Does Medicare Cover Power Lift Recliners?
Understand how Medicare covers power lift recliners. Learn the criteria, process, and costs for obtaining these essential mobility aids.
Power lift recliners are chairs with a motorized mechanism that helps individuals transition from a seated to a standing position. This article clarifies how Medicare addresses coverage for these assistive devices, detailing the conditions and processes involved.
Medicare Coverage for Power Lift Recliners
Medicare Part B, which covers medical insurance, may provide coverage for power lift recliners. These recliners are categorized as Durable Medical Equipment (DME) if deemed medically necessary for use in the home. Medicare typically only covers the motorized lifting mechanism of the chair, not the entire furniture piece itself. This means the cost of the chair’s frame, upholstery, and other comfort features are generally not covered. The decision to cover the lift mechanism hinges on a determination of medical necessity by a healthcare professional.
Meeting Coverage Criteria
For Medicare to consider covering the lift mechanism of a power lift recliner, specific medical criteria must be satisfied. A physician must prescribe the lift chair mechanism as part of a patient’s treatment plan. The patient must have severe arthritis of the hip or knee, or a severe neuromuscular disease, which prevents them from standing up from a regular chair without assistance. It is also required that the patient be able to operate the lift mechanism independently and possess the ability to walk once assisted to a standing position, even if using a cane or walker.
The prescribing physician must conduct a face-to-face examination with the patient to assess their condition and confirm the medical necessity. This examination helps ensure the lift mechanism is appropriate for the patient’s specific needs. Detailed medical records supporting the diagnosis and the need for the device must be provided by the physician. The physician and patient typically complete and submit a Certificate of Medical Necessity for Seat Lift Mechanisms Form (CMS-849), which outlines the medical requirements for coverage.
Obtaining a Medicare-Covered Power Lift Recliner
Once all medical criteria and documentation are in place, the process of acquiring a Medicare-covered power lift recliner can begin. Patients should ensure they have the necessary physician’s order and supporting medical records readily available. The next step involves finding a Medicare-approved supplier for Durable Medical Equipment. It is important to choose a supplier that accepts Medicare assignment, meaning they agree to accept the Medicare-approved amount as full payment for the covered service or item.
The chosen supplier will work directly with the patient’s doctor and Medicare to submit the claim for the lift mechanism. Patients can expect a period of review by Medicare before approval or denial is issued. If approved, the supplier will arrange for the delivery and proper setup of the power lift recliner. This streamlined process ensures that the administrative burden is largely handled by the supplier once medical necessity is established.
Understanding Your Costs
Even with Medicare coverage, beneficiaries are responsible for certain out-of-pocket costs associated with a power lift recliner. Medicare Part B typically covers 80% of the Medicare-approved amount for the lift mechanism, after the annual Part B deductible has been met. For 2025, the Medicare Part B deductible is $257. This means the beneficiary is responsible for the deductible, if not already satisfied for the year, and a 20% coinsurance for the lift mechanism.
The remaining cost of the chair itself, beyond the lift mechanism, is generally not covered by Medicare and is the full financial responsibility of the beneficiary. For example, if the lift mechanism is priced at $500 and the total chair is $1,000, Medicare would cover 80% of the $500 (after deductible), and the beneficiary would pay the remaining 20% of the mechanism’s cost plus the entire $500 for the chair’s non-covered components. It is advisable to confirm all potential costs with the supplier upfront to avoid unexpected expenses.