Posted on August 16th, 2019
For seniors looking to purchase a lift chair, the 80-20 rule means savings for “durable medical equipment” (DME) such as lift chairs. If seniors qualify, 80-20 means that Medicare coverage will cover 80% of the costs of a lift chair, so you’re only responsible for the remaining 20%.
However, Medicare coverage and eligibility is a complicated matter when it comes to lift chairs. There is a whole range of exceptions and caveats to coverage that you’ll need to understand. The rules of Medicare tell you which features disqualify you, how your personal, medical situation qualifies, and how to access a lift chair for medical and mobility purposes.
Lift chairs qualify as durable medical equipment under the terms of Original Medicare, but certain features that may not be covered – but your particular mobility and medical condition may demand.
A lift chair looks sort of like a giant loveseat, and you may not notice a difference – until you realize that this one-seater comes with a remote control or has a few built-in buttons. This recliner-type seater may recline, but its primary and most important function is that it moves the seated user from a sitting to a standing position using a built-in mechanized hydraulic system.
Without any effort or unnecessary shifting on the part of the user, the chair seamlessly glides forward and props the individual up slowly. There’s no momentum involved, so there’s minimal chance of the user becoming dizzy.
This forward-spring motion is why the chair needs some extra room when placed in a living area. However, users don’t seem to mind because the lift chair is designed to be medically supportive of mobility issues and necessary for healing from surgery.
Lift chairs provide a whole host of benefits, including:
Studies show that when used as a therapeutic tool or an assistive mobility aid, the lift chair is a highly useful and effective at-home solution to reduce bedsores and strengthen weak muscles over time.
Original Medicare recognizes the myriad benefits of a lift chair, and so it offers coverage for what they deem as durable medical equipment. However, there is some variation in Medicare plans about which features are and aren’t covered.
Coverage depends on the plan you have with Medicare. The essential feature that Medicare will cover is also the chair’s greatest benefit: its lifting mechanism.
Many lift chairs include other features that may either disclude them from being considered medically necessary. The other side of that coin is that these features can increase user-friendliness, extend its use, and promote user satisfaction, but they’re not integral to the lifting function.
You may either have to pay out of pocket or opt for a more flexible plan that would cover the bells and whistles you need.
Medical equipment with lift mechanisms fall under the category of “patient lifts.” Medical equipment with lifting capability counts as durable medical equipment, since it’s specifically intended for your at-home use. It requires a doctor’s prescription to be Medicare-approved, but you can access the chair through multiple options that include:
At base, the model that you choose needs to have a lifting mechanism. The chair will be covered in full by Medicare as long as this and a few other guidelines about supplier and doctor eligibility are met.
Original or traditional Medicare coverage will only cover the motorized or lifting mechanism of your chair, so many seniors to pay out of pocket for the rest of the lift chair’s features, such as its reclining mechanism.
Many lift chairs come with zero gravity or infinity positioning, which allows you to recline the backrest and stretch out the seat. If you can find a lift chair with a built-in reclining position, that’s a bonus for you because you can benefit from the improved circulation borne of keeping your legs elevated slightly above your heart.
Even chairs that recline at a 45-degree angle but go no further allow some of the pressure to be taken off though. Your chair still falls under the DME category but you’ll be able to enjoy the flexibility of two-, three-, and even infinite positions.
To take advantage of reclining features of the rest of the lift chair, many older adults and seniors choose a Medicare Supplement Plan. As additional insurance designed to extend your Original Medicare coverage, Medicare Supplement Plans can cover for co-insurance, copayments, deductibles, and other out-of-pocket medical costs.
Some chairs have heated backrests and massage features built right in. These features are not considered medically necessary though, so your coverage, which doesn’t cover the entirety of your lift chair purchase, may also not cover these extras.
If you know that heat and massage therapy is important to you, make sure that your Medicare plan will pay for the maximum amount of coverage. You can then choose to allocate any saved money towards these features instead.
The good news is that Medicare coverage has no guidelines on a chair’s materials. Your preference of upholstery won’t automatically disqualify your purchase from Medicare coverage.
The caveat is that you’ll be paying out-of-pocket for any materials that don’t come standard, but would be an upgrade to your purchase. For example, if your chosen model of lift chair offers leather as a premium upgrade with a higher price, paying for it is your responsibility. Again, you can pair your supplemental coverage with Medicare Plan B (Original Medicare) to offset these extra costs.
Supplemental plans are useful because they allow you to customize your lift chair purchase according to your needs. Every user’s situation varies but Medicare requires all users to fulfill a certain set of criteria.
To qualify for a lift chair, you have to demonstrate a medical need according to Medicare’s own standards. Medicare will only honor its promise to cover the seat lift mechanism of the chair if you can meet their preset criteria.
First, you must be enrolled in and covered by Medicare Part B or Medicare Advantage (Part C) plan. The latter is part of a private insurance provider’s policy so you’ll need to make sure they don’t have any extra coverage rules, costs, and suppliers when getting your lift chair.
