Medicare will cover some medical equipment, such as a lift chair. These chairs assist you in rising from a sitting to a standing position. While standing is difficult for those with mobility issues, these chairs are excellent for this purpose.
Here are some concerns you may have about Medicare covering lift chairs and how to maximize your reimbursement.
Medicare covers lift chairs
When you use a lift chair for a medical reason, Medicare covers it. Medicare, however, does not cover the entire cost of the chair. Part B deals with DME, which includes the motorized lifting mechanism.
For the upholstery, cushioning, and frame, you’ll have to pay for everything on your own.
For reimbursement from Medicare, DME must meet the following criteria:
- Relatively long-lasting (you can use it repeatedly)
- Medical reasons
- Use in home
- Most often 3-5 years
- Helps those who are sick or injured
Wheelchairs, walkers, and crutches are all DME.
The lift’s chair portion is not medically necessary, so it is not covered.
Is this available to me?
Medicare Part B might cover a lift chair if you qualify. If you are 65 or above or have other qualifying medical conditions, you can get Medicare benefits. These conditions include severe disabilities, end-stage renal disease, and ALS (amyotrophic lateral sclerosis).
Medicare Advantage recipients may still be eligible for a lift chair. Medicare Advantage (Medicare Part C) is when you select a private insurance company to handle your Medicare benefits.
If you register in a Medicare Advantage plan, you should expect to receive at least the same level of coverage, if not more.
To get a prescription for the chair, you must see a doctor first. Also, medical lifts have these factors in mind when determining whether they are necessary:
- Severe arthritis in your knees or hips
- The chair’s operability
- Your ability to stand up without assistance
- Even with the aid of a walker, you can walk again (if you depend on a scooter or walker, this may make you ineligible)
- Once you’re standing, you can walk
- Other methods like physical therapy have not helped you get from sitting to standing.
Costs and reimbursement
Medicare Part B cost
The lift chair’s mechanism is covered by Medicare Part B. Your deductible with Part B is $203 in 2021. The lift mechanism will cost you 20% of the Medicare-approved amount. Additionally, you’ll be responsible for the entire chair’s cost.
Medicare-participating physicians and suppliers
Only providers of Medicare services can authorize a lift chair to be covered by Medicare, and the supplier must be a Medicare beneficiary.
To locate lift chairs, check if the company is Medicare-approved and accepts assignments. Participating chair companies could potentially charge you more than the accepted Medicare amount, and you would be liable for the difference.
How does reimbursement work?
Medicare suppliers are likely to charge the total price in advance and then request reimbursement from Medicare.
In most cases, Medicare providers will file a claim on your behalf. If the supplier fails to file, you can file a claim online. A claim must include the following items:
- Insurance claim form
- A lengthy invoice
- A letter explaining your claim
- Claim-related paperwork, like your doctor’s prescription
In 12 months, either the supplier or you must claim reimbursement for the lift chair.
Certain businesses may rent lift chairs. This may affect your Medicare costs. The company you rent from can better explain your monthly Medicare costs. Some Medigap policies (also known as Medicare supplement insurance) can help you pay for chair copayments. Check plan details for coverage details.
What exactly is a lift chair?
A lift chair helps someone transition from sitting to standing. When you press a button, the chair moves in a reclining position. Lift chairs may have additional features, such as heat or massage. Some chairs can even be completely flat, allowing you to sleep in them.
Many features and upgraded upholstery materials available lead to different chair prices. The vast majority of chairs cost between $400 and $1,000.
A lift chair transports you from the bottom of a staircase to the top by pressing a button. This allows caregivers to transfer you from a wheelchair to a bed or the other way around.
A lift chair is Medicare DME, so some of the chair’s costs will be covered. Also, Medicare-approved suppliers only supply items ordered with a doctor’s prescription.
You’ll have to pay for the chair in full upfront, and Medicare will reimburse you for 80% of the approved cost of the chair’s motorized lifting component.