Does Medicare Cover Stairlifts?
Uncover Medicare's stance on stairlift coverage. Understand the nuanced reasons behind its policies and explore viable alternative funding solutions.
Medicare, a federal health insurance program, covers millions of Americans, primarily those aged 65 or older and younger individuals with certain disabilities. Many beneficiaries inquire about coverage for home modifications or assistive devices like stairlifts, to maintain independence and safety. Understanding Medicare’s definitions and criteria for medical equipment is important to determine what types of equipment and services are financially supported.
Understanding Medicare Coverage for Medical Equipment
Medicare Part B covers Durable Medical Equipment (DME). DME refers to equipment that can withstand repeated use and is primarily for a medical purpose. To qualify as DME, an item must be useful only to someone who is sick or injured, used in the home, and expected to last for at least three years.
DME helps manage a health condition, aid recovery, or support daily activities at home. Examples of commonly covered DME include wheelchairs, oxygen equipment, hospital beds, and patient lifts. Medicare generally covers 80% of the approved cost for medically necessary DME after the Part B deductible is met, with the beneficiary responsible for the remaining 20% coinsurance.
Stairlifts and Medicare’s DME Criteria
Despite their utility, stairlifts typically do not meet Medicare’s definition of Durable Medical Equipment. Medicare classifies stairlifts as home modifications or accessibility devices, not medical equipment directly treating an illness or injury. Original Medicare (Parts A and B) does not cover home modifications, even if a physician recommends them.
Stairlifts are permanently attached to the home’s structure, reinforcing their classification as home modifications. Unlike a wheelchair or hospital bed, which directly serve a medical purpose, a stairlift alters the home environment. Medicare’s focus for DME is on equipment that directly addresses a medical need, not on alterations to improve access. Consequently, Original Medicare generally does not cover the cost of a stairlift.
Exploring Other Funding Options for Stairlifts
Since Original Medicare does not cover stairlifts, individuals must explore alternative funding.
Medicare Advantage Plans
One option is Medicare Advantage (Part C) plans, offered by private insurance companies approved by Medicare. These plans cover everything Original Medicare does, and some may offer supplemental benefits, including coverage for home modifications or assistive devices like stairlifts. Coverage varies by plan and location, so beneficiaries must review their specific plan details.
Medicaid Programs
Medicaid, a joint federal and state program, can also assist. Many state Medicaid programs offer Home and Community-Based Services (HCBS) waivers that may cover home modifications for eligible individuals to remain in their homes. Eligibility for these waivers is typically based on financial need and a medical assessment indicating a need for a nursing facility level of care. State and local agencies, non-profit organizations, and charities may also provide grants or financial assistance for home accessibility modifications.
Department of Veterans Affairs (VA) Grants
Veterans with service-connected disabilities may find assistance through the Department of Veterans Affairs (VA). The VA provides various grants, such as the Specially Adapted Housing (SAH), Special Housing Adaptation (SHA), and Home Improvements and Structural Alterations (HISA) grants, which can help fund home modifications including stairlifts. These grants help eligible veterans adapt their homes to their disability-related needs.