Will Medicare Pay for a Floor Lift Chair?

According to Medicare rules, beneficiaries may be able to get a portion of the cost of a lift chair covered, provided certain criteria are met. The key question, however, is not whether Medicare will pay for a lift chair, but rather, will Medicare pay for a floor lift chair specifically, and what exactly does that coverage entail?

This article outlines the precise conditions for receiving coverage for the lifting mechanism and explains the crucial differences between standard lift chairs and specialized floor lifts.

Quick Summary

Medicare can help cover the cost of the motorized lift mechanism in a floor lift chair if it's considered medically necessary and prescribed by a doctor, but it won't cover the entire chair itself. You must meet specific eligibility requirements and purchase from a Medicare-enrolled supplier to qualify for partial reimbursement, which typically covers 80% of the approved device cost.

Key Points

• Partial Coverage Only: Medicare covers the motorized lift mechanism of a chair, not the entire piece of furniture, and only if it is deemed medically necessary.

• Medical Necessity is Key: To get any coverage, you must receive a prescription from a doctor documenting your inability to stand from a seated position due to a qualifying condition.

• Floor Lifts Are Covered as DME: Specialized floor lifts used to raise a person who has fallen are also considered durable medical equipment (DME) and can be covered under Part B.

• Find an Approved Supplier: You must purchase or rent the equipment from a DME supplier who is enrolled in and accepts Medicare assignment.

• Expect Out-of-Pocket Costs: After your Part B deductible is met, Medicare pays 80% of the approved amount for the lift mechanism, leaving you responsible for the 20% coinsurance and the cost of the rest of the chair.

• Medicare Advantage Plan Variations: If you have a Medicare Advantage plan, contact your specific plan to understand its coverage rules and network suppliers, which can differ from Original Medicare.

How Medicare Covers Lift Mechanisms

When it comes to coverage for lift chairs, including those designed to lift a person from the floor, Medicare has very specific rules. A common misunderstanding is that Medicare will pay for the entire piece of furniture. In reality, Original Medicare (Part B) only classifies the motorized lift mechanism as Durable Medical Equipment (DME). The frame, cushions, upholstery, and other non-essential components are not covered.

To be eligible for coverage, the lift mechanism must be prescribed by a doctor for in-home use. Medicare then covers 80% of the Medicare-approved amount for the device, after you've met your Part B deductible. You are responsible for the remaining 20% coinsurance, plus the full cost of the chair's non-covered parts. For individuals with a Medicare Advantage (Part C) plan, coverage must be at least as comprehensive as Original Medicare, but costs and specific rules can vary, so it's always best to check with your plan provider.

The Difference Between Standard and Floor Lift Chairs

Understanding the distinction between a standard lift chair and a specialized floor lift is critical for navigating Medicare coverage.

Standard Lift Chair

This is a reclining armchair with a built-in motorized mechanism. It assists users from a sitting position to a standing position by tilting the chair forward. This is the device Medicare most commonly provides partial coverage for, contingent on a doctor's prescription and medical necessity requirements.

Floor Lift or Patient Lift

A floor lift is a more specialized piece of equipment designed to lift an individual who has fallen and is already on the floor. These are separate devices, not built into a recliner. Medicare also considers these patient lifts to be DME and may offer coverage under Part B if they are deemed medically necessary. Coverage for a floor lift would also follow the 80/20 cost-sharing model after the Part B deductible is met.

Medical Necessity Requirements for Coverage

Regardless of the type, Medicare will only cover a motorized lift mechanism if it is considered medically necessary. To establish this, you and your physician must follow a specific process. The key requirements include:

• Face-to-Face Visit: You must have an in-person appointment with your doctor to assess your mobility needs.
• Formal Prescription: Your doctor must provide a written prescription specifically for a seat lift mechanism.
• Certificate of Medical Necessity: Your physician will need to complete and submit a Certificate of Medical Necessity for Seat Lift Mechanisms (CMS-849) form.

Your doctor must also document that your medical condition prevents you from standing up from a regular chair independently. This can be due to conditions like severe arthritis of the hip or knee, or other neuromuscular disorders. Furthermore, you must be able to walk, with or without a cane or walker, once you are standing. If you use a wheelchair or scooter, you may not qualify for lift chair coverage.

How to Get Started with a Medicare-Approved Lift Chair

Follow these steps to pursue coverage for a lift mechanism:

1. See Your Doctor: Discuss your mobility challenges and the need for a lift chair during a face-to-face visit. Your doctor will determine if it is medically necessary and provide the necessary documentation.
2. Find a Medicare-Enrolled Supplier: Use the supplier locator tool on Medicare.gov to find a DME provider that accepts Medicare assignment. Buying from a non-approved supplier means Medicare will not pay its share.
3. Rent or Buy: Depending on the equipment, Medicare rules, and the supplier's policy, you may have the option to rent or buy the lift chair.
4. Confirm Your Plan Details: If you have a Medicare Advantage plan, contact your plan administrator to understand their specific rules, in-network suppliers, and potential costs.
5. Understand Your Out-of-Pocket Costs: Before finalizing your purchase, confirm with the supplier how much you will owe, including the 20% coinsurance for the lifting mechanism and the full cost of the chair's other components.

Comparing Coverage for Different Lift Devices

To clarify the varying coverage, here is a comparison table:

Feature	Standard Lift Chair	Floor Lift/Patient Lift	Stairlift (Home Modification)
Covered by Medicare?	Partial coverage for the motorized lift mechanism only.	Yes, covers the patient lift as DME.	Generally no, considered a home modification.
What is Covered?	80% of the Medicare-approved amount for the lift mechanism, after the Part B deductible.	80% of the Medicare-approved amount for the lift device, after the Part B deductible.	Typically not covered, but check with your Advantage plan.
Patient Responsibility	20% coinsurance on the lift mechanism, plus the full cost of the chair itself.	20% coinsurance on the lift device, plus the cost of any non-covered accessories.	Full cost is usually the patient's responsibility.
Purpose	To assist a person from a seated to a standing position.	To lift an individual who has fallen to a safe height.	To transport a person up and down a flight of stairs.
Medical Necessity Required?	Yes, a doctor's prescription is required for the mechanism.	Yes, requires a doctor's prescription for use in the home.	Not applicable for Medicare coverage determination.

Conclusion: Navigating Coverage for Your Mobility Needs

Medicare's rules regarding lift chairs are clear but nuanced. While the answer to will Medicare pay for a floor lift chair is technically yes, it is important to remember that this coverage only applies to the motorized lifting mechanism itself, not the entire piece of furniture. For both standard lift chairs and specialized floor lifts, the process requires a formal prescription from a Medicare-approved doctor, a demonstration of medical necessity, and a purchase from a Medicare-enrolled supplier.

Before making a purchase, have a detailed conversation with your healthcare provider and supplier to understand all the medical and financial requirements. This proactive approach ensures you receive the maximum benefits you are entitled to, helping you maintain your independence and safety at home while managing your costs effectively.

Additional Considerations and Planning

Beyond the initial coverage, there are other aspects to keep in mind when acquiring a lift chair or floor lift. Maintenance and repairs, for instance, are important considerations. After you assume ownership of the equipment, you might be responsible for these costs. Some Medicare Advantage plans might offer benefits that differ from Original Medicare, so reviewing your plan's details is always a good idea. Additionally, Medigap plans, which are Medicare Supplement Insurance, may help cover the 20% coinsurance you are responsible for with Original Medicare. Always speak to both your doctor and your supplier, and consult the official Medicare website for the most accurate and up-to-date information on eligibility and coverage.

For more information on Medicare's coverage for Durable Medical Equipment, visit the official Medicare website: www.medicare.gov.

Frequently Asked Questions

What specifically does Medicare cover for a lift chair?

Medicare Part B covers the motorized lift mechanism, which is considered durable medical equipment (DME), not the entire chair. You are responsible for the rest of the chair's cost.

What is the difference in Medicare coverage for a standard lift chair versus a floor lift chair?

Medicare covers the lift mechanisms for both, provided they are medically necessary. A standard lift chair's mechanism helps you rise from a seated position, while a floor lift device helps you get up after a fall.

What are the medical requirements to get a floor lift chair covered by Medicare?

To qualify, you must have a medical condition, like severe arthritis or a neuromuscular disease, that prevents you from standing up from a regular chair independently. You must also be able to walk once you are standing.

Can I get a lift chair for free through Medicare?

No, a lift chair is unlikely to be free. Medicare only covers 80% of the Medicare-approved cost of the lift mechanism, and you are responsible for the 20% coinsurance, the Part B deductible, and the full cost of the chair's non-covered parts.

Do I have to buy my lift chair from a specific supplier?

Yes. To receive Medicare coverage, you must purchase the lift chair or floor lift from a DME supplier that is enrolled in Medicare and accepts assignment.

Will my Medicare Advantage plan cover a lift chair?

Medicare Advantage plans are required to cover at least what Original Medicare covers. However, plan rules, costs, and network suppliers can vary, so you should contact your plan provider for specifics.

How do I start the process of getting a floor lift chair through Medicare?

Start by scheduling a face-to-face appointment with your doctor. They will assess your needs, determine medical necessity, and fill out the required documentation, including a Certificate of Medical Necessity (CMS-849).