Is the Perfect Sleep Chair Covered by Medicare?
Navigating Medicare coverage for lift chairs? Learn what's covered, eligibility requirements, and your financial responsibilities.
A lift chair, sometimes referred to as a “Perfect Sleep Chair,” is an assistive device designed to help individuals transition from a seated to a standing position. These chairs typically feature a motorized mechanism that gently lifts and tilts the chair base forward, making it easier for users to stand up without straining. For those experiencing mobility challenges, such chairs can significantly enhance independence and safety within their home environment. Medicare, a federal health insurance program, may offer coverage for specific types of durable medical equipment (DME), which can include certain components of these lift chairs.
Medicare Coverage of Lift Chairs
Medicare, specifically Medicare Part B, classifies lift chairs as Durable Medical Equipment (DME) when they meet particular medical necessity criteria. Medicare’s coverage for these chairs is highly specific and does not extend to the entire furniture piece. Medicare only covers the motorized lifting mechanism itself, which is the part that assists with standing. The cost of the chair frame, upholstery, cushioning, and any other comfort or aesthetic features are not covered.
For the lift mechanism to be considered for coverage, a beneficiary must meet several medical necessity requirements. The individual must have severe arthritis of the hip or knee, or a severe neuromuscular disease, making it difficult to stand independently. Additionally, the beneficiary must be unable to stand up from a regular chair without assistance from another person. They must also be able to operate the lift chair independently once standing. A physician must prescribe the lift chair as part of a treatment plan to address these specific medical conditions. These criteria ensure the equipment is medically necessary for mobility, not just comfort or convenience.
Requirements for Medicare Coverage
To obtain Medicare coverage for a lift chair’s mechanism, precise documentation and adherence to specific conditions are necessary. A physician’s order is required, stating the diagnosis, confirming medical necessity, and indicating the duration needed.
A face-to-face examination with the prescribing physician or another qualified healthcare professional is mandatory before the order is written. This examination must occur within a specific timeframe, typically six months prior, to confirm medical necessity. Medical records from this examination must contain detailed documentation supporting the coverage criteria.
The supplier of the lift chair must also be Medicare-approved. Using a non-approved supplier can result in the claim being denied, leaving the beneficiary responsible for the full cost.
The Process for Obtaining a Covered Lift Chair
After fulfilling all necessary requirements, the process for obtaining a covered lift chair begins by locating a Medicare-approved Durable Medical Equipment (DME) supplier. These suppliers are familiar with Medicare claims and required documentation.
The chosen supplier will work directly with the prescribing physician to obtain the necessary paperwork, including the physician’s order and supporting medical records. The supplier then compiles this information and submits the claim to Medicare on behalf of the beneficiary.
Upon approval, the supplier arranges for delivery and often setup of the lift chair. The supplier typically handles direct billing to Medicare for the covered portion of the equipment.
Financial Aspects of Coverage
Even with Medicare coverage, beneficiaries are responsible for certain out-of-pocket costs related to a lift chair. Medicare Part B typically covers 80% of the Medicare-approved amount for the lift mechanism, after the beneficiary has met their annual Part B deductible. This means the beneficiary is generally responsible for the remaining 20% coinsurance of the covered portion.
Medicare only covers the lift mechanism itself, not the entire chair. Beneficiaries are responsible for 100% of the cost attributed to the chair’s frame, upholstery, and other features beyond the motorized lift. Suppliers often provide an Advance Beneficiary Notice of Non-coverage (ABN) when Medicare may not cover an item or service, or if the beneficiary is responsible for a non-covered portion. This notice informs the beneficiary of potential costs before services are rendered.
Supplemental insurance plans, such as Medigap policies or Medicare Advantage plans, can also influence a beneficiary’s out-of-pocket expenses. These plans may cover some or all of the coinsurance and deductible amounts that Medicare Part B does not pay. Beneficiaries should review their specific plan details to understand how it coordinates with Medicare coverage for DME.