I had to take out a loan for a lift chair. my question will medicare help me with it. if I already brought one and will be installed this week. I do not know. and I get extra help with my part b plan. I hope someone may be able to answer this question.
Covered Portion: Medicare Part B classifies the seat-lift mechanism as durable medical equipment (DME) and may cover 80% of the Medicare-approved amount for this specific component after you meet the Part B deductible.
Non-Covered Portion: You are responsible for the remaining 20% of the lift mechanism cost, the entire cost of the chair's frame, upholstery, cushions, and any extra features like heat or massage.
Medical Necessity: Coverage is provided only if a physician determines it is medically necessary as part of a treatment plan to improve a condition or prevent it from worsening.
Eligibility Criteria for Coverage
To qualify for coverage of the lift mechanism, specific criteria must be met to demonstrate medical necessity:
You must have severe arthritis of the hip or knee or a severe neuromuscular disease.
You must be completely unable to stand up from a regular chair in your home without assistance.
The device must be part of a doctor's treatment plan.
Once standing, you must be able to walk, even if you use a cane or walker.
You do not live in a skilled nursing facility or hospice.
You cannot have a power wheelchair or scooter that is already covered by Medicare.
Addressing Muscle Use Concerns
Using a lift instead of leg muscles is relevant to Medicare's criteria. The policy explicitly requires that the person must be "completely incapable of standing up from a regular armchair" and, once standing, must have the ability to walk.
The intent is for the device to assist with the sit-to-stand transition so the individual can still ambulate, thereby engaging their muscles and maintaining mobility in their home. If a person cannot walk even after standing, a lift chair would not meet the coverage criteria.
For official information regarding Medicare benefits, use the official Medicare website or call them directly at 1-800-MEDICARE (1-800-633-4227).
From AI and matches what I was told years ago.
Lift chairs are available with two motors for more functionality for those who must spend a lot of time in the chair. More expensive but might be worth it for the flexibility provided.
Go onto the Federal Medicare site - Medicare.gov - and then go to the DME coverage section. There will be info on “lifts”and what is required for them to be a paid for by Medicare and how this gets filed. DME Coverage is a Part B benefit. If you stayed on Original Medicare then you should have Part B coverage with its premium (abt $175 a mo this year) taken out from your SS monthly income.
Now if you left Original Medicare and went with a Medicare Advantage plan that is all dependent on what Advantage Plan you sign up with and if they have any participating in network DME providers that include lifts. Personally I think if you switched to a AP, coverage is very unlikely as the more specialized equipment is out of network.
fwiw DME tends to be written up as a prescription after a surgery or a hospitalization and the item tend to be issued to you when your discharged or is ordered for delivery to your home as part of the discharge process. DME can be something smallish, like a front wheeled walker or a Breg cold therapy cube or a TENS unit, these you’d get upon exiting the hospital or a post op visit, as the hospital or clinic have these stacked up in storage. (as a side note, we are about to get our 3rd BREG as hubs is having hip surgery, our insurance has no qualms on paying for them after any orthopedic surgery but they won’t cover a TENS unit, trying to discern why is an exercise in futility). Bigger DME like a specialized bed or a Hoyer lift would be something that would be ordered by your doctor from a participating provider company enrolled with Medicare or a 3Rd party health insurance provider (like BlueCross) and they would coordinate with you to transport it and install it. Medicare and health insurance can pay for DME if ordered by your physician and determined necessary once your annual deductible is paid.
If you bought this “lift” from a salesperson at an event…. like you went to a healthy seniors luncheon or health fair…. Imo it was more than likely this lift was bought as private pay and on contract and not a benefit of any health insurance policy. That salesperson got a commission on the sale.
I doubt Medicare will help after the fact.
It may have to be ordered from a medical supply house though, not sure about that.
You might want to call your insurance company and see what the requirements are for it.