Will Medicare Pay for a Lift Chair Recliner?

Medicare Part B (Medical Insurance) covers patient lifts as durable medical equipment (DME) that your doctor prescribes for use in your home.

Your Costs in Original Medicare

If your supplier accepts Assignment you pay 20% of the Medicare-approved amount, and the Part B Deductible applies. Medicare covers the cost for different kinds of DME in different ways. Depending on the type of equipment and qualifying diagnosis for a power recliner lift chair:

• You may need to rent the equipment.
• You may need to buy the equipment.
• You may be able to choose whether to rent or buy the equipment.

Medicare will only provide DME coverage if your doctors and DME suppliers are enrolled in Medicare. Doctors and suppliers have to meet strict standards to enroll and stay enrolled in Medicare. If your doctors or suppliers aren’t enrolled, Medicare won’t pay the claims submitted by them, including lift chair coverage. 

How do I qualify for a recliner lift chair?

The seat lift mechanism can be covered by Medicare when the following criteria are met:

1. Having Medicare Part B (Medical Insurance) or a Medicare Advantage Plan (Part C).
2. Obtain a "Certificate of medical necessity" (schedule appointment with doctor)

Medicare-participating suppliers: You must order your lift chair from a Medicare-participating supplier that accepts assignment, otherwise Medicare will not pay for it.

Determining medical necessity: 

1. The patient is completely incapable of standing up from a regular chair
2. The patient has severe arthritis of the hip or knee, or a severe neuromuscular disease
3. The lift chair is part of the physician's course of treatment to effect improvement or slow deterioration in the patient's condition
4. When standing, the patient can walk independently or with the aid of a walker or cane; transferring directly to a wheelchair can prevent Medicare from paying for the device

Medicare’s Competitive Bidding Program

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. 

Step by Step Guide to Medicare Coverage for Lift Recliner Chairs

The motorized portion of the lift chair is a Medicare covered item, so if you qualify, Medicare may cover up to 80% of the approved amount for the motor.You would be responsible for any co-pay or deductible amounts as well as the additional cost of the furniture portion of the chair. In order to determine if you qualify, you will need to follow these steps:

Step 1

Obtain a prescription from your physician for the seat lift chair.You may need an in-person or face-to-face visit with your physician.

Step 2

Your provider has a special form for your physician to fill out. You will need to take this form (or have your provider send it) to your physician. It contains several questions about your condition that will help determine your Medicare coverage.In order to qualify for the seat lift mechanism under Medicare, there are a few things to keep in mind:

1. You must have severe arthritis of either the hip or knee, or have a severe neuromuscular disease. Your doctor will help determine this.
2. The seat lift mechanism must be a part of your doctor’s treatment plan to help either improve your condition or to slow down or stop the progression of your condition.
3. You must be unable to stand up from a regular armchair or any chair in your home.
4. Once standing, you must be able to walk, even if you use a cane or walker to do so.Medicare will not cover a lift chair if you are in the hospital or are in a skilled nursing facility.You will not qualify for a lift chair if Medicare has paid for a manual wheelchair, scooter or power wheelchair. You may still qualify if the doctor determines your condition has improved and you are now able to walk, even if it’s with a cane or walker

Step 3

Once your provider obtains the appropriate medical information from your physician, you will next need to select your lift chair. Upon obtaining your lift chair, your provider will submit the claim to Medicare for you.

In addition: Please check the Medicare website for latest information (Medicare.gov).