People who need help getting in and out of their chair daily due to life changes such as aging, arthritis, or a recent mobility-limiting surgery, often consider buying a lift chair. However, lift chairs can cost hundreds – or even thousands of dollars, leaving many Medicare beneficiaries wondering if their Medicare health insurance coverage will help pay any of the lift chair’s costs. While Medicare typically won’t pay for a lift chair in full, Medicare Part B (Medical Insurance) or Medicare Part C (Medicare Advantage) may cover the seat-lift mechanism as durable medical equipment (DME) if your doctor determines that it’s medically necessary and will help your condition. Read on to learn more about Medicare coverage of lift chairs.
What is a lift chair?
First, it’s important to understand what a lift chair is – and is not. A lift chair is different from a stair lift; a chair used to carry people up and down a staircase. Nor is it the same as a patient lift; an assistive device that helps caregivers move their loved ones from one location to the next – such as from a bed to a wheelchair. A lift chair looks like a large comfortable leather or fabric recliner that could sit in your living room. Yet what makes a lift chair different from a regular chair is its seat-lift mechanism that tilts the base and back of the chair forward to help raise you up into a standing position or lower you back into a seated position without other help.
How do I qualify for a lift chair?
Will Medicare pay for a lift chair? The seat lift mechanism for a lift chair may be covered by Medicare if the following criteria are met:
Medicare coverage: You must have Medicare Part B (Medical Insurance) or a Medicare Advantage Plan (Part C). If you get your Medicare benefits through a Medicare Advantage Plan, talk to your private insurance provider about coverage rules, costs, and suppliers to use when getting a lift chair.
Certificate of medical necessity: You must schedule an appointment with your physician to obtain a prescription for the lift chair that determines medical necessity and have sections B and D completed on a “Certificate of Medical Necessity for Seat Lift Mechanisms form,” also called “Medicare form CMS-849.”
Determining medical necessity: A lift chair’s seat lift mechanism may be considered medically necessary if the following requirements are met:
- The patient has severe arthritis of the hip or knee, or a severe neuromuscular disease
- The patient is completely incapable of standing up from a regular chair
- When standing, the patient can walk independently or with the aid of a walker or cane; transferring directly to a wheelchair can prevent Medicare from paying for the device
- The seat lift mechanism is part of the physician’s course of treatment to effect improvement or slow deterioration in the patient’s condition
Medicare-participating suppliers: You must order your lift chair from a Medicare-participating supplier that accepts assignment, otherwise Medicare will not pay for it.
How much does it cost to buy a lift chair?
If you qualify for a lift chair, Medicare typically only covers the seat lifting mechanism part – not the entire chair itself. Depending on the state you live in, the reimbursement amount may be around $300, and you would have to pay the rest.
Like all Part B items covered by Medicare, after paying the annual deductible, you will pay 20 percent of the Medicare-approved amounts for the lift chair if you buy from a supplier that accepts assignment.
Where do I buy a lift chair?
Before choosing a supplier, visit Medicare.gov to find one that accepts assignment, or the Medicare-approved amount as full payment for covered services. After entering your zip code, select the “Seat Lift Mechanisms” category and search through the directory of suppliers with an “M” symbol, indicating they accept Medicare assignment.
If you have Medicare coverage through a Medicare Advantage Plan, follow your plan’s guidelines for approval and purchase and call your plan’s customer service number to ask about steps for coverage of a patient lift chair mechanism.
Looking for Medicare coverage? We offer free comparisons for Medicare Advantage Plans (Part C), Medicare Supplement (Medigap), and Medicare Prescription Drug (Part D) Plans. Get a quote from Medicare.org, or contact a licensed sales agent at 1-877-388-0596 – TTY 711 to help you find the right Medicare coverage for your needs.