A decrease in mobility and range of motion is an inevitable aspect of the aging process. The geriatric population of our society is often riddled with issues such as arthritis, musculoskeletal degeneration, lack of coordination, diabetes, mobility-limiting surgeries, etc. All of these conditions lead to impaired mobility. This means many elders often require help getting in and out of chairs.
In such situations, a lift chair can surely be a life-saver, however, these contraptions can cost hundreds and even thousands of dollars. Consequently, many Medicare beneficiaries often wonder- Are lift chairs covered by Medicare?
We must realize that Medicare is an expansive program that covers a wide range of medical supplies and services. This makes figuring out the coverage of your plan a challenging process. The purpose of this article is to guide you in the right direction to help you figure out the Medicare coverage policies of lift chairs and how you can be reimbursed for the maximum amount for your purchase.
What Is A Lift Chair?
First and foremost, it is necessary to understand what a lift chair actually is and how it functions. A lift chair can often be confused with other mobility assistance devices such as stair chairs and patient lifts.
While stair chairs are meant to carry people up and down staircases, patient lifts are assistive devices that help caregivers move patients from one location to another. The purpose of a lift chair, however, is to assist you in standing up from a seated position.
Most lift chairs look like everyday recliners, great for relieving pressure from your back and joints. However, they are actually motorized devices that assist you from a completely seated position to a standing position using a built-in mechanized hydraulic system. Lift chairs are designed to provide medical support for mobility issues and are often necessary while healing from surgeries.
The Types Of Lift Chairs
1. Two-position Lift Chairs
These are the simplest form of lift chairs and possess two basic reclining positions- the standard 90-degree upright angle and a 45-degree reclined angle with your legs elevated and back reclined at a 45-degree angle from its upright position.
2. Three-position Lift Chairs
Three-position lift chairs are quite similar to two-position lift chairs, however, they feature an additional reclining angle that goes almost entirely flat. This position alleviates more pressure off your back and joints and is ideal for short naps, reading, or watching television.
3. Infinite-position Lift Chairs
These chairs offer the most flexibility and range of motion providing you with a variety of positions to choose from. These chairs are also known as zero-gravity chairs. As the name suggests these chairs can provide “infinite” positions. This is achieved by utilizing different motors for your back recliner and leg elevator. While these are often the most expensive type of lift chairs, they offer the most comfort for a variety of situations.
The Benefits Of Lift Chairs
There are a plethora of benefits that come with lift chairs for seniors suffering from mobility impairment. Studies have even shown that when used as a therapeutic tool and an assistive mobility aid, lift chairs can be highly effective in treating bedsores and regaining muscle strength. Some of the benefits provided by lift chairs include:
- Offers seniors suffering from osteoarthritis independence and helps them regain mobility.
- Reduces the risk of potential slip-and-falls.
- Encourages better posture throughout the day with the help of multiple seated positions.
- Provides greater freedom of movement for seniors suffering from chronic fatigue issues and reduces the energy demands on their bodies.
- Alleviates the tension and pressure of joints and muscles while transitioning from seated to standing positions.
Medicare recognizes these benefits of lift chairs as an assistive mobility aid and therefore offers coverage to Medicare beneficiaries. However, there are variations in Medicare plans regarding which features are covered and which are not. So, let’s look at the Medicare coverage policies in a little more detail.
Does Your Medicare Plan Cover Lift Chairs?
Does medicare pay for lift chairs? – is a common query among seniors suffering from mobility impairment. The good news is the answer is- Yes. Lift chairs are considered as Durable Medical Equipment (DME) and are covered by Part B of your Medicare coverage. Medicare recognizes lift chairs as DME used to treat conditions such as arthritis, and other balance and mobility issues.
The Medicare coverage for DME follows the 80-20 rule. If seniors qualify for this, it means that Medicare will cover 80% of the costs of lift chairs. So, you shall be responsible only for 20% of the payment.
Do keep in mind that Medicare coverage and eligibility can be complicated at times. Lift chairs do qualify as DME under Medicare, however certain features included in your chair may not be covered under your plan.
The essential feature that Medicare covers are also the lift chair’s greatest benefit – the lifting mechanism. Additional coverage will depend on the plan you have with Medicare. Do remember, medicare will not cover chairs that employ a spring mechanism to lift you out.
Lift chairs often include features that may not be considered a medical necessity. However, these features can promote user satisfaction and extend its benefits. Let’s look into which features are covered and which are not under a Medicare plan.
Medical equipment with lifting mechanisms falls under the category of durable medical equipment. These are specifically designed and intended for at-home use and require a doctor’s prescription to be approved by Medicare.
The chair model you choose to buy or rent should have a lifting mechanism. As long as the lift chair follows supplier guidelines, the cost should be covered in full by Medicare.
Original Medicare coverage will only cover the motorized lifting mechanism of your chair. However, many lift chairs these days come equipped with a reclining mechanism allowing you to recline the backrest or extend the seat. These chairs provide additional benefits such as improving circulation by allowing you to keep your legs slightly elevated above the heart level.
To reap the benefits of the additional features of lift chairs many elders prefer a Medicare Supplement Plan. A Medicare Supplement Plan is additional insurance designed to extend the benefits of your original Medicare coverage. A supplement plan can cover co-payments, coinsurance, deductibles, and other medical expenses.
Lift Chair Materials
Medicare coverage has no guidelines restricting the type of material used in the chair. This means your preference of upholstery will not disqualify the purchase from Medicare coverage.
The caveat is that you will need to stick to the standard material provided by the supplier. Any upgrade to the material of the lift chair will require you to pay out of your own pocket.
