by Russell Noga | Updated January 17th, 2024
If you’re inquiring about lazy boy lift chairs covered by Medicare, understand that Medicare covers the lift mechanism portion, not the entire chair.
In this article, we’ll delve into what’s covered, your out-of-pocket costs, and how to navigate the Medicare process.
Get ready for a clear overview without any unnecessary jargon or embellishments.
- Medicare covers the cost of the seat lift mechanism in lift chairs at 80% once the Part B deductible is met, but it does not cover the chair itself, or features such as heat and massage.
- To qualify for Medicare coverage, the lift chair must have a motorized lift mechanism, be prescribed by a certified physician, and be supplied by a Medicare-approved supplier.
- The total cost for a lift chair can vary greatly, with Medicare typically covering around $500 for the lift mechanism; beneficiaries are responsible for the remaining 20%, any deductibles, and the full cost of the chair.
Exploring Medicare Coverage for Lazy Boy Lift Chairs
Lazy Boy lift chairs serve as a lifeline for many individuals dealing with mobility issues, offering more than just comfort. Encouragingly, Medicare covers lift chairs, particularly their seat lift mechanisms.
You see, Medicare views the lift mechanism as a piece of durable medical equipment, making it eligible for coverage. However, one must realize that the coverage excludes the chair itself and non-essential features like heat and massage therapy or extra upgrades like leather.
So, how much coverage can you expect? Once the Part B deductible is met, Medicare will cover 80% of the seat lift mechanism’s cost, leaving the beneficiary to cover the remaining 20%.
Moreover, other chair features, including the reclining function, are not covered and must be paid out of pocket.
The Specifics of Seat Lift Mechanism Coverage
As we’ve established, Medicare covers 80% of the seat lift mechanism’s cost. However, this coverage is sanctioned only when the lift chair is prescribed by a certified physician and obtained from a Medicare-approved supplier.
The lift chair’s lifting mechanism must be motorized to qualify for coverage under Medicare. This coverage applies whether you have Original Medicare or a Medicare Advantage Plan.
Nevertheless, keep in mind that cost specifics can vary based on your particular plan.
Criteria for Medicare Paying for a Lift Chair
Now, you may be wondering, “What conditions need to be satisfied for Medicare to cover the lift chair?” The answer lies in the principle of medical necessity.
For a lift chair to be covered, it must be prescribed by a physician as medically necessary for the patient’s specific health condition.
Typically, severe arthritis of the hip or knee and severe neuromuscular disease are the medical conditions that often meet the eligibility criteria for Medicare coverage of a lift chair. Yet, bear in mind that even with these requirements met, enrollment in Medicare Part B or a Medicare Advantage plan is necessary for lift chair coverage.
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The Role of Durable Medical Equipment in Medicare Plans
Lift chairs fall under the category of Durable Medical Equipment (DME) according to Medicare’s classification. This classification carries significant implications for the kind of coverage you can expect.
The coverage for lift chairs as DME is usually similar under both Original Medicare and Medicare Advantage plans, given that the law mandates Advantage providers to offer benefits equivalent to those offered by Original Medicare. However, take into account that Medicare Advantage plans may include extra coverage rules, costs, and provider networks that can affect the overall lift chair coverage.
Understanding DME Coverage Under Medicare Part B
Medicare Part B covers 80% of the cost of the lift chair’s seat lift mechanism, leaving the patient to pay the remaining 20% and the cost of the chair.
This is because, under Medicare Part B, DME is defined as equipment that is:
- used for a medical reason
- typically useful to someone sick or injured
- used in the home.
For a lift chair to qualify for coverage as DME, it must be equipped with a motorized seat lift mechanism, be prescribed by a physician, and be supplied by a Medicare-enrolled provider.
How Medicare Advantage Plans May Affect Lift Chair Coverage
Medicare Advantage plans provide medicare cover for seat lift mechanisms similar to Original Medicare, covering 80% of the cost. However, the specific costs involved may vary depending on the individual plans.
Eligibility for lift chair coverage under Medicare Advantage plans is determined based on the guidelines outlined in Medicare Part B. Once approved, Medicare covers 80% of the lifting mechanism, while the beneficiary is responsible for the remaining 20% as well as the cost of the chair.
Always consider reviewing your Medicare Advantage plan specifics for detailed information on lift chair coverage.
Financial Considerations for Medicare-Eligible Lift Chair Shoppers
While comprehension of Medicare coverage is vital, considering potential out-of-pocket expenses while shopping for a lift chair is of equal significance. The cost of lift chairs can vary widely, typically ranging from $600 to approximately $2,000, depending on factors such as brand, vendor, and specific features of the chair.
Medicare typically covers around $500, which is 80% of the cost for the lift mechanism in a lift chair. The remaining 20% and the full cost of the chair itself are left to the beneficiary.
However, supplementary insurance coverage or discounts could potentially contribute to reducing the ultimate expense of a lift chair.
Estimating Your Lift Chair Costs with Medicare
With Medicare coverage, beneficiaries may experience Medicare pay for a lift of around $350 plus the Part B deductible for the lift chair mechanism. However, the overall cost can be significantly reduced if you have a Medigap plan, which can cover the 20% coinsurance.
Remember, the total cost of a lift chair is influenced by the Medicare Part B deductible. You’ll be required to cover 20% of the allowable charges for the lift chair’s motorized mechanism, in addition to any remaining portion of your annual Part B deductible.
Seeking Additional Insurance Support
Medigap insurance can be a great boon when it comes to covering the 20% coinsurance for the lift chair mechanism. Though it won’t cover the cost of the chair itself, it can significantly reduce your out-of-pocket expenses.
Once you have Medicare Part B, which provides coverage for 80% of the lifting mechanism expenses, you can utilize Medigap for covering the remaining 20% of lift chair mechanism costs.
Navigating the Purchase Process for a Medicare-Covered Lift Chair
Once you’ve understood the coverage details and financial considerations, the next step is to navigate the purchase process. This involves finding an approved supplier and obtaining a prescription from a primary care physician.
The primary care physician has a pivotal role in assessing the patient’s medical need for a lift chair and prescribing it if deemed necessary for the patient’s condition. Following the purchase, the necessary documentation must be submitted to Medicare for reimbursement.
Finding a Medicare-Approved Supplier
Finding a Medicare-approved supplier is the first step in the purchase process. This is crucial because Medicare will not cover the cost if the chair is purchased from a non-medicare participating supplier.
You can find a list of Medicare-approved medical equipment and suppliers by entering your ZIP code on Medicare’s page for medical equipment and suppliers. Once you’ve identified a Medicare-approved vendor, you can proceed with the purchase.
The Importance of a Primary Care Physician’s Role
Your primary care physician has a vital part in your quest for Medicare-covered lift chair. They diagnose your condition, evaluate your need for a lift chair, and provide the necessary prescription and documentation.
The prescription should clearly state the medical necessity of the lift chair for you. Your physician will also need to complete the Medicare Form CMS-849, which will be submitted to the Centers for Medicare to formalize your coverage claim for a lift chair.
Enhancing Mobility: Benefits of a Lift Chair for Those with Severe Neuromuscular Disease or Severe Arthritis
Lift chairs, also known as lift chair recliners, are more than just a piece of furniture; they are a tool for enhancing mobility and improving quality of life, especially for individuals with severe neuromuscular diseases or arthritis.
They offer a range of benefits, from promoting independence and mobility for seniors with osteoarthritis to enabling greater freedom of movement for those dealing with chronic fatigue.
They alleviate pressure on joints and muscles and facilitate secure sit-to-stand transfers, ensuring a comfortable standing position. With different varieties like two-position, three-position, and infinite-position chairs, there’s a lift chair tailored to meet diverse user requirements.
Common Questions About Lift Chairs and Medicare Coverage
Patients often have numerous questions regarding lift chair and Medicare coverage. From coverage details to claim process, it’s crucial to have all your queries addressed to make an informed decision.
The required documentation to establish medical necessity includes a letter of medical necessity from a doctor, a prescription, and a completed CMS-849 form certifying the need for a seat lift mechanism.
It usually takes approximately 30 days for the claim to be processed. If approved, Medicare covers 80% of the cost for the lifting mechanism, while the beneficiary is responsible for the remaining 20% and the full cost of the seat portion of the chair.
The realm of Medicare coverage for Lazy Boy lift chairs might appear intricate, but grasping the subtleties can aid in making informed decisions.
Remember, Medicare covers the seat lift mechanism if it is deemed medically necessary and prescribed by a physician.
Additional insurance such as Medigap can assist in compensating for expenses not covered by Medicare.
You are responsible for your annual Part B deductible and the remaining 20% of the lift mechanism cost in a lift chair.
Acquiring a lift chair entails securing a prescription from a primary care physician and submitting the required documents to Medicare for reimbursement, including any medicare prescription drug coverage information if applicable.
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Frequently Asked Questions
How much does Medicare pay for a lift chair?
If you qualify, Medicare typically covers 80% of the allowable charges for the motorized lift portion of the chair only. You may also need to pay your Part B deductible and the remaining 20% for the device and the cost of the chair itself.
What diagnosis will cover a lift chair?
To cover a lift chair, the diagnosis of severe arthritis of the hip or knee or severe neuromuscular disease is necessary for Medicare qualification. These are the stipulations to keep in mind when considering a lift chair for coverage under Medicare.
Will medical pay for a lift chair?
Medicaid may cover the cost of a lift chair if the patient meets the requirements, with coverage varying by state. It’s important to check the specific eligibility criteria in your state.
What is the role of a primary care physician in the process of obtaining a lift chair through Medicare?
The primary care physician plays a crucial role in the process of obtaining a lift chair through Medicare by diagnosing the patient, assessing the medical necessity for the lift chair, and providing the required prescription and documentation. This ensures that the patient meets Medicare’s criteria for coverage.
What is the potential out-of-pocket expense for a patient for a lift chair covered by Medicare?
The potential out-of-pocket expense for a patient for a lift chair covered by Medicare is approximately $350 plus the Part B deductible, but it can be reduced if the patient has a Medigap plan that covers the 20% coinsurance.
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Russell Noga is the CEO and Medicare editor of Medisupps.com. His 15 years of experience in the Medicare insurance market includes being a licensed Medicare insurance broker in all 50 states. He is frequently featured as a featured as a keynote Medicare event speaker, has authored hundreds of Medicare content pages, and hosts the very popular Medisupps.com Medicare Youtube channel. His expertise includes Medicare, Medigap insurance, Medicare Advantage plans, and Medicare Part D.