Determining Your Eligibility For A Lift Chair
Your eligibility depends on your physical and medical condition. Specifically, you need to demonstrate that:
You have severe arthritis or a severe neuromuscular disease in your knee or hip.
Youre unable to stand up from a regular chair without assistance.
The lift chair is an integral part of your treatment plan, as outlined and recommended by your doctor, and your primary care physician is prescribing it for improvement or stopping your current condition from worsening.
You can use the assistance of a walker or cane, but you dont use a wheelchair or scooter.
Your doctor is the attending or consulting physician for the treatment of the condition.
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 wont be eligible for a future 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:
Be able to withstand repeated use
Be designed specifically for a medical condition
Be used inside the home for therapeutic benefits
Provide at least three years of use
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, youll be responsible for the remaining 20%.
Illinois Medicaid Lift Chair Coverage
Medicaid in Illinois is operated by the Department of Health and Family Services . There are services focused on seniors 65+ and those 60+ with disabilities. The Aging Community Care Program promotes in-home, safe care for seniors as its also less costly for the state than nursing facilities.
Will Medicaid pay for a lift chair in Illinois? If you medically need a lift chair in your home for daily living, it might be paid for by Medicaid and seniors programs in Illinois.
You can ask for direction on getting a DME lift chair at:
- The Medicaid Agency for Home and Community 557-1868
- The Department of Aging Senior Help Line 1-800-252-8966
Another possibility for getting a lift chair paid for in Illinois is through the Department of Human Services AABD Cash Program if youre age 65 or older and either receive the federal Supplemental Security Income benefits or dont qualify for SSI because of your income level. The Aid to the Aged, Blind, or Disabled is cash help for needed items.
Youll have to show proof of income, your birth certificate, and other items requested by a DHS caseworker. To find out if youre eligible for a cash amount that will be enough at least to pay for a gently used or rental lift chair, call:
- AABD Cash Program – 1-800-843-6154
Does United Healthcare Over Lift Chairs
UnitedHealthcare offers a range of different Medicare Advantage plans through UnitedHealthcare Medicare Plans.
All of these plans must offer at least the same coverage as Medicare Parts A and B, and so they will have the same coverage for the mechanized hydraulic lift part of a lift chair, as does Original Medicare, and with the same guidelines and criteria for qualification.
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What Constitutes Medical Necessity
Lift chairs must be deemed medically necessary for Medicare reimbursement. A beneficiary must meet the following requirements for a lift chair to be considered a medical necessity:
- Diagnosed with a neuromuscular disease or severe arthritis of the knee or hip
- Unable to get up from a sitting position in a regular chair
- Able to walk independently or with the use of a cane or walker
- Receiving treatment aimed at improving or slowing the deterioration of their condition that requires the use of the seat-lift chair
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Nebraska Medicaid Lift Chair Coverage
The Nebraska Medicaid program is operated by the Department of Health and Human Services. If Durable Medical Equipment is medically necessary and prescribed by a physician, it is often fully covered.
Medicaid will likely pay for a lift chair in Nebraska if the treating physician specifies it provides a medically needed, therapeutic benefit for a diagnosed disease or condition, and its not to be in the home for comfort or convenience. The disease or condition for which a lift chair is prescribed must be severe enough that the patient cant get up from a regular chair, meaning that they would otherwise be confined to a bed or wheelchair for a lot of the time.
The prescribing physicians order for the lift chair or other DME must include Certification of Medical Necessity , and the equipment order must be hand-signed by them not stamped. The physician’s full name, address, and telephone number must also be present on the DME order.
For more information on Nebraska Medicaid eligibility for seniors, visit:
- Nebraska Medicaid Eligibility 632-7633
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Refusal To Serve Members
Revision 18-2 Effective September 3, 2018
If a provider refuses to serve a member, the reason the provider cannot adequately meet the needs of the member must be stated in writing to the members managed care organization . The reason for provider refusal must be related to the providers limitation and not previous experience with the member or discriminated against because of age, disability or gender, etc. The provider must work with the MCO to coordinate alternative provider agency arrangements. The MCO must coordinate the transfer of services on behalf of the member.
Revision 21-2 Effective August 1, 2021
Services and care provided, as identified and authorized on Form H1700-1, Individual Service Plan, must assist the member to attain or maintain the highest practicable physical, mental and psychosocial well-being.
Services provided are tailored to meet the members goals and needs based upon her or his medical condition, mental and functional limitations, ability to self-manage, and availability of family and other support.
MCOs must recognize and support the members right to a dignified existence, privacy and self-determination.