Heat And Massage Therapy
Some lift chairs have built-in heat and massage therapy. These features are generally not considered a medical necessity and are usually not covered by Medicare Plan B.
However, if heat and massage therapy is an important feature for you, a Medicare Supplement Plan can help. Like we mentioned earlier a supplemental plan is useful because it allows you to customize your lift chair according to your needs.
Now you know the type of lift chairs Medicare covers and the features that will be included in your coverage. However, to utilize your Medicare plan you need to know how to qualify for it. So, let’s take a deeper look at the qualification criteria.
How To Qualify For Lift Chair Medicare Coverage
Medicare will only cover the costs of your lift chair if you can demonstrate a physical and medical need for the chair. Your physician will help you determine whether or not you are eligible for one.
Determining Your Eligibility For A Lift Chair
- Your eligibility will depend on your physical and medical condition. Specifically, you will need to demonstrate to Medicare that -You suffer from severe osteoarthritis or a severe neuromuscular disease affecting your hip or knee.
- You are physically incapable of standing up from a regular chair without any assistance.
- A lift chair is an integral part of the treatment plan for your condition. This needs to be outlined and recommended by a doctor and your family care physician in a prescription.
You use the assistance of a walker or cane to help you get around, however, you do not own a wheelchair or mobility scooter. Owning one can disqualify you from Medicare coverage for a lift chair.
To make sure your lift chair is covered by Medicare you must be enrolled in and covered by Medicare Part B or Medicare Advantage Part C. Do keep in mind Medicare Advantage Part C is part of a private insurance provider’s policy. Therefore, you will need to check for any extra coverage rules, costs, and suppliers while purchasing a chair.
1. A Certificate Of Medical Necessity
A certificate of medical necessity is mandatory in order to qualify for Medicare coverage of your lift chair. To demonstrate medical necessity you will need to schedule an in-person appointment with your physician. For lift chairs, Medicare coverage requires your doctor to be enrolled as an active participant of Medicare. Medicare has its own standards that your doctor must meet, so make sure your doctor is enrolled as well.
After a thorough medical examination, your doctor shall grant you a prescription stating the requirement of an at-home lift chair for your medical condition. You will also need your physician to fill out sections B and D on the official certificate of Medical Necessity for Seat Lift Mechanism form (also known as the Medicare Form CMS-849).
After the required paperwork is complete you will need to submit this information to your provider/supplier. You need to make sure you are making the purchase from a Medicare-participating supplier or else the purchase will not be eligible for Medicare coverage.
2. Medicare Approved Lift Chair Suppliers
Medicare has a specific set of rules for coverage of all durable medical equipment, including lift chairs. As stated earlier both your doctor and the supplier must be enrolled in the Medicare program. Your doctor and health care providers should be able to give you a list of the Medicare-approved suppliers in your area.
You could also use the supplier locator tool available on the Medicare official website. Enter your zip code on the website and then search under the ” Seat Lift Mechanisms” category. You will be provided with a directory of suppliers with an “M” symbol, indicating they are Medicare approved and accept Medicare assignment.
Medicare’s Competitive Bidding Program
Depending on where you live, the Medicare Competitive Bidding Program may apply to your purchase. Through this program, suppliers of DMEs submit bids to Medicare, which Medicare then utilizes to set a fixed price they are willing to pay for each item. Longitudinal studies have shown that such a program can help you get a better deal, as competition drives down the prices of medical equipment.
If you live in an area where the Competitive Bidding Program is established, you can only make your purchase from an approved supplier. Even if there are various other suppliers available that accept Medicare assignment.
How Much Will A Lift Chair Cost?
Typically, Medicare coverage of your lift chair will only cover the seat lifting mechanism and not the entire chair. Depending on the state you reside in, the reimbursement amount would be around $300, and you will be required to pay the rest of the amount.
To qualify for Medicare coverage you will also need to pay your Part B deductible, which is $198 as of 2021. The Medicare Part B deductible is the amount you need to pay out of your own pocket before your Medicare insurance coverage begins.
Once Medicare covers 80% of the cost of the lifting mechanism you will be required to pay 20% coinsurance. You will also have to pay 100% of the remaining cost of the chair.
If the idea of paying 20% coinsurance and extra charges seems a bit steep, there are other options available in the form of Supplement Plans.
Medicare Supplement Plans
There are a range of Supplement Plans to choose from, let’s take a look at the options available –
1. Medicare Supplement Plan N
Under this plan, you do not have to pay the 20% coinsurance. However, you will still be required to pay the excess charges and Part B deductible.
2. Medicare Supplement Plan G
This plan covers the 20% coinsurance and any excess charges, however, you are required to pay the Part B deductible.
3. Medicare Supplement Plan F
Under this coverage plan the 20% coinsurance, Part B deductible, and any excess charges are all taken care of by Medicare.
Getting Your Lift Chair – Final Thoughts
For older adults suffering from degenerative bone and neuromuscular conditions, mobility can be significantly impaired. In such situations, a lift chair becomes a necessity, and the benefits of having one often outweigh the cost considerations.
However, Medicare provides an opportunity to ensure savings while reaping the benefits of the effective therapeutic tool at home. While the eligibility criteria and coverage process might seem like a lengthy undertaking, it is well worth the efforts.
In fact, your providers and lift chair suppliers can go through the entire paperwork fairly quickly. A better understanding of the criteria and procedures can assist you and make the entire process easier. Do make sure to choose the right lift chair based on your needs and medical situation to get the best benefits from your lift chair.