Will Medicare Cover the Purchase of a Seat Lift Chair?

March 22nd, 2012 by @lamberts

Medicare Part B covers a variety of home medical equipment, including seat lift chairs.  Since many of our patients have questions about coverage, qualifying health conditions, and customizable options, Homecare Advocate is going to cover the Seat Lift Chair basics.

Homecare Advocate Blog: Will Medicare Cover the Purchase of a Seat Lift Chair?

Qualifying Conditions

In order for Medicare to pay for your home medical equipment, you need to have a qualifying medical need.  In the case of seat lift chairs, Medicare requires that you have severe arthritis of the hip or knee or have a severe neuromuscular disease.  To qualify, you must not be able to rise from a chair on your own, but once standing you can ambulate on your own (even if you use a walker or cane for assistance).  Those who require a wheelchair or similar device to move around do not qualify.

Medicare relies on your physician’s documented notes in your medical record to show that you have one of the above qualifying conditions and that your physician believes that your condition will either improve or that further deterioration will be prevented once you have the seat lift chair.  Your physician will need to provide your home medical equipment company with a Certificate of Medical Necessity for your seat lift chair and a prescription that contains the following information:

  • Beneficiary name
  • Detailed description of the item
  • Signature of the treating physician (& date signed)
  • Start date of need
  • Length of need

Coverage & Cost

Medicare will only cover the lift mechanism inside a seat lift chair, not the seat lift chair itself.  Medicare has an established rate (an “allowable”) that determines the price of the item.  The allowable for a seat lift mechanism is $362.33.

Like all Part B items covered by Medicare, the patient is responsible for paying the 20% co-pay of the Medicare allowable for an item.  This co-pay may be paid by your secondary insurance, or you may pay for it out of pocket.  Medicare prohibits the home medical equipment company from waiving the co-pay.  In the case of a seat lift mechanism, the 20% co-pay of $362.33 is $71.

The patient will be financially responsible for paying for the rest of the seat lift chair cost.  This cost can vary depending on the size of chair, the fabric options, and any additional features added on.  Please keep in mind that there is an annual deductible that must be met for Part B before Medicare will pay for anything; the 2012 deductible is $140.

The home medical equipment company may process your order in one of two ways, “assigned” and “unassigned”.  The more common, way is “unassigned claim” in which the customer pays for everything up front, and Medicare reimburses the patient for the portions Medicare pays for once the claim is approved.

Seat Lift Chair Options

There are a variety of two-position and three-position seat lift chairs for you to choose from.  Your home medical equipment company should know your measurements so that the chair is appropriate for your body.  (Think of Goldilocks: you don’t want one too big or too small, you want it just right.)

Types of Chairs

Two position chairs have a seated position and a lifted position.

Three-position chairs have the seated, lifted, and reclined positions.  These are popular chairs since one can elevate their legs at/above their heart and are comfortable for resting/napping.

Bariatric (heavy duty) chairs are able to handle up to 700pounds, whereas the standard weight limits on seat lift chairs are around 325-375 pounds.

Additional Features

Depending on the manufacturer and model of seat lift chair, you may be able to add on a variety of customizable features so suit your preferences and needs.  Common options are:

  • Upgraded fabrics (and pick your color)
  • Heat & Massage
  • Head and Neck Pillow
  • Extra Pocket

Delivery, Warranty, & Service

Some companies, like Lambert’s, offer delivery with the purchase of a seat lift chair.  Check with your local home medical equipment company on their delivery service area and whether or not there is a fee.  Lambert’s does not charge if the delivery destination is within our service area.  Likewise, the warranty and repairs will vary depending on the manufacturer and the company you purchase your seat lift chair from.  For example, Lambert’s does not charge for any labor of work done on the chair the first 6 months of ownership.  In all cases, ask your equipment company for an estimate before having a repair performed on your chair.

I hope this overview has helped!  Do you have additional questions about seat lift chairs, coverage, and options?  Contact your local homecare company for more information.

::AWP::

26 Responses to “Will Medicare Cover the Purchase of a Seat Lift Chair?”

April 23, 2012 at 9:11 pm, medigap said:

Medicare supplement plans was designed for seniors to make them active and stay healthy. There wide variety of medicare supplement plans, and you can choose the best plan that suits for you.