Revision 21-2 Effective August 1, 2021
PAS includes assistance with the performance of ADLs and IADLs necessary to maintain the home as a clean, sanitary and safe environment. PAS is provided to the member, as authorized on Form H1700-1, Individual Service Plan, or as delivered through CFC.
How To Apply And Get Medicare Reimbursement For A Lift Chair
Seniors interested in acquiring a chair should first contact their physician for a medical review.
The physician will need to complete CMS-849 to indicate what the qualifying condition is to warrant Medicare approval for the lift.
Once the form is complete and submitted, seniors can approach a Medicare supplier who sells patient lifts and will often be able to file a claim regarding the chair to be submitted for coverage.
For suppliers who dont participate in Medicare, applicants can download a form from the Medicare site to be submitted as a request for coverage and reimbursement for the lift portion of the chair.
This video is helpful in explaining more about the qualifications needed for Medicare cover.
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Who Is Eligible For A Lift Chair From Medicare
There are two main parts to a lift chair: the chair itself and the mechanical component that raises and lowers the seat. Medicare Part B only helps pay for the mechanical component, not the chair itself.
Below is a list of the requirements you must meet for Medicare to cover your lift chair.
- You must have severe arthritis or a severe neuromuscular disease in your knee or hip.
- You must be unable to stand up from a regular chair without assistance.
- The lift chair lift should be included in your treatment plan from your doctor and must be prescribed to improve your current condition or to stop it from getting worse.
- You can use the assistance of a walker or cane, but you do not use a wheelchair or scooter.
- Your doctor must be either the attending or consulting physician for the treatment of the condition.
IMPORTANT: Medicare only covers durable medical equipment if your doctor and your DME supplier participate in Medicare.
Lift Chairs On Medicare
If you’re on Medicare Part B, your insurance may cover most of the cost of a lift chair once you pay the deductible. You’ll owe around 20%, and Medicare will pay the rest. But the specific amount you’ll owe depends on what other insurance you have and who your supplier is.
Before Medicare can cover the cost of your lift chair, your doctor will judge whether the chair is a medical necessity for you. So, your doctor will fill out the medical necessity form, which asks them to confirm the following:
- If you’ve been diagnosed as having severe knee or hip arthritis, or another severe neuromuscular disease
- If you can move around once you’ve stood up
- If you can’t stand up by yourself from any other type of chair
- If you’ve tried other treatments and devices to help you stand, but they’ve failed
Under Medicare, you might be asked to rent a lift chair instead of buying it or you may be given a choice of either buying or renting it. Your doctor and supplier must both be enrolled in Medicare. Ask your doctor for a list of approved lift chair suppliers near you.
Under Medicare Part B, lift chairs are a type of durable medical equipment â or DME â called a “patient lift”. As a DME, the lift chair should work for at least 3 years.
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Where And How To Purchase
Medicare will only reimburse people who buy a chair through a supplier who accepts Medicare assignment. If the company does not accept Medicare assignment, people may pay more for their lift chair.
Most DME companies accept Medicare assignment, but a person may wish to check with the company before making any final decisions.
Other stores that sell lift chairs, such as department stores, do not take assignment. A person can choose to buy their chair through these stores, but they will pay 100% of the cost.
Utah Medicaid Lift Chair Coverage
The Utah Department of Health Medicaid program provides medical support, including long-term care, for low-income seniors aged 65 and older. Durable Medical Equipment approval for items such as a lift chair is done case-by-case and may be fully covered.
The DME must serve a reusable medical purpose that can be used in a home setting. A physician must prescribe the DME and describe why the item is necessary for the patients diagnosis after a face-to-face examination. The date and doctors signature must be on the prescription.
For Utah Medicaid, the DME usually must be purchased new and not be a rental, used, or refurbished, although these conditions may change. These restrictions also may or may not apply to a lift chair, so its best to learn more about current lift chair coverage by contacting:
- UT Medicaid Information 1-801-538-6155
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Will Medicare Pay For A Sleep Chair
Yes, as a sleep chair is a type of lift chair.
Original Medicare Part B will typically cover 80% of the cost of the mechanized hydraulic seat lift in a sleep chair, as long as it is hydraulic, and so long as your chair has been prescribed as medically necessary by a Medicare-enrolled physician.
The rest of the chair is not at all covered by Medicare as it only considers the seat lift to be medically necessary and the rest is not medical in nature so doesnt qualify for coverage.
The criteria for coverage that you have to meet to qualify for the prescription are those that I listed above.
