Does Medicare Cover the Cost of a Lift Chair?
Navigate Medicare's coverage for lift chairs. Learn about eligibility, specific requirements, costs, and how different plans may affect your benefits.
Lift chairs serve as valuable mobility aids, assisting individuals in transitioning between sitting and standing. Many people inquire about Medicare coverage for these devices. Understanding Medicare’s provisions involves specific guidelines and requirements.
Medicare Coverage for Durable Medical Equipment
Medicare Part B, which is medical insurance, covers Durable Medical Equipment (DME). DME refers to equipment that withstands repeated use, serves a medical purpose, is suitable for home use, and lasts at least three years. Lift chairs are categorized as DME by Medicare. Coverage for any DME under Medicare Part B is contingent upon medical necessity.
Specific Requirements for Lift Chair Coverage
For a lift chair’s seat lift mechanism to be covered, Medicare applies specific medical necessity criteria. An individual must have severe arthritis in the hip or knee or a severe neuromuscular disease. The person must also be completely unable to stand up from a regular armchair or any chair in their home without assistance. Once standing, the individual must demonstrate the ability to ambulate, meaning they can walk independently or with the aid of a cane or walker.
A physician’s order or prescription is a mandatory component for coverage. This document must explicitly state the medical necessity of the lift chair for home use, as part of the physician’s course of treatment. The prescribing physician must complete specific sections on the “Certificate of Medical Necessity for Seat Lift Mechanisms form” (Medicare form CMS-849). Medicare only covers the motorized seat lift mechanism itself. The cost of the chair’s frame, upholstery, cushioning, or any other comfort-related features is not covered.
Costs and Approved Suppliers
When obtaining a lift chair through Original Medicare Part B, beneficiaries are responsible for financial obligations. The annual Medicare Part B deductible for 2025 is $257. After this deductible has been met, Medicare pays 80% of the Medicare-approved amount for the covered seat lift mechanism. The beneficiary is then responsible for the remaining 20% coinsurance.
Obtain the lift chair from a Medicare-approved supplier. These suppliers must be enrolled in the Medicare program, often requiring accreditation and a surety bond to ensure compliance with quality standards. To minimize out-of-pocket expenses, choose a supplier who accepts Medicare assignment. A supplier who accepts assignment agrees to accept Medicare’s approved amount as full payment, meaning they cannot charge the beneficiary more than the applicable deductible and 20% coinsurance.
Medicare Plan Variations
While Original Medicare (Parts A and B) provides a standardized framework for coverage, Medicare Advantage (Part C) plans operate differently. Medicare Advantage plans are offered by private insurance companies and are required by law to cover at least the same services and items as Original Medicare, including medically necessary durable medical equipment.
However, Medicare Advantage plans often have their own specific rules, networks of approved suppliers, and cost-sharing structures, which can differ from Original Medicare. These plans may require prior authorization or dictate specific brands or suppliers. Individuals enrolled in a Medicare Advantage plan should contact their plan provider to understand their precise coverage details, potential out-of-pocket costs, and network requirements for durable medical equipment.