Does Medicare Cover Electric Hoyer Lifts?

An electric Hoyer lift is a type of patient lift designed to safely transfer individuals with significant mobility limitations, such as those who are non-weight-bearing or require full support. These powered devices, often used with a patient sling, facilitate movements between various surfaces like a bed, wheelchair, or toilet. Their primary purpose in a home healthcare setting is to minimize physical strain on caregivers and enhance patient safety during transfers. Medicare may provide coverage for such equipment under specific conditions, as electric Hoyer lifts are categorized as Durable Medical Equipment (DME).

Determining Coverage Eligibility

Electric Hoyer lifts are classified as Durable Medical Equipment (DME) by Medicare under Section 1861 of the Social Security Act. For Medicare to cover an electric Hoyer lift, it must meet several criteria for medical necessity. The lift must be prescribed by a physician enrolled in Medicare, and this physician must document that the lift is medically necessary because the patient’s severe mobility impairment makes manual transfers unsafe or impossible.

The lift must be for use in the patient’s home. It must also be durable, serve a medical purpose, and not be useful to someone who is not sick or injured. Medicare generally prefers to rent DME rather than purchase it outright. However, an electric Hoyer lift may be purchased if it is determined to be more cost-effective over its expected lifespan than continuous rental.

Steps to Obtain a Covered Lift

The process to obtain a covered electric Hoyer lift begins with a physician consultation. The patient’s doctor must complete the necessary prescription and detailed documentation, confirming the medical necessity of the lift for the patient’s specific condition.

The next step involves choosing a Medicare-approved Durable Medical Equipment (DME) supplier. It is important to select a supplier that accepts “assignment” from Medicare. Approved suppliers can be found through Medicare’s official website or by asking the prescribing physician. The supplier works with the patient’s doctor and Medicare to submit required paperwork for approval. Upon approval, the supplier will deliver the electric Hoyer lift and provide instructions on its use to both the patient and caregivers.

Understanding Your Financial Responsibility

Beneficiaries have financial responsibility even when an electric Hoyer lift is covered by Medicare. After meeting the annual Part B deductible, Medicare generally pays 80% of the Medicare-approved amount for Durable Medical Equipment (DME). The beneficiary is responsible for the remaining 20% coinsurance.

The “Medicare-approved amount” is the payment amount that Original Medicare sets for a covered service or item. It is important to use a supplier who accepts “assignment” because they agree to accept the Medicare-approved amount as full payment, preventing them from billing you for more than the deductible and coinsurance. Secondary insurance, such as a Medigap policy or Medicaid, may help cover the 20% coinsurance, reducing out-of-pocket costs.

Variations in Medicare Plans

Coverage for electric Hoyer lifts can differ based on the type of Medicare plan an individual possesses. Original Medicare (Parts A and B) covers DME, including patient lifts, under Part B.

Medicare Advantage Plans, also known as Part C, are offered by private companies approved by Medicare. These plans must cover at least the same benefits as Original Medicare, including DME. Medicare Advantage plans may have different rules, costs, or network requirements. These plans may require prior authorization, have different cost-sharing (copayments or coinsurance), or necessitate using specific network providers. Beneficiaries with a Medicare Advantage Plan should contact their plan directly to understand coverage terms and the process for obtaining a lift.