Are Lift Chairs Covered by Insurance?
Navigate the nuanced world of lift chair insurance coverage. Understand the requirements and financial considerations for essential mobility support.
Navigate the nuanced world of lift chair insurance coverage. Understand the requirements and financial considerations for essential mobility support.
Lift chairs are specialized recliners designed with a powered lifting mechanism to assist individuals in transitioning safely between sitting and standing positions. These chairs can be beneficial for those experiencing mobility challenges due to various health conditions. A common concern for individuals considering a lift chair is whether insurance will help cover the cost. Coverage can be complex and depends on several factors, including the type of insurance plan and the specific medical necessity criteria met.
Medicare Part B (Medical Insurance) may cover the seat lift mechanism of a lift chair, classifying it as Durable Medical Equipment (DME). To qualify for coverage, the lift chair must be medically necessary and prescribed by a Medicare-enrolled physician. Medical necessity generally means the individual has severe arthritis of the hip or knee, or a severe neuromuscular disease, making them completely incapable of standing up from a regular chair. Once standing, the person must be able to walk independently or with an aid like a walker or cane. If a person transfers directly to a wheelchair, Medicare may not cover the device.
The prescription must state medical necessity as part of a treatment plan. This often involves completing Medicare form CMS-849. Medicare typically covers only the lifting mechanism itself, not the entire chair, including the frame, upholstery, or additional features like heat or massage.
After the annual Part B deductible is met, Medicare usually covers 80% of the Medicare-approved amount for the lift mechanism. The individual is then responsible for the remaining 20% coinsurance. For 2025, the annual Medicare Part B deductible is $257. The reimbursement amount for the lifting device can vary, meaning the individual would pay the rest of the full chair’s cost.
Medicare Advantage Plans (Part C) are required to offer at least the same coverage as Original Medicare, including DME. However, specific rules, costs, and approved suppliers may differ. Beneficiaries with these plans should consult their private insurance provider for details. It is essential to obtain the lift chair from a Medicare-approved DME supplier, as Medicare will not cover claims from ineligible healthcare professionals or retailers.
Private health insurance plans, including employer-sponsored plans and those obtained through the Affordable Care Act (ACA) marketplace, may also offer coverage for lift chairs. However, coverage terms vary significantly among different insurers and specific plans. Similar to Medicare, private insurers typically require a doctor’s prescription and a determination of medical necessity for the lift chair.
These plans often consider the lift mechanism as durable medical equipment, similar to Medicare. Coverage may be limited to the lifting component rather than the entire chair, and optional features like massage or upgraded fabrics are generally not covered. Individuals should contact their insurance provider directly to understand their specific policy details, including any requirements for pre-authorization or specific documentation.
It is advisable to confirm whether the plan includes benefits for durable medical equipment and to inquire about any deductibles, co-pays, or co-insurance amounts that would apply. Understanding whether a supplier is in-network or out-of-network is also important, as using out-of-network providers can result in higher out-of-pocket costs. Reviewing the policy’s terms regarding DME can help clarify what is covered and under what conditions.
Obtaining insurance coverage for a lift chair involves a structured process that begins with a healthcare provider. The first step is to secure a detailed prescription from a physician enrolled with your insurance provider. This prescription must state the medical necessity for the lift mechanism, explaining how it addresses a specific medical condition and improves mobility or prevents further deterioration. The doctor may need to complete specific forms, such as Medicare form CMS-849.
After obtaining the necessary medical documentation, find a Durable Medical Equipment (DME) supplier. Ensure the supplier is approved by Medicare or is in-network with your private insurance plan. These suppliers often handle direct billing to your insurance, which can simplify the process. They will verify your coverage and ensure all required paperwork is submitted correctly.
If the supplier does not handle direct billing, or if you purchase the chair and seek reimbursement, you will need to submit a claim to your insurance provider. This typically involves providing the prescription, proof of purchase, and the completed medical necessity forms. If a claim is denied, individuals have the right to appeal the decision. The appeals process usually involves multiple levels, starting with a redetermination request and potentially escalating to a reconsideration by an independent review entity. Gathering additional supporting documentation from your doctor, such as medical records or a letter of appeal, can strengthen your case during this process.
Even with insurance coverage, individuals will likely incur some out-of-pocket expenses for a lift chair. These costs typically include deductibles, co-insurance, and co-payments. A deductible is the amount you must pay for covered healthcare services before your insurance plan begins to pay. For Medicare Part B, this deductible is $257 in 2025.
Once the deductible is met, co-insurance refers to the percentage of the cost of a covered service you are responsible for. A co-payment is a fixed dollar amount you pay for a service. These can vary widely with private insurance plans.
The “Medicare-approved amount” or “allowed amount” by private insurers is the maximum amount the insurance company will pay for a covered service. If a DME supplier charges more than this approved amount and does not “accept assignment” (agree to accept the Medicare-approved amount as full payment), you may be responsible for the difference, known as excess charges. It is important to ask the DME supplier for a clear, itemized cost breakdown before finalizing a purchase.