How Do I Get Medicare To Pay For Lift Chair
To get coverage from Medicare, you need a prescription for a lift chair from a Medicare-approved physician.
Lift chairs must also be purchased or rented from a Medicare-approved supplier that accepts assignment. Medicare will determine if your chair lift must be purchased or rented. In some instances, you may be able to choose the option you prefer.
Once eligibility requirements are met, Medicare will pay 80% of the Medicare-approved cost of the lifting mechanism in the lift chair. You will be responsible for the other 20% of the cost of the lifting mechanism. You will also be responsible for the cost of the chairs other parts, such as the frame and upholstery.
If you have Medicare supplemental insurance , your plan may cover the 20% you are responsible for.
In addition, you will have to meet your Part B deductible before Medicare will pay its portion of the cost.
Looking For Medicare Coverage
Are you unhappy with your current Medicare coverage? Medicare Advantage may be a good alternative. Or if you like Original Medicare, you could supplement your coverage with a Medicare Supplement plan to help cover costs that Medicare doesnt.
To find a plan that may work better for you, call an experienced agent today.
Canvas Or Nylon Sling Or Seat
Aetna considers a canvas or nylon sling or seat for a hydraulic/mechanical lift medically necessary as an accessory when ordered as a replacement for the original equipment item. Note: A nylon or canvas sling or seat for a patient lift is included in the allowance for a patient lift when provided at the same time.
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Health Care In The Home Medicaid And State Programs
Programs which have been designed specifically for low income families, the disabled and the elderly for care in the home, are calledHome and Community Based Services , Waivers or 1915 Waivers.
The object of the programs is to provide the participants with the help they need to remain in their homes, and to be able to maintain their independence in the community.
These programs and waivers, will all help to cover home medical equipment DME and even home modifications or remodeling, and often cover the whole cost.
To find out if you are eligible for any programs, contact your State Medicaid Agency here.
To learn more about HCBS programs, or waivers, you can go here on Medicare.gov
For the purposes of participants on these programs, home means
- a custodial care facility
What Are Lift Chairs
Lift chairs resemble a typical recliner you might already have in your home, but they are equipped with a motorized device that raises and gently tilts it forward to help you get to a standing position more easily. They are generally available in two-position and three-position styles. You may be able to find some infinite position chairs that let you customize the settings to one most comfortable for you.
Dont confuse a lift chair with a stair lift chair, which is a motorized chair that takes you up and down the stairs. Lift chairs are also different from patient lifts, which come in different forms and are used to help a caregiver or family member move you, for example, from a wheelchair to a bed.
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Medicare Lift Chair Requirements
In order to receive reimbursement for the lift mechanism of a lift chair, you must purchase the right type of chair and meet the eligibility requirements, described below.
Note that if you can successfully transfer from the lift chair to wheelchair, Medicare may not consider the equipment a medical necessity. also, Medicare will not pay for lift chairs for recipients living in hospice, a skilled nursing facility or a nursing home.
Does Insurance Cover Lift Chairs What You Need To Know
We’ve already discussed private insurance that individuals may have through Medicare Plan B. However, we haven’t yet discussed whether private insurance may cover the cost of this important mobility device.
If you have a private insurance policy through an employer or self-funded account, it’s important to discuss your coverage with your agent. Alternatively, you can call your insurance company directly to find out what mobility assistance devices your policy may cover.
In certain circumstances, private insurance companies may pay to rent or buy a lift chair. Some only partially cover lift chairs while others fully cover them. Still others don’t cover the cost at all. So, this really is a case-by-case basis.
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Does Medicare Cover A Lift Chair
Yes, lift chairs are covered by Part B of your Medicare coverage. They are considered durable medical equipment used to treat certain conditions like arthritis or other balance or mobility issues. These standards should be included in any Medicare Advantage Plan.
However, you wont be covered for a lift chair if youre residing in a hospital or skilled nursing home for the time being. You also wont qualify if Medicare has already paid for a scooter, wheelchair, or another motorized device.
The piece of equipment that is covered by Medicare is the motor and contraption that helps lift you out of the seat. However, Medicare wont cover chairs that use a spring device to lift you out as well as the fabric, cushion, and other accessories arent covered even though the device is built into the chair.
In total, Medicare will pay for about 80 percent of the motorized device, and you will pay for the remaining 20 percent as well as the costs for the rest of the chair. Supplemental plans will help cover all the costs Medicare doesnt, too.
The reimbursement on a lift mechanism is between $280-$300.
