What to Know About Medicare Coverage, Lift Chairs, and DME

• A lift chair is a type of chair that resembles a recliner but that has medical benefits due to its seat lift mechanism. 

• Lift chairs help patients move from a sitting position to a standing position more easily. This helps those with severe arthritis, severe neuromuscular disease, and other musculoskeletal conditions.

• Medicare will not cover the seat portion of a lift chair but it will cover the seat lift mechanism as durable medical equipment. 

• A Medicare Advantage plan will cover seat lift mechanisms in the same manner as Original Medicare, but different costs may be involved overall based on the Medicare Advantage insurance plan selected.

In the event a Medicare beneficiary can no longer walk independently or easily move around in their daily life, they may need the assistance of patient lifts. One type of patient lift is known as a lift chair. But is a lift chair covered by Medicare? If so, how much does Medicare pay?

Medicare coverage for lift chairs isn’t necessarily straightforward. This is because Medicare pays for only a portion of a lift chair as durable medical equipment (DME). It will not pay for the entire chair, however. The lift chair must also be deemed to be a medical necessity, which has its own set of criteria that must be met. It’s important to note that Medicare will also not cover a lift chart if a beneficiary is in a hospital or skilled nursing facility.

This article will explain everything there is to know about Medicare coverage, lift chairs, and durable medical equipment coverage in general.

The Federal Medicare Program defines durable medical equipment (DME) as medically necessary equipment and supplies, which a doctor prescribes for a patient’s home use. DME intends to improve a patient’s quality of life. Examples of DME covered by Medicare include hospital beds, walkers, patient lifts, and more.

How Does Medicare Coverage Work For DME?

As a reminder, Original Medicare only consists of Medicare Part A (hospital insurance) and Medicare Part B (medical insurance). Original Medicare does not include prescription drug coverage (Medicare Part D). 

Medicare Part B is the portion of Original Medicare that handles DME coverage. Medicare pays for DME in different ways, as it will all depend on the specific item involved. Whether the DME is rented or purchased will also play a role in how Medicare coverage works.

In most cases, Medicare covers a portion of the Medicare-approved amount for DME, leaving Medicare recipients to cover remaining out-of-pocket costs. A Medicare-approved supplier must also be involved and the DME must be doctor-prescribed.

Note: Learn more about durable medical equipment and Medicare coverage at this resource.

Patient lifts are an umbrella term for medical equipment that helps patients who are not physically able to move around and complete activities of daily living as easily as they could before. Medicare considers patient lifts to be DME.

There are various types of patient lifts available. These include: 

• Lift chairs

• Stair lifts

• Manual patient lifts

• Transfer aids

• Bathtub lifts

• Sling

A lift chair looks like a regular chair, such as a recliner, but it is anything but. While both regular recliners and lift chairs can be comfortable to lounge in, a lift chair has a medical need for its use. Lift chairs can help improve the quality of life for those living with various conditions such as severe arthritis of the knees or hips, as well as muscular problems.

Lift chairs also have a seat lift mechanism that makes it easier for patients to go from a seated position to a standing position. This motorized lifting device is in the base of the chair. It allows the chair to be moved about for the needed positioning on command.

Ultimately, seat lifts can be an integral component of improving a patient’s overall mobility and ability to move about in their daily life.

What Are The Different Types of Lift Chairs? 

There are various types of lift chairs available. These include: 

• Two-position lift chair

• Three-position lift chair

• Infinite-position lift chair

• Zero gravity chair

Medicare only covers the lifting mechanism of lift chairs, not the chair itself. The use of a lift chair must also be deemed to be a medical necessity and prescribed by a doctor. 

How Medical Necessity Is Defined

There are a number of specifics that must be met in order for a lift mechanism to be deemed medically necessary. To start, a doctor must prescribe the chair for the patient’s specific condition. Form CMS-849 must be submitted to the Centers for Medicare and Medicaid Services. 

Other criteria that show a chair is needed for medical reasons include: 

• The patient can no longer stand up independently from a regular chair

• The patient is able to operate the chair without assistance

• The patient can walk independently or with a walker

• The patient has severe arthritis 

• If the patient does not have access to a lift chair, they must stay in bed

Medicare Costs For a Seat Lift Mechanism 

If the lift chair is Medicare-approved, Medicare pays for 80 percent of the lifting mechanism, leaving beneficiaries to pay the remaining 20 percent. This is because Medicare considers lift chair mechanisms to be durable medical equipment, which is covered under Medicare Part B.

In order to get Part B coverage, one must pay the monthly Part B premium as well as meet the annual deductible. In 2022, Medicare Part B’s annual deductible is $233.

Note: Learn more about patient lifts and Medicare at this resource.

The beneficiary must also account for the cost of the actual seating part of the lift chair. This

The Importance of Confirming Medicare-Approved Suppliers and Physicians 

Medicare will only cover these devices if both the supplier and the prescribing physician are enrolled in Medicare. Both of these parties must meet strict standards to both enroll and stay enrolled in Medicare. Always check to make sure all parties are enrolled in Medicare to avoid Medicare not paying claims submitted by each of them.

In addition, both the Medicare supplier and doctor must accept the Medicare assignment. 

Medicare Advantage plans consist of both Medicare Part A and Medicare Part B bundled into one health plan. Therefore, it will cover lift chairs in the same way as Original Medicare, meaning as durable medical equipment under Medicare Part B. 

That said, MA plans also often include additional benefits as part of their plans.

Medicare part D helps patients cover the costs of their prescription drugs. Part D plans do not help to cover the cost of DME such as lift chairs; Part B is what aids patients in covering costs for DME. However, cost coverage and benefits vary greatly from plan-to-plan so be sure to contact your insurance company to ensure what your Part D plan covers before making any payment decisions.

Medicare supplement insurance, also known as Medigap or MedSupp, are supplemental Medicare plans that help ​“fill in the gaps” of Original Medicare. A Medigap plan may assist Medicare beneficiaries to pay the out-of-pocket cost portion of lift chairs.

Medigap policies are sold by private insurance companies and help pay some out-of-pocket costs such as deductibles, coinsurance, and copays. This may include the Medicare Part B deductible, which, in turn, would cover DME, including a lift chair’s motorized lifting mechanism. 

This will help lower a lift chair’s costs all-around since other financial obligations are being met, leaving more financial wiggle room for Medicare beneficiaries to cover the remaining part of the chair such as the chair itself, and accessories such as cushions.

What diagnosis would deem a lift chair “medically necessary”?

There are a range of issues that might cause a doctor to deem a lift chair medically necessary. Common conditions include neuromuscular disease and severe arthritis in the hip or knee. Ultimately, it’s the doctor’s decision if a lift chair is medically required or not.