Does Medicare Pay for Electric Recliners?
Navigating Medicare coverage for an electric recliner? Understand the distinction between recliners and medically approved lift chairs, plus coverage details.
Medicare is a federal health insurance program that provides coverage for millions of Americans, primarily those aged 65 or older, and certain younger individuals with disabilities. This program helps manage healthcare costs, including medical services and equipment. Many people inquire whether certain types of seating, often generically referred to as “electric recliners,” are covered under Medicare.
Understanding Medicare’s Terminology
A common “electric recliner” is typically designed for comfort or convenience, offering various positions for relaxation. Medicare generally does not cover these recliners because they do not serve a primary medical purpose. In contrast, Medicare may cover a specific type of equipment known as a “lift chair” when it qualifies as Durable Medical Equipment (DME).
A lift chair includes a motorized lifting mechanism. This mechanism is designed to gently move an individual from a seated position to a standing position, assisting those who have difficulty rising unassisted. This functionality differentiates it from a non-medical recliner, making it eligible as DME due to its medical function. Durable Medical Equipment is defined by Medicare as equipment that can withstand repeated use, is primarily for a medical purpose, is generally not useful to someone without illness or injury, and is used in the patient’s home.
Medicare’s Coverage Criteria for Lift Chairs
Medicare Part B covers durable medical equipment (DME), which can include the lifting mechanism of a lift chair, provided specific criteria are met. The primary requirement for coverage is medical necessity. A physician must determine the equipment is essential for the patient’s condition. This requires a physician’s order or prescription, which must include the diagnosis and a clear explanation of why the lift chair is medically necessary.
The physician must document that the patient has a severe medical condition, such as severe arthritis of the hip or knee or a severe neuromuscular disease, which makes them unable to stand up from a regular chair in their home. The patient must also be able to walk independently or with the aid of a walker or cane once standing. The physician must complete a Certificate of Medical Necessity (CMS-849).
Acquiring a Lift Chair and Understanding Costs
Once medical necessity criteria are met and a physician’s order is obtained, acquire the lift chair from a Medicare-approved Durable Medical Equipment (DME) supplier. Confirm the supplier is enrolled in Medicare and accepts “assignment.” A supplier accepting assignment agrees to accept Medicare’s approved amount as full payment, which helps manage a beneficiary’s out-of-pocket costs.
For Medicare Part B, after the annual deductible is met, Medicare generally pays 80% of the Medicare-approved amount for the lift mechanism. The beneficiary is responsible for the remaining 20% coinsurance. The beneficiary must pay the full cost of the chair portion, as Medicare only covers the motorized lifting device itself. If a supplier does not accept assignment, they can charge more than the Medicare-approved amount, leading to higher out-of-pocket expenses.