Medicare Part B does include the coverage of Durable Medical Equipment (DME). DME is a large category of items and a Lift Chair is included in that list. There are some rules regarding this coverage that are important to understand.
A Lift chair is a recliner that has the added feature of a motorized lift device. This device both raises and lowers the chair to facilitate easier transfers into and out of the chair.
In reviewing the coverage under Medicare Part B there are two important factors to consider. First, Medicare will only cover the lifting mechanism, not the chair itself. So there will be a cost to the consumer for the chair, when Medicare covers the lift mechanism.
Second, the Lift chair is prescribed by a doctor and is purchased through a supplier enrolled in Medicare. The Prescription or order from the doctor is required for all DME purchased and covered by Medicare. In order for the doctor to prescribe this Lift Chair, your mother must have the correct diagnosis and medical criteria. These may include severe arthritis of the knee or hip, a neuromuscular disease, trouble with balance and others.
In the situation where your mother is having trouble with transferring to and from her chair, this Lift Chair could improve her independence. The assistance offered by the mechanical lift means that a second or third person does not need to be present to get into and out of the chair. This of course can be very useful in keeping your mother at home as long as possible, or more independent in the Assisted Living Facility she is in.
If your mother is in a Skilled Nursing Facility, Hospice or Nursing Home Medicare will not cover the cost of a Lift Chair. In those settings there should be staff available to help with this transfer. In some facilities a Lift Chair could be provided by the facility.
The cost of the Lift Chair we mentioned briefly, but to be more specific, remember that Medicare will only cover the cost of the Motorized Lift Device in the chair. So only part of the total cost of the chair will be paid for. Medicare Part B has an annual deductible of $233 and after the deductible is met, Medicare will cover 80% of the cost. The remaining 20% would be covered by the secondary insurance if your mother has that (Medicare Supplement Plans) or out of pocket.
When reviewing suppliers that are enrolled in Medicare, remember that Original Medicare is national coverage. There are literally thousands of approved DME providers that sell Lift Chairs. Some of them are local and some are national companies. I almost always recommend local and I try to ‘shop local’ whenever I can. I would begin with talking with your mother’s physician. This individual has to prescribe the chair if appropriate, and they or their office staff may have a recommendation. I would also recommend using the internet to search DME suppliers. That search engine comes up with LOTS of alternatives, look for one near you or that you have a reference for.
In the situation where your Mother has a Medicare Advantage Plan, the same coverage rules apply for appropriateness of the Lift Chair. The difference is the cost to her. Each Medicare Advantage Plan must cover what Medicare covers, the cost structure will most likely be different. If your mother has a Medicare Advantage Plan, I would suggest reaching out to the plan to see how a Lift Chair is covered with regard to the cost structure and also where they recommend buying it. Medicare Advantage Plans often require you to use specific providers (in-network), so start with the Medicare Advantage Plan to get the best possible coverage.
The idea of a lift chair is a useful tool to maintain your mother’s independence. Using her Health Insurance could be a way to reduce the total cost of the chair for you and your mother. Good luck with this great idea!