Medicare helps people pay for medical care and services and is composed of many “parts”. Part A covers hospital and major medical expenses, but not any equipment or supplies. It is Part B that can cover necessary medical supplies and equipment – known as Durable Medical Equipment (DME). However, not only must the equipment qualify as a DME, the patient also must qualify to be covered. Discussed below are the details of how Medicare may help you to get a lift chair.
Unlike Part A, Part B coverage is not automatic. You must overtly enroll for coverage and pay the required ongoing premium payment. If you are not properly and currently enrolled in Part B, you can not get help in buying any kind of medical equipment or supplies. Also, there is an annual deductible that you must pay out of pocket before you can get any coverage. After you have met the deductible, Part B typically pays for 80% of approved DME expense.
Medicare will only cover DME expense that they consider a medical necessity for the particular patient. This requires a written medical prescription from a Medicare approved physician, accompanied by a medical narrative report from the doctor, to show that you medically need to have the DME – in this case a lift chair. For most patients, the following criteria have to be fully or mostly met:
• You have severe arthritis of the hip or knee or a severe neuromuscular disease.
• You can’t stand up on your own from a regular chair.
• Without the lift chair, you’d be confined to a bed or chair.
• Once standing, you can walk independently, even if you need the assistance of a walker or cane.
• You do not live in a skilled nursing facility, hospice or nursing home.
Lift chairs are only considered partially eligible as a DME. This is because Medicare only considers the actual lifting mechanism and motor as DME and not the rest of the actual chair itself. Since these chairs are already built with the lifting mechanism included, you are not expected to buy the chair and the mechanism separately. Rather, Medicare will calculate the dollar value of the particular lift chair’s mechanism and reimburse you based on that amount.
The typical allowed ‘cost’ of the lifting mechanism is between $400 – $500. If you have already met your annual Part B deductible, that means Medicare will reimburse you $320 – $400 – which is 80%. This means that if you buy a lift chair with a price of $800 (which is about the median price for such chairs), your final out of pocket cost can be reduced to $400. So, while this is not totally paying for the lift chair, it does cut your actual cost in half.
An eligible lift chair must meet certain Medicare guidelines and requirements. While you can buy the lift chair from numerous stores, it is strongly advised to only buy the lift chair from a Medicare approved DME supplier. This way, you can be assured that the chair you buy will meet the necessary requirements. Also, an approved supplier can usually assist you in filing the necessary claim forms and documents to get your Medicare reimbursement.
– You should get Medicare approval as being an eligible patient in advance or you may end up having to pay for the full price of the lift chair.
– Only motorized lift chair mechanisms are covered. Some lift chairs only have manual spring mechanisms, which are not covered at all.
– The physician who provides you with the prescription and necessary documentation must be a current Medicare approved doctor.
– If you have already received financial assistance from Medicare for another mobility aid such as a scooter or motorized wheelchair within the last few years, Medicare will probably not approve the coverage for a lift chair.
– You must be living in a private residence, not in any kind of nursing or care home.