Will Medicare Pay for a Lift Chair?

For individuals with limited mobility, lift chairs—also known as power lift recliners—can be life-changing. These chairs make it easier to sit down and stand up, offering enhanced comfort, independence, and safety for those with conditions such as arthritis, muscular dystrophy, or other age-related physical challenges. However, many individuals wonder if Medicare, the federal health insurance program for people age 65 or older (and some younger people with disabilities), will cover the cost of a lift chair.

The short answer is: Medicare typically does not cover lift chairs, but there are exceptions and some nuances worth understanding. In this article, we’ll break down the details regarding Medicare’s coverage of lift chairs and what options are available to those seeking assistance in paying for them.

What Is a Lift Chair?

A lift chair is a specially designed recliner that helps individuals with mobility issues get in and out of a seated position. These chairs come with a motorized lift mechanism that tilts the seat forward, raising the person to a standing position, and then gently reclines to a sitting position. This is particularly beneficial for people who struggle to stand up or sit down due to conditions like arthritis, stroke, or other mobility impairments.

Lift chairs are often confused with regular recliners, but they differ in that they provide power assistance. In most cases, they are covered by Medicare under certain conditions. However, understanding exactly when and how this coverage applies requires a bit more detail.

Does Medicare Cover Lift Chairs?

Medicare Part B (Medical Insurance) generally does not cover lift chairs as durable medical equipment (DME). However, there are some exceptions, and coverage depends on specific criteria. Medicare is more likely to cover the cost of the lift chair if it meets the following conditions:

1. It is Prescribed by a Doctor: A physician must prescribe the lift chair for the patient, and the patient must have a documented medical need. For Medicare to consider the chair as DME, the doctor must provide a prescription and medical records showing that the lift chair is necessary for the patient’s condition.

2. The Lift Mechanism is Separate: Medicare will not cover the entire lift chair, but it may cover only the lifting mechanism. This means that if you have a chair with a reclining function but without the lift feature, Medicare is unlikely to provide any coverage. However, the motorized lift mechanism itself may be covered as DME under Medicare Part B, assuming all conditions are met.

3. It is Considered Medically Necessary: To be eligible for Medicare reimbursement, the lift chair must be deemed medically necessary by a healthcare provider. This means that a lift chair must be required to help the individual stand up or sit down due to a medical condition or disability. The condition should result in functional limitations that prevent the patient from performing these tasks without assistance.

4. Cost and Reimbursement: If Medicare does cover the lift mechanism, you will typically be required to pay a portion of the cost. This may include a deductible, a 20% co-payment, and any other out-of-pocket expenses depending on the specifics of your Medicare plan. The chair must be purchased from a Medicare-approved supplier, and you should check with them beforehand to ensure they meet the necessary guidelines.

What’s Not Covered?

Medicare does not generally cover the cost of the chair itself, the upholstery, or any other non-medical parts of the lift chair. Additionally, Medicare will not cover lift chairs when they are used for comfort purposes rather than medical necessity. If a lift chair is not prescribed by a physician or is deemed to be more for personal comfort than medical need, it is unlikely to be covered under Medicare.

Steps to Take for Medicare Coverage of Lift Chairs

If you believe that a lift chair could benefit you or a loved one and you would like to explore Medicare coverage options, here are the steps to follow:

1. Consult with a Doctor: Speak with your healthcare provider about whether a lift chair would be a medically necessary piece of equipment. A doctor’s prescription is required for Medicare to consider covering the cost of the lift mechanism.

2. Verify DME Supplier: Medicare only reimburses for equipment purchased from suppliers who are enrolled in Medicare. You should check with your supplier to confirm they are authorized and that the equipment meets all necessary criteria.

3. Check for Medical Necessity: Ensure that the lift chair is medically necessary for your situation. Your doctor may need to provide specific documentation that explains your condition and why a lift chair is needed.

4. Review Your Costs: Be prepared for the possibility that you will still have out-of-pocket costs. If Medicare does cover the lift mechanism, you may be responsible for the deductible, co-payments, and any additional charges not covered under Medicare’s guidelines.

Other Ways to Pay for a Lift Chair

If Medicare doesn’t cover the full cost of a lift chair, there are other options to consider:

• Medicare Advantage Plans: Some Medicare Advantage Plans (Part C) may offer more comprehensive coverage for DME, including lift chairs. It’s worth checking with your specific plan to see if this is included.

• Private Insurance: If you have supplemental insurance (Medigap) or private health insurance, your policy may cover some or all of the costs not covered by Medicare.

• Veterans Benefits: If you are a veteran, you may be eligible for coverage through the Veterans Health Administration (VHA). Check with the VHA for more details.

• Out-of-Pocket: If all else fails, you may need to pay for the lift chair out of pocket. Many suppliers offer financing options, which can help spread the cost over time.

Final Thoughts

While Medicare does not generally cover the cost of lift chairs in full, there is a possibility that the lift mechanism could be reimbursed if it meets specific medical necessity guidelines. It’s important to work closely with your doctor and an approved DME supplier to determine if you qualify for coverage and what your out-of-pocket costs might be. Always check with your Medicare plan or a representative to understand what options are available to you.

Ultimately, if a lift chair can improve your quality of life by providing the assistance needed to stand and sit safely, it may be a worthwhile investment, whether covered by Medicare or not.