What Are Lift Chairs
Lift chairs look like big reclining armchairs, and may be reclining chairs, but with the difference that the chair has a mechanized hydraulic lift.
The hydraulic lift is for the primary function of the chair, to move the user from a seated position to a standing position.
The mechanized hydraulic lift is designed to smoothly lift the user at a very slow pace to avoid any dizziness and discomfort to users who have mobility issues.
Lift chairs can come with a variety of reclining positions 2 position lift chairs, 3 position lift chairs and infinite position lift chairs.
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Medicare Lift Chair Reimbursement
Here are additional details about the doctor evaluation and prescription needed to receive reimbursement for your lift chair. Your doctor will write the prescription if they feel that without it you may be confined to the chair or bed.
Lift chairs are typically approved for patients with muscular dystrophy, severe arthritis and neuromuscular diseases. However, your doctor will help you determine whether you are eligible for this benefit.
Your doctor will fill out the relevant sections of CMS-849, the same form you need to complete and file to receive the reimbursement.
Medicare Stair Lift & Wheelchair Ramp Funding
We hope this information can be used to help you or a loved one secure funding for a stairlift or wheelchair ramp. Please be aware that while you can seek these forms of funding, we do not accept any Medicare or Medicaid payments because we are not a Medicare or Medicaid provider.
For more information, please contact us to discuss your options.
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Qualifying For A Medicare
Prior to 1986, Medicare coverage for lift chairs was restricted to patients suffering from muscular dystrophy, severe arthritis of the knee or hip, or other neuromuscular diseases. In 1986, the Health Care Financing Administration amended its policy to cover lift chairs based on medical necessity instead of diagnostic categories.
The requirements to qualify as a medical necessity are as follows:
- A physician must determine you can benefit therapeutically from its use.
- The lift chair is part of the doctors course of treatment and will likely support the improvement or slow down the deterioration of your condition.
- The condition is so severe that the only alternative is confinement in bed or a chair.
Both your doctor and lift chair supplier must be accepted by Medicare. Otherwise, Medicare wont pay your submitted claim. Medicare-participating suppliers can only charge you the coinsurance and Part B deductible for the DME-approved amount.
Theres no limit to the amount you can pay for durable medical equipment provided by a non-participating supplier. So make sure your doctor and supplier are accepted in Medicare.
What Should You Do Next
So, now you have a thorough understanding of how to reach out through Medicaid to seek reimbursement for a lift chair device. If you haven’t already done so now is a great time to make an appointment with your doctor to find out if you’re eligible for a lift chair prescription.
On the other hand, if you have already discussed the matter with your doctor, you can get started filling out the paperwork and shopping for a lift chair. Be sure to use one of the Medicare-approved suppliers in the links provided in the article.
If you aren’t eligible for Medicare but have private insurance, find out if your policy covers the cost of lift chairs. Additionally, check with the Veterans Administration if you have served in the military to find out if you’re eligible for any other mobility devices. We have also identified three organizations that help seniors obtain mobility devices to help them gain the independence available with a lift chair!
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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.
Wyoming Medicaid Lift Chair Coverage
Wyoming Medicaid is operated by the Department of Health and it covers Durable Medical Equipment used at home. The equipment must be physician-ordered and prescribed after a face-to-face medical exam.
Many DME items requested may only need a verbal confirmation from the treating physician and supplier. In the case of seat lift mechanisms and lift chairs though, any coverage from Wyoming Medicaid requires a written order from a doctor. DME also must be standard, not deluxe, models that meet patients medical needs.
To learn whether Medicaid will pay fully for a lift chair in your case, contact:
- Wyoming Medicaid 777-7531
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Where To Get An Approved Lift Chair
You can get an approved lift chair by searching through the Medicare Supplier Directory, which has information about suppliers who provide durable medical equipment in the U.S. Enter your ZIP code and choose patient lifts to find an approved supplier in your area.
Suppliers must satisfy strict qualifying standards to get a Medicare supplier number. Some questions to ask when choosing a supplier may include:
- Do you have a Medicare supplier number?
- Do you accept Medicare assignment?
- Will you bill Medicare for me?
Anyone who carries Medicare Part B can get a lift chair as long as its a medical necessity. Medicare Advantage plans may also cover lift chairs, but you must call your plans primary care provider to get DME coverage.
Repair and maintenance requirements for durable medical equipment also vary depending on whether you own or rent the equipment. If you own the DME, your supplier has no obligation to offer repair services. However, your supplier must repair and maintain the equipment if youre renting it.