Does Medicare Help Pay for a Lift Chair?

Understanding Medicare’s provisions for health-related equipment, particularly for specialized items like lift chairs, can be complex. This article aims to clarify the circumstances under which Medicare may provide coverage for lift chairs, offering detailed insights into the specific requirements and financial considerations involved.

Medicare Part B Coverage for Durable Medical Equipment

Medicare Part B, which covers medically necessary outpatient care, includes coverage for Durable Medical Equipment (DME). DME must meet specific criteria to qualify for coverage. This equipment must be durable, meaning it can withstand repeated use, and used for a medical purpose. Additionally, it must be appropriate for use in the home and generally not useful to someone who does not have an illness or injury. [2]

When Medicare Part B covers DME, it typically pays 80% of the Medicare-approved amount after the annual Part B deductible has been met. The beneficiary is then responsible for the remaining 20% coinsurance. All covered DME must meet strict medical necessity requirements. [2]

Specific Coverage Rules for Lift Chairs

Medicare Part B offers coverage for a component of a lift chair, specifically the lift mechanism, but not the chair portion itself. Medicare views the chair itself as furniture and therefore does not cover its cost. The lift mechanism, considered “seat lift equipment” or “patient lift” under DME classification, is covered only when specific medical necessity criteria are fulfilled. [3, 4]

To qualify for coverage of the lift mechanism, an individual must have severe arthritis of the hip or knee or a severe neuromuscular disease. The individual must also be unable to stand up from a regular chair without assistance from another person. Furthermore, the beneficiary must be able to operate the lift chair themselves, or have someone available who can operate it for them. [3, 4] The lift chair must be prescribed by a physician as an integral part of the individual’s treatment plan.

Obtaining a Medicare-Covered Lift Chair

Securing a Medicare-covered lift chair begins with obtaining a written prescription from a physician. This prescription must include specific medical documentation that thoroughly supports the necessity of the lift mechanism. [3]

It is imperative to purchase the lift mechanism from a Medicare-approved Durable Medical Equipment (DME) supplier. These suppliers are authorized by Medicare to provide equipment and process claims. Beneficiaries can locate approved suppliers through Medicare’s official website or by consulting their physician for recommendations. [1]

A supplier that accepts “assignment” is crucial, as this means they agree to accept the Medicare-approved amount as full payment for the covered service or item. By doing so, the beneficiary is only responsible for their coinsurance and any unmet deductible amounts. The Medicare-approved supplier typically manages the claim submission process directly to Medicare on behalf of the beneficiary.

Your Out-of-Pocket Costs

When Medicare covers the lift mechanism of a lift chair, beneficiaries incur specific out-of-pocket expenses. After the annual Medicare Part B deductible is met, Medicare pays 80% of the Medicare-approved amount for the lift mechanism. For 2025, the standard Part B deductible is $240. [0]

The beneficiary is responsible for the remaining 20% coinsurance for the lift mechanism. The beneficiary is responsible for 100% of the cost of the chair portion of the lift chair. This is because Medicare does not consider the chair itself to be medical equipment, but rather furniture. Some individuals may have secondary insurance, such as Medigap or Medicaid, which could help cover some of these out-of-pocket costs, including the deductible and coinsurance.

Medicare Advantage Plan Considerations

Medicare Advantage plans, also known as Medicare Part C, are required to provide at least the same level of benefits as Original Medicare, including coverage for Durable Medical Equipment like the lift mechanism for a lift chair. [5]

However, Medicare Advantage plans may have different rules, costs, and network requirements compared to Original Medicare. These plans might require beneficiaries to use specific in-network suppliers, and they may have different deductibles, copayments, or coinsurance amounts for DME. Individuals enrolled in a Medicare Advantage plan should contact their specific plan provider directly to understand their exact coverage details and any procedural requirements for obtaining a lift chair. [5]