Lift chairs are medical grade chairs that have a motorized device installed that powers and lifts the chair from the floor. The device enables the user to go from a seated to standing position and vice versa.
The benefit of this device helps individuals suffering from certain conditions that make it hard to perform acts of daily living, such as getting up from a chair, due to muscle weakness or overall fatigue.
Conditions such as arthritis, multiple sclerosis (MS), muscular dystrophy, those suffering from chronic back pain or musculoskeletal injuries, congestive heart failure, and individuals who have suffered from a stroke are just to name a few.
Not only does a lift chair provide assistance for those suffering from a medical condition making it hard for them to go from sitting to standing, but lift chairs look similar to the modern day recliner.
With them looking aesthetically pleasing in the living area of the home, seniors are more willing to obtain this medical grade device.
Medical items or devices used for a specific medical condition, fall into the category of durable medical equipment or DME. For insurance coverage, DME must meet certain criteria for in-home use, to be covered.
Medicare Coverage for Lift Chairs
Durable medical equipment generally falls under your Medicare Part B benefits. There is certain criteria that must be met in order for your Part B benefits to provide coverage. The device must be considered medically necessary from a healthcare provider and also provide the following:
- It must be able to withstand repeated use, therefore rendering it, “durable”
- It must used for a medical condition
- It must be obtained for use inside the home for therapeutic benefits
- It must provide at least 3 years of use.
So the big question is now, will Medicare cover my lift chair? There are 2 parts that combine the whole lift chair itself. There is the seat-lift mechanism and then there is the actual chair/recliner.
Traditional Medicare Part B benefits will only cover the lifting mechanism device as this is the only item to fall under medical necessity with the Medicare Part B, DME guidelines. Regardless of whether or not the lift mechanism is built into the chair, Traditional Medicare benefits will not cover the chair itself.
Again, in order for Medicare Part B to consider the lift mechanism as medically necessary, it must meet certain criteria. Most importantly, it must be deemed as medically necessary from your healthcare provider, stating that the lift chair is a fundamental requirement for your specific medical condition.
If your doctor prescribes a lift chair for use in regards to your condition, Medicare Part B will then cover the seat lift mechanism only. Once approved, your Part B benefits will cover the lift mechanism at 80%.
The remaining 20% coinsurance is left financially responsible to the Medicare beneficiary to pay for out of pocket. The reclining chair itself will not be covered and you will be also be left responsible to pay for that specific item.
What Does Medicare Consider Medically Necessary for Lift Chairs
There are many conditions in which individuals have difficulty arising from a seated position. Whether your condition is due to weakness, fatigue, deconditioning or a chronic musculoskeletal problem, menial, everyday duties like getting out of a chair can be physically tasking.
This is when a device such as a lift chair can come in handy. In cases where a patient is unable to arise without assistance, the healthcare provider can deem a lift chair as a medically necessary device in terms for living with the specific condition. Medicare Part B benefits may provide coverage for a lift chair if you experience any of the following:
- If you suffer from a neuromuscular disease such as, muscular dystrophy or multiple sclerosis. Individuals suffering from a neuromuscular disease experience progressive weakness and degeneration of the skeletal muscles that control movement. It often worsens over time and can become debilitating. A lift chair can help those suffering from weakness as they may be unable to get up without assistance.
- If you suffer from severe arthritis of the hip or knees. Both conditions can cause difficulty with transitional movements, especially getting out of a chair. Not only due to pain, but the lack of mobility and decreased range of motion can require assistance with simple tasks. A lift chair can help with those suffering from degenerative arthritis.
- If the medical condition your physician is treating you for, states that regular movement or ambulation is necessary for treatment of the condition or to slow progression of the condition, then DME may be covered. If the specific DME is a lift chair, and is medically necessary as part as your providers treatment plan, then the lift chair may be covered.
- If your condition renders you unable to stand, therefore leaving you confined to your bed or chair, then a seat lift may qualify as medically necessary.
Regardless of your condition, you will need to contact a DME supplier that’s enrolled through Medicare in order for Medicare benefits to provide payment. In some areas, there is something called the Medicare Competitive Bidding Program. This program ensures DME coverage if:
- You carry Traditional Medicare benefits
- You can obtain competitively bid equipment and their subsequent supplies in competitive bidding locations.
Under this program, the contract suppliers are unable to change any more than the 20% coinsurance or any unmet portion of your Medicare Part B deductible. This applies for any equipment/DME included in the Medicare Competitive Bidding Program.
Additional Help with Medicare Coverage for Lift Chairs
With 80% of the lift mechanism being the ONLY thing covered with your Medicare Part B benefits, the remaining 20%, as well as the chair cost itself can be expensive. For this fact alone, seniors may be leery at even considering the device, regardless of the severity of the condition.
By obtaining a Medicare Supplement Plan, some of the additional medical costs that wouldn’t be covered with Traditional Medicare, may end up being covered. A Medicare Supplement Plan works together with your Traditional Medicare benefits and depending on the plan, can pick up those costs associated with coinsurance, copayments, deductibles and other out of pocket medical costs.
Call us today for more information on these plans and how they can save you money. Depending on what is needed for you healthcare essentials, we can help find the right plan through the variety of options available. Combined with Traditional Medicare and a Prescription Part D Plan, a Medicare Supplement Plan can provide most, if not full, healthcare coverage costs.
Call or click on our online forms today. Our licensed insurance agents can answer any questions may have and can start saving you money today!
Added Benefits of Using an Assisted Lift Chair
Not only do they help with standing, there are some additional perks and benefits when it comes to using lift chairs. According to an article online at West Village Patch, here are a few:
- Lift chair recliners can help provide a sense of independence
- A lift chair reduces the potential chance of injury in the elderly. You can reserve strength and prevent an injury such as a back strain or fall simply by using a lift chair.
- A lift chair saves time. As most elderly require help, some in the form of a caregiver, a lift chair can assist in standing or sitting. With the ease of the device, it effectively limits the time it would normally take to transfer an individual
- A lift chair provides comfort! There are added features including foot rests, a reclining position, heat, massage and storage areas that make this medical degrade device even more functional.
- There are a variety of available makes and models for lift chairs. This includes chair size and design to help aid the individuals needs based on weight and height.
As one can easily see, a lift chair is beneficial in more ways than one! Talk to your healthcare provider today for more information and to see if you qualify for this specific DME.