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Are you or a loved one facing mobility challenges and looking for a way to become more independent and comfortable around the house? Lift chairs can make a world of difference to people with impaired mobility or special needs.
They are also referred to as “patient lifts” and health insurers classify them as ‘durable medical equipment’ (DME).
The question on everyone’s mind who needs such a chair is, “Will Medicare pay for a lift chair?”
In this article, we summarize Medicare coverage for lift chairs and provide the information you need to make informed decisions.
What is a Lift Chair?
Lift chairs are medical equipment that resembles the standard reclining chair. They are mechanically powered to rise up and down to help users sit down and get up with minimal effort.
Lift chairs reduce the risk of falls and help individuals with mobility issues, such as seniors or people with disabilities.
How Lift Chairs Work
Lift chairs operate through a simple remote control that allows users to adjust their height, footrest, headrest, and chair back. The lift mechanism provides support while sitting down and standing up, reducing strain on the knees and hips.
Beyond their functional benefits, lift chairs also offer unparalleled comfort and relaxation. Most models come with a range of ergonomic features that promote good posture and alleviate pressure points.
Maintaining independence is important for the overall well-being of seniors and people with disabilities. They play a pivotal role in:
- Creating safer living spaces.
- Reducing the risk of falls.
- Lessening the reliance on caregivers for daily activities.
Lift chairs foster autonomy and comfort and can significantly improve the quality of life for users and their families.
Understanding Medicare Coverage for Lift Chairs
Strict standards and rules govern Medicare coverage of lift chairs. Make sure you have all the necessary details before submitting a claim.
Explanation of Medicare Part B Coverage and Durable Medical Equipment (DME) Benefits
Medicare Part B (Health Insurance) covers medically necessary DME for beneficiaries as long as a Medicare-approved healthcare provider prescribes it. Although lift chairs are classified as durable medical equipment, Part B does not cover the cost of the entire lift chair, just the cost of the lifting apparatus. Fabric, cushions, or accessories like heat foam and massage pads are not covered under Medicare, for instance.
If you purchase the lift chair from a vendor who accepts Medicare assignment, you will have to pay 20% of the Medicare-approved amount once you’ve met the annual Part B deductible.
Not all lift chairs qualify for coverage, however. To be eligible for reimbursement, it must meet specific requirements outlined by Medicare.
Eligibility Criteria for Lift Chair Coverage Under Medicare
A lift chair must meet the following criteria to be eligible for Medicare coverage:
- A doctor’s prescription: A Medicare-approved physician must prescribe the lift chair as medically necessary given an individual’s condition and mobility limitations.
- Supplier requirements: The lift chair supplier must be part of Medicare and meet all Medicare DME supplier standards.
- Medical necessity: Medicare requires that the lift chair be deemed medically necessary for use within the home, and not for convenience.
Overview of Medicare Advantage (Part C) and Its Coverage for Lift Chairs
Private insurance companies offer Medicare Advantage or Part C plans as an alternative to Original Medicare (Part A and Part B). Medicare Advantage plans must provide at least all the benefits of Original Medicare, with the opportunity for add-on features and extra benefits.
Lift chair coverage under Medicare Part C comes down to the specifics of each plan. In other words, some Part C plans may cover them while others may not. Make sure to review plan details thoroughly to understand the extent of coverage as it relates to lift chairs.
How to Obtain Medicare Coverage for a Lift Chair
Here is a step-by-step guide to walk you through the process of requesting coverage for a lift chair under Medicare.
- Consult with your physician: Discuss your mobility challenges with your doctor and obtain a prescription for a lift chair if it is deemed medically necessary.
- Choose a Medicare-enrolled supplier: Select a supplier who meets Medicare standards and provides durable medical equipment.
- Complete necessary documentation: Work with your supplier to fill out all required paperwork accurately. Make sure to include the doctor’s prescription and other relevant documentation.
- Submit the claim to Medicare: Your supplier will submit the claim on your behalf to Medicare for review and reimbursement.
Necessary Documentation and Forms for Medicare Reimbursement
Include the following documents when submitting a Medicare claim for a lift chair:
- Doctor’s prescription: A clear and detailed prescription stating the medical necessity of a lift chair.
- Certificate of medical necessity (CMN): This form provides additional information about the patient’s medical condition and justifies the need for the lift chair.
- Supplier documentation: The supplier has to provide proof of delivery and a detailed description of the lift chair’s specifications.
How to Navigate Common Challenges During the Application Process
A thorough understanding of Medicare rules in general, and lift chair coverage in particular, is crucial to negotiating the application process successfully.
Here are some of the most common challenges:
Coverage Denials
Medicare can deny coverage for a lift chair for a variety of reasons. You have the right to appeal the decision if that happens. Work closely with your supplier to gather additional information to support the claim during the appeals process.
Limited Coverage
Review details of your Original Medicare or Medicare Advantage plan to understand the extent of coverage for lift chairs. Some plans may offer partial coverage, while others may not cover lift chairs at all.
Learn More About Durable Medical Equipment Coverage With Coverright
Navigating Medicare coverage for lift chairs and other durable medical equipment can seem daunting. Remember to consult with your physician, choose a reputable Medicare-enrolled supplier, and follow the application steps carefully to increase your chances of approval.
Reach out to CoverRight if you need further assistance with any aspect of Medicare. We provide concierge services to help you navigate the complexities of Medicare with ease.
Frequently Asked Questions
What Types of Lift Chairs Are Eligible for Medicare Coverage?
Medicare covers lift chairs with a lifting mechanism to assist individuals with mobility issues in sitting and standing up. The lift chair must be deemed medically necessary, prescribed by a doctor, and provided by a Medicare-enrolled supplier.
Will Medicare Cover the Full Cost of the Lift Chair?
Medicare Part B covers 80% of the approved amount for durable medical equipment. Beneficiaries are responsible for paying the remaining 20% as copayment once they have met their Part B deductible.
Can I Choose Any Lift Chair Model, or Are There Specific Requirements for Coverage?
Medicare does not impose specific model requirements for lift chairs, as long as the coverage request meets the medical-necessity criteria and a Medicare-enrolled supplier provides it.
What Should I Do If Medicare Denies My Lift Chair Claim?
You have the right to appeal the decision if Medicare denies your claim. Gather any additional information or documentation that supports the medical necessity of the lift chair, and work with your supplier to initiate the appeals process.