- You mustnt be able to stand up on your own from a regular armchair
- If you have severe arthritis in your knee or hips
- If you didnt have the chair, your would be confined to another chair or bed
- If you can operate the lift chair yourself
- Once youre standing, you need to be able to walk, even if its with the help of a cane, walker, or some other device
How Do I Find Approved Lift Chairs Medicare Suppliers
Medicare has specific rules about coverage for lift chairs and other durable medical equipment. First, both the doctor who prescribes the equipment and the supplier who provides it must be enrolled in Medicare. Your doctor or other health care provider should be able to give you a list of approved suppliers in your area, or you can use the supplier locator tool on the Medicare website.
Depending on where you live, lift chairs and other devices may be under the Medicare Competitive Bidding Program. This is a cost-saving program that helps Medicare enrollees get the lowest prices on their covered devices. If you live in an area where the Competitive Bidding Program is in place, you can only get your lift chair from an approved supplier, even if there are other suppliers in the area that accept Medicare assignment.
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Am I Eligible To Receive These Benefits
You are eligible for coverage of a lift chair if youre enrolled in Medicare Part B. To qualify for Medicare, you must be at least 65 years old or have other qualifying medical conditions. These conditions may include a severe disability, end stage renal disease, or ALS .
If you have Medicare Advantage, you are still eligible to receive a lift chair. Medicare Advantage or Medicare Part C is when you choose a private insurance company to cover your Medicare benefits.
Because Medicare Advantage companies must cover all aspects that original Medicare does, you should get at least the same amount of coverage, if not additional benefits.
You also need to be evaluated by a doctor to get a prescription for the chair. Here are some of the things your doctor will assess when considering if a lift chair is medically necessary:
- if you have severe arthritis in your knees or hips
- your ability to operate the chair
- your ability to stand up from the chair without assistance
- your ability to walk, even with assistance from a walker, after the chair has lifted you
- you can walk once you are standing
- you have tried other treatments to help you go from sitting to standing without success
Note
If youre an inpatient at a hospital or resident at a nursing facility, you wont qualify for coverage of a lift chair. You must live in a residential home to qualify for this benefit.
Will Medicare Pay For My Lift Chair
Medicare Part B will pay some of the costs of your lift chair under the durable medical equipment coverage. Medicare Part B pays for your lift chair only when your doctor or other health care provider prescribes it for use in home health care. A nursing home or hospital that provides you with Medicare-covered care doesnt qualify as your home, but a long-term care facility may qualify.
Medicare Part B helps pay for the lifting device rather than the chair itself. As a result, coverage wont extend to cushions, fabric, or any other chair accessories.
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Certificate Of Medical Necessity
In order to qualify for lift chair coverage, you have to start by making a doctors appointment. Talk to your doctor about writing a prescription for a lift chair. This is the first step in determining medical necessity. The doctor will need to complete parts B and D of Medicare form CMS-849. This form is also called the Certificate of Medical Necessity for Seat Lift Mechanisms form.
Now What Do You Do With The Signed Prescription
Now you have your prescription
- locating an equipment supplier is going to be first you need to find a Medicare-enrolled DME supplier take a look at the link to the Medicare supplier locator in the next section of this article
- once you have a supplier, remember they must be a Medicare-enrolled participating supplier who accepts assignment this will keep the costs as low as possible for you
- pick out the equipment with the supplier which corresponds to your prescription the prescriptions have special codes which indicate the range of DME from which you can choose
- check that all the paperwork for Medicare is done correctly the supplier will help you, so that you comply with Medicare guidelines
Original Medicare part B typically covers 80% of the Medicare-approved price for your DME.
If you are purchasing or renting your DME from a Medicare-enrolled participating supplier who accepts assignment, you will just have to pay your Medicare 20% coinsurance payment of the Medicare-approved price of the DME, and if it applies, your policy deductible.
Always check that the supplier is a Medicare-enrolled participating supplier who accepts assignment ! One who isnt, can ask for as much as 15% percent on top of the Medicare-approved price, and you will pay that, not Medicare.
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How To Get A Lift Chair Through Medicaid
Do you find it difficult or impossible to get out of a chair unassisted due to a physical limitation? A lift chair can help you stand up or sit back down without assistance. In some cases, Medicaid may help you pay for this important mobility tool.
Remember that Medicaid varies drastically from Medicare. For example, Medicaid is a state-run program, whereas Medicare is a federal government program administered by individual states. For Medicare, this means that your eligibility can vary widely depending on where you live.
The easiest way to determine your eligibility is by visiting your state’s Medicaid website. Refer to the Medicaid State by State Directory for the relevant contact list. This list has the contact information as well as the telephone number for you to get the information you need. When you speak to someone, let them know that you want to apply for lift chair reimbursement.
If you schedule an appointment, make sure to bring proof of income, a photo ID and a copy of your insurance policy. You will also need a letter or prescription from your doctor indicating that a lift chair can help you retain independence. Since procedures vary for every state, it’s important to write down all the paperwork you’ll need to complete the application and receive partial or full reimbursement for a lift chair.
