Does Medicare Pay for Recliners or Lift Chairs?

Medicare helps beneficiaries access medical services and equipment. For individuals needing mobility assistance, understanding Medicare’s coverage of durable medical equipment (DME) is important. This coverage provides necessary items for use in a beneficiary’s home, supporting their health and independence.

Medicare’s Coverage of Recliners

Medicare generally does not cover standard recliners, as these are typically considered comfort furniture. However, Medicare Part B may cover a specific type of “recliner” known as a lift chair, but only the lifting mechanism itself.

The lift chair must be classified as durable medical equipment, meaning it is prescribed by a doctor for home use, can withstand repeated use, and is expected to last at least three years. To be considered for coverage, the lift mechanism must be medically necessary to help a beneficiary stand from a seated position. This ensures the equipment addresses a specific functional limitation rather than merely providing convenience. A doctor’s order is always required to establish this medical necessity.

Establishing Medical Necessity

Establishing medical necessity for a lift chair’s lifting mechanism is crucial for Medicare coverage. The prescribing physician must document why the equipment is necessary for the patient’s medical condition. The doctor’s order must explicitly state the patient’s specific medical reason for needing the lift mechanism, such as severe arthritis or a neuromuscular disease, which prevents them from independently rising from a chair. It must also specify how the lift mechanism will directly address this limitation.

Documentation should confirm the patient can operate the lift chair controls themselves. Medical records should clearly demonstrate a functional limitation the lift mechanism aims to alleviate. This detailed medical rationale ensures that the request aligns with Medicare’s criteria for durable medical equipment. Without a clear and comprehensive medical necessity justification, Medicare is unlikely to approve coverage for the lift mechanism.

The Process of Acquiring a Lift Chair

The first step involves finding a Durable Medical Equipment (DME) supplier that is approved by Medicare. Medicare-approved suppliers are enrolled with Medicare and agree to accept Medicare’s terms and conditions for payment. These suppliers will submit the claim, including the doctor’s order and medical documentation, to Medicare on the patient’s behalf.

In some instances, Medicare may require prior authorization for the lift chair’s lifting mechanism before coverage is approved. The supplier usually manages this authorization process, which can involve Medicare reviewing the medical necessity documentation in advance. After approval, the supplier will arrange for the delivery and setup of the lift chair in the beneficiary’s home.

Financial Considerations and Denials

Beneficiaries should be aware of their potential financial responsibilities when acquiring a Medicare-covered lift chair. Under Medicare Part B, after the annual deductible is met, Medicare typically pays 80% of the Medicare-approved amount for durable medical equipment. For 2025, the Medicare Part B annual deductible is $257.

Supplemental insurance, such as Medigap policies, or Medicare Advantage plans (Medicare Part C) may help cover these out-of-pocket costs. Medigap plans can pay for the Part B coinsurance, while Medicare Advantage plans may have different cost-sharing structures, including varying deductibles and coinsurance rates.

If Medicare denies coverage for the lift chair’s lifting mechanism, the beneficiary will receive an Explanation of Benefits (EOB) or a denial letter detailing the reason. Beneficiaries have the right to appeal this decision, typically starting with a redetermination request, which involves a review of the claim and supporting documentation by Medicare.