To prove that you demonstrate medical necessity, you’ll first need to schedule an in-person appointment with your physician. Your physician will grant you a prescription that states you have a medical condition that requires the use of an at-home lift chair.
Your doctor will also need to fill out sections B and D on the official Certificate of Medical Necessity for Seat Lift Mechanisms form – otherwise known as Medicare Form CMS-849.
Pro-tip: Check to make sure that you’re purchasing from a Medicare-participating supplier that accepts assignment. Otherwise, Medicare won’t cover the costs.
Once you have the required paperwork completed, you’ll need to send this information to your provider. It’s your provider’s responsibility to submit the claim for your chosen chair to Medicare – but first, you need to demonstrate physical and medical eligibility.
Original Medicare requires that your doctor and lift chair supplier also be active participants enrolled in Medicare. Medicare has its own set of standards that these suppliers and doctors must meet – so make sure that your physician and supplier are enrolled.
Pro-Tip: Even if a supplier is enrolled in Medicare, they may not be active participants who are accepting assignment. If this is the case and they’re not actively participating, they can choose not to accept your request and can charge whatever they’d like for your DME.
Medicare will pay for your lift chair as long as you meet the criteria for eligibility. Your physician needs to assess you along these criteria because their verification is like a stamp of approval to Medicare. It tells Medicare that you have a legitimate need.
Your eligibility depends on your physical and medical condition. Specifically, you need to demonstrate that:
Pro-Tip: Before you submit your claim for a manual wheelchair, power wheelchair, or scooter to Medicare, think it over! This claim automatically means that you won’t be eligible for a future (or current!) lift chair claim to Medicare.
For Medicare purposes, you, your physician, and your chosen supplier all need to meet a predetermined set of standards. However, your lift chair also needs to:
Once all four aspects of your purchase meet Medicare standards, your Medicare Part B benefits kick in, covering up to 80% of your purchase. If you have no other supplemental insurance, you’ll be responsible for the remaining 20%.
Many individuals feel confused at this concept, but your Part B deductible is the amount you first need to pay out of your own pocket before your Medicare insurance coverage begins. In 2019, this figure rose to $185, up $2 from previous years.
You’ll also be responsible for the 20% co-insurance, which is the amount left over from the actual cost of the chair.
If the idea of paying the 20% co-insurance seems to be a stretch for you, there are options. You have a range of Medicare Supplement Plans to choose from.
You may also be familiar with Medicare Advantage (Part C), Medicare Prescription Drug (Part D), and Medigap. It’s a good idea to compare all Medicare Supplement Plans before you choose the right one for you.
Medicare Advantage Plans are like your HMO or PPO and give you extended coverage. As of 2019, changes to the provisions of these plans may group lift chairs as an allowable supplemental health care benefit.
These changes make it easier than ever for those with a specific injury or physical and medical need to access lift chairs in a cost-effective way.
If you don’t have a Medicare Supplemental Plan, you’re not entirely at a disadvantage. The excess charges for features like heat and massage or zero-gravity reclining, or the 20% co-insurance you have to pay may be tax-deductible.
It’s best to consult a tax specialist, but in general the IRS says that you can deduct a number of qualified medical expenses and a lift chair comes under capital expenses. If you want to claim your lift chair as a tax-deductible expense, make sure to have a prescription from your physician proving medical necessity.
If you’re planning to use Medicare to offset the cost of a lift chair, you should be aware that the Medicare Competitive Bidding program may apply to your purchase.
It changes the amount of money Medicare pays for DME items according to location. Through this program, suppliers submit bids for DMEs and Medicare then uses these bids to set the amount they’re willing to pay for each item. There is some proof through longitudinal studies that show that this sometimes works in your favor because the competition drives prices of medical equipment down.
Many older adults and seniors with mobility issues and degenerative bone or neuromuscular conditions see the lift chair as a must-have rather than a nice-to-have. These individuals would both qualify for Medicare and would likely purchase a lift chair regardless of coverage – especially if they have private insurance.
In other words, the benefits of buying a lift chair often outweigh the consideration of cost. However, if you can ensure savings while still benefiting from an in-home therapeutic solution, you should take advantage of it.
Medicare’s eligibility criteria and coverage may seem like a lengthy process, but your provider and lift chair supplier can help you go through the paperwork fairly quickly. Along with Part B coverage, you can also take advantage of the tax-deductible nature of medical equipment like lift chairs.
The key here is to make sure that you’re buying the right model. With your forms filled out, take the time to research the best chair on the market and one that is tailored specifically to your needs.
Lift chairs are not all created equal. If you experience mobility issues along with other problems like sleep apnea, Restless Leg Syndrome, or sore joints and muscles, you want to focus on a lift chair model like Perfect Sleep Chair — which is designed to address a multitude of symptoms through one design.
Lift chairs can be an innovative solution for older adults and seniors, but it can also extend its use to the rest of your household. It can easily become one of the ways to age in-home while still remaining safe and comfortable.