It’s important to ask all the questions that you may have at the meeting. For example, find out how long the application and approval process typically takes.
Does Medicare Cover Lift Chairs
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Does Medicare Cover Lift Chairs?
Medicare is an expansive program covering such a wide range of services and supplies that its impossible to memorize every single part of coverage for your plan. While there is a portal on the Medicare website that can help guide you in the right direction as to what service or supply youre interested in is covered, its easy to lose yourself in a rabbit hole searching for answers when it comes to equipment that is highly specific to your condition.
One of these conundrums can occur when figuring out coverage of lift chairs.
These devices help people with mobility issues stand and sit down without too much pain, but how do you know if you qualify? Does your doctor have to write a prescription for one? How much does Medicare cover for a lift chair, if it covers for one at all?
These are all questions that may come up when you begin looking for a lift chair. Were here to help answer them for you. First, lets get into the most basic question of what exactly a lift chair is and how it works.
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Nursing Services In Assisted Living Facilities
Revision 20-1 Effective March 16, 2020
Assisted living facilities must have sufficient staff to assist with member medication regimens , Title 26, §553.41). Nursing for this task may be included on the individual service plan , depending on the members needs and the facility type. Licensed nurses who own an ALF or are employed by the facility may directly administer medication to members residing in ALFs, but are not required to do so. In ALFs, delegation of nursing tasks to facility attendants is not allowed by licensure. See Section 7200, Assisted Living Services, Section 7224, Personal Care 3, and Section 7230, Other Services Available to Members.
If, because of licensure, an ALF does not provide nursing services, other facility employees may not deliver services other than personal assistance services and administration of medications. If a resident needs additional services that are not available in the ALF, the managed care organization must ensure the members needs are met. The MCO may do so through contract with a Home and Community Support Services Agency or an independent health care provider.
Medicare Coverage For Lift Chairs
Part B will cover the actual seat-lift mechanism only. To be considered medically necessary equipment, a doctor must indicate the chair for the patients specific health condition. Once the lift chair gets approval, Medicare covers 80% of the lifting mechanism. The beneficiary must pay the remaining 20%, plus the cost of the seat portion of the lift chair.
How to Determine if the Lift Chair is Medically Necessary:
- The patient cant stand on their own from a regular chair
- Can operate the chair on their own
- Can walk independently or with a walker
- Suffers from severe arthritis
- Without the use of a chair, the patient suffers confinement to a bed
If the beneficiary is able to transfer from the lift chair directly to a wheelchair, that could prevent Medicare from approving the lifting mechanism as medically necessary. The lift chair mechanism wont be covered through Medicare if a patient is residing within a skilled nursing facility, hospice, or nursing home facility.
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How Much Does It Cost To Rent Or Buy A Lift
After you have paid your annual deductible, you will pay 20% of Medicare-approved amounts for the lift purchase or rental and maintenance. Those costs may be higher if the supplier doesn’t accept the assignment. Patient lifts are in the “Capped Rental” category, which means you may choose to rent or purchase them from a Medicare-approved lift chair dealer.
Once Medicare has made 10 monthly rental payments you will be given an opportunity to purchase the lift. The supplier will send you a “Purchase Option” letter in the ninth month of the rental. You will have 30 days to reply.
If you reply and want to buy your lift:
- Medicare will make three more payments, and the lift is yours.
- Medicare will cover 80% of maintenance costs, but it is your responsibility to find a Medicare-approved supplier to cover the costs.
If you do not answer or choose to continue renting:
- Medicare will make a total of 15 rental payments, and the lift is yours to use as long as you need.
- The supplier keeps ownership of the chair and is responsible for maintaining it.
What Is The Best Lift Chair For The Money
Before purchasing a lift chair, talk to your doctor about the type that may be best for you. Since you will incur most of its cost, keep your budget in mind, as well.
Two-position lift chairs are the most basic. They give you the option of sitting upright or reclining at a 45-degree angle, with your legs elevated.
Lift chairs arent meant to be used as beds. However, if you plan on using yours for napping as well as sitting, you may wish to purchase a three-position lift chair. This type of chair allows you to recline in a near-flat position.
Infinite position lift chairs are the most versatile. This type is also sometimes referred to as a zero-gravity lift chair. They include several motors so that you can position your legs and upper body in a wide range of positions. The number of motors the chair contains wont alter the payment portion you can expect to receive from Medicare.
Your lift chair may be front and center in your living room, or in a more private area of your home. Either way, it may be important to you that your chair is attractive, and doesnt look like a piece of medical equipment. When possible, try to get a chair that enhances your décor, and feels like a welcoming addition to your room. You have the right to enjoy your chair, and to feel at home in it.
Get the health benefits and savings youre entitled to.
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