Does Medicare Pay for Power Lift Chairs?

Power lift chairs assist individuals with mobility challenges, providing a way to transition safely from seated to standing. Many wonder if Medicare covers these chairs, which can improve independence and reduce fall risk. These chairs are distinct from stair lifts or patient lifts, as they are designed to assist with sitting and standing within a room, resembling a typical recliner with an added motorized function. Understanding Medicare’s rules helps beneficiaries determine eligibility and navigate the process.

Medicare Coverage for Power Lift Chairs

Medicare classifies power lift chairs as Durable Medical Equipment (DME). For coverage, DME must be medically necessary, prescribed by a doctor, used in the patient’s home, and have an expected lifespan of at least three years. Medicare Part B covers the motorized lifting mechanism of a power lift chair. It typically covers only this lifting device, not the chair’s frame, upholstery, or additional features like heat or massage.

Only the lifting mechanism is considered medically necessary, as it helps a person stand or sit. Other chair elements are viewed as comfort or convenience features, which Medicare does not cover. If a beneficiary qualifies, Medicare Part B typically pays 80% of the Medicare-approved amount for the lifting device after the annual Part B deductible is met. The beneficiary is then responsible for the remaining 20% coinsurance for the lifting mechanism, along with the full cost of the chair’s furniture portion.

Medicare Advantage Plans (Part C) also cover DME, including lift chairs, but their specific coverage rules, costs, and approved suppliers may vary. Beneficiaries should consult their plan provider directly to understand specific benefits and out-of-pocket expenses. Some Medicare Advantage plans might offer additional benefits beyond Original Medicare, though the core coverage for the lift mechanism remains consistent.

Eligibility Requirements for Coverage

To qualify for Medicare coverage of a power lift chair’s lifting mechanism, a beneficiary must meet specific medical necessity criteria and obtain proper documentation. A physician’s order or prescription is required, stating that the lift chair is medically necessary as part of the patient’s treatment plan to improve or prevent worsening of their condition. The physician must also complete a “Certificate of Medical Necessity for Seat Lift Mechanisms form” (Medicare form CMS-849).

The patient must have a severe medical condition, such as severe arthritis of the hip or knee, or a severe neuromuscular disease, that makes them unable to stand up from a regular chair without assistance. This inability to rise is a primary factor for medical necessity. The patient must also be able to operate the lift chair themselves or with a caregiver, and walk once standing, even with a cane or walker.

The lift chair must be for use in the patient’s home, as Medicare does not cover these devices for individuals residing in skilled nursing facilities or hospitals. Physician documentation must support these criteria, showing that without the lift chair, the patient would be largely confined to a chair or bed. Medicare will not cover a lift chair if the beneficiary has recently received a manual wheelchair, scooter, or power wheelchair, unless their condition has improved to the point where they can now walk with assistance.

Obtaining a Medicare-Covered Lift Chair

After meeting eligibility and securing the physician’s order, acquire the power lift chair. Choose a Durable Medical Equipment (DME) supplier that is enrolled in Medicare and accepts assignment. An accepting supplier agrees to the Medicare-approved amount for the lifting mechanism, reducing out-of-pocket costs. Beneficiaries can contact Medicare or use the Medicare website to find approved suppliers in their area.

Beneficiaries provide the physician’s prescription and medical documentation to the DME supplier. The supplier usually handles the billing directly with Medicare, submitting the claim on behalf of the beneficiary. However, in some cases, the beneficiary may need to pay for the lift chair upfront and then submit a claim to Medicare for reimbursement.

The patient’s financial responsibility includes the annual Medicare Part B deductible, if not met, and the 20% coinsurance for the lifting mechanism’s Medicare-approved amount. The beneficiary is also responsible for the full cost of the chair’s non-covered components, like upholstery and frame. Clarify all potential costs with the DME supplier before finalizing the order, including any delivery or setup fees.