program may be applicable to your purchase if you intend to utilize Medicare to offset the cost of a lift chair.
The amount that Medicare pays for DME items varies depending on region. Suppliers who participate in this program offer bids on DMEs, and Medicare considers these bids to determine the price it will pay for each item. There is some evidence from long-term studies that suggests this can occasionally work in your favor because medical equipment prices are driven down by competition.
The lift chair is seen by many older adults and seniors as a necessity rather than a nice-to-have by those with mobility challenges, degenerative bone disorders, or neuromuscular conditions. These people, especially if they have private insurance, would both be eligible for Medicare and most likely buy a lift chair regardless of coverage.
In other words, the advantages of purchasing a lift chair frequently outweigh the cost. However, you should profit from an in-home therapeutic option if you can guarantee savings while doing so.
Medicare’s qualifying requirements and coverage may appear to be a drawn-out process, but your doctor and the supplier of your lift chair can assist you in completing the paperwork swiftly. You can benefit from the tax-deductible nature of medical equipment like lift chairs in addition to Part B coverage.
Making sure you purchase the appropriate model is crucial in this situation. After completing your paperwork, spend some time looking into the greatest chair available and one that is especially suited to your requirements.
Not all lift chairs are created equally. Consider a lift chair type like the Perfect Sleep Chair if you have mobility challenges coupled with additional disorders like sleep apnea, restless legs syndrome, or aching joints and muscles. This chair is made to address a variety of symptoms with a single design.
Lift chairs can be a creative solution for elderly citizens and older people, but they can also be used by other members of your family. It is conceivably one of the safest and most comfortable ways to age at home.