Does Medicare Help Pay for Lift Chairs?

A lift chair is a power-operated armchair designed to help individuals transition from a sitting to a standing position. It features a motorized mechanism that gently tilts the seat forward, assisting users with mobility challenges. Many individuals wonder if Medicare provides coverage for their cost. Medicare can help cover the expense of a lift chair under specific circumstances, provided certain requirements are met. This article explains how Medicare approaches coverage for these devices and what beneficiaries need to know.

Medicare Coverage for Lift Chairs

Medicare generally classifies lift chairs as Durable Medical Equipment (DME). These are items used in the home, have a medical purpose, and can withstand repeated use for at least three years. Coverage for DME, including the seat-lift mechanism of a lift chair, falls under Medicare Part B. For Part B to cover a DME item, it must be medically necessary and prescribed by a Medicare-enrolled doctor for use in the beneficiary’s home.

Medicare Part B covers only the “seat-lift mechanism” portion of the chair, not the entire chair itself. This means Medicare helps with the cost of the motorized lifting device, but not furniture aspects like fabric, cushioning, or accessories such as heat or massage functions. Medicare generally pays 80% of the Medicare-approved amount for the lifting device after the Part B deductible is met. Beneficiaries are responsible for the remaining 20% coinsurance and the full cost of the chair’s other components.

Specific Medical Criteria for Coverage

For Medicare to consider the seat-lift mechanism medically necessary and eligible for coverage, beneficiaries must meet precise medical criteria. The individual must have severe arthritis of the hip or knee, or a severe neuromuscular disease. This condition must prevent them from being able to stand up independently from a regular armchair or any chair in their home.

The beneficiary must be able to walk once standing, either independently or with the assistance of a cane or walker. Medicare does not cover a lift chair if the individual transfers directly from the chair to a wheelchair, as the purpose of the device is to facilitate standing and ambulation. The lift mechanism must be an integral part of the physician’s prescribed therapeutic treatment plan, intended to improve the patient’s condition or slow its deterioration. It cannot be for mere convenience.

The doctor’s written order, or prescription, must clearly state the medical necessity of the lift chair. This involves completing a “Certificate of Medical Necessity for Seat Lift Mechanisms Form,” also known as Medicare form CMS-849. This form requires the physician to document the diagnosis, confirm the inability to stand without assistance, and attest that the patient can ambulate once standing. A face-to-face visit with the physician is often required before the prescription is issued.

The Process for Obtaining a Lift Chair

Once a physician determines a lift chair’s seat-lift mechanism is medically necessary and provides the required prescription and documentation, the next step involves working with a supplier. Obtain the lift chair from a Medicare-approved Durable Medical Equipment (DME) supplier that accepts Medicare assignment. If a supplier is not enrolled in Medicare or does not accept assignment, Medicare will not pay the claims, leaving the beneficiary responsible for the full cost.

Beneficiaries can locate Medicare-approved suppliers through the official Medicare website’s “Find Medical Equipment & Suppliers” search tool by entering their zip code and filtering by equipment type. The DME supplier is responsible for submitting the claim directly to Medicare on behalf of the beneficiary. The supplier should also provide an Advance Beneficiary Notice of Noncoverage (ABN) if they believe Medicare might not cover the item, informing the beneficiary of potential out-of-pocket costs.

Medicare reviews the submitted claim to determine approval or denial based on the documented medical necessity and other criteria. While some beneficiaries might initially pay for the chair and then seek reimbursement from Medicare, it is recommended to work with a supplier who bills Medicare directly. This helps avoid potential complications and ensures the supplier adheres to Medicare’s specific billing rules.

Understanding Your Costs and Payment Assistance

Medicare Part B covers 80% of the Medicare-approved amount for the seat-lift mechanism after the annual Part B deductible is met. The beneficiary is responsible for the remaining 20% coinsurance. For example, in 2025, the Part B deductible is $257. After this deductible is paid, Medicare covers 80% of the approved cost of the lift mechanism, and the individual pays the remaining 20% plus the full cost of the chair’s non-covered components.

Several options can help cover these out-of-pocket expenses. Medigap, or Medicare Supplement Insurance, policies are sold by private insurance companies and can help pay for costs that Original Medicare does not cover, such as the Part B deductible and coinsurance. Different Medigap plans offer varying levels of coverage for these gaps.

For individuals with limited income and resources, Medicaid, a joint federal and state program, may offer assistance. Medicaid can help cover Medicare costs like premiums, deductibles, and coinsurance, and may also cover services not typically covered by Medicare. Medicare Savings Programs (MSPs) are state-run initiatives that help eligible individuals with Medicare pay for some of their premiums and cost-sharing. Veterans may also be eligible for benefits through the Department of Veterans Affairs (VA), which can cover the lift mechanism, though not always the entire chair. Various state and local programs, as well as non-profit organizations, may also provide financial assistance or donated medical equipment.