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June 27, 2014 at 10:12 pm, Karen said:

he has medicare and a supplement. Do u no of any places that may rent the chair until he is able to sit and stand up on his own, Also, I understand he needs a letter from his doctor to show medical necessity

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October 29, 2014 at 9:43 am, Ashley Plauche said:

Karyn, I’m not aware of any companies who rent seat lift chairs at this time due to the liabilities of properly cleaning and inspecting the chair between rentals. Seat lift chairs are tricky to clean, as they may get bedbugs, mites, etc in the cushions that may not be visible upon initial inspection. Other issues, such as incontinence or smoking in the house, could damage the chair as well. You are correct that your friend will need proper documentation demonstrating medical necessity and face-to-face encounter. Here’s a link from the Centers for Medicare & Medicaid Services that may help explain the detailed documentation required.

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October 06, 2012 at 11:17 pm, Irina Olde said:

I enjoyed the post. It was a awesome read. Packed with a ton of great info I will be back. Hopefully to see more great info added. Thanks allot.

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August 18, 2013 at 6:44 am, Rubin Sandlian said:

Not to take over this thread, but I’m looking for a great insurance company and I can’t figure out who is good and who is not. Do you have any info on this insurance agency? They’re located in Louisville, near my home, but I can’t find reviews on them. – Braden Insurance Agency Inc., 3069 Breckenridge Lane, Louisville, KY 40220, (502)454-9191

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December 22, 2013 at 9:48 pm, Rhonda Brewer said:

please send me info on the seat lift. I have Degenerative Disc Disease, and I have Medicade and Medicare

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January 29, 2014 at 11:59 am, Any siguencia said:

My mother has artrithis problems and steophorosis and she need one of the chairs
She has madicaid and Medicare and I will like to know
If she is elegible for one of the chairs she is 78 years old.

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October 29, 2014 at 11:31 am, Ashley Plauche said:

Amy, your local home medical equipment company can work with you and your physician to see if they believe Medicare and/or Medicaid will cover the chair lift mechanism. Severe arthritis of the hip or knee is one of the qualifying medical diagnoses that will help, but your mother will need to be able to self-ambulate (not wheelchair bound) once standing in order for Medicare to pay for it. There are other medical necessity criteria and documentation requirements that must be met for Medicare to pay for it; your local home medical equipment company can help you through this process. Best of luck!

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April 18, 2014 at 10:28 am, Son Alai said:

It’s hard to find knowledgeable people for this subject, but you seem like you know what you’re talking about! Thanks

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May 10, 2014 at 1:19 am, Beverly fogle said:

My husband has a terrible time getting up and down..he is totally handicap..I am disable and can not help him up and down..with being on disability and social security we can not afford a lift chair for him..I have watched him struggle so many times..I just wish Medicare would help someone like him..worked all his life and retired after all those years to this..

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June 10, 2014 at 4:29 pm, Horst Ratzke said:

Please advise; will Medicare provide the funds toward the chair purchase of choice or must we purchase form a Medicare selected medical company?

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October 29, 2014 at 11:17 am, Ashley Plauche said:

To submit a claim for reimbursement for the lift mechanism (which is what Medicare will cover for qualifying patients), one must purchase the chair from a company that meets the Supplier Standards and has a Medicare billing number. For example, you cannot go into Joe’s Furniture Depot and buy a seat lift chair and turn the receipt to Medicare. However, you could go to Jane’s Home Medical Equipment with a prescription, and Jane’s employees will work with your physician to collect the necessary documentation of medical necessity, chart notes documenting the face-to-face encounter, and any other documentation required to submit your claim to Medicare. It is commonplace for home medical equipment companies to file the claim for you, even if they file it “unassigned”. Please keep in mind that Medicare only pays for the lift mechanism component, so the rest of the chair is considered furniture and will not be covered. In that regard, you can select any chair of your choice from a Medicare-authorized supplier since the chair itself is paid out of pocket. There are a lot of options and upgrades available on the market so that you get one that is appropriately fitted to you and has the comforts you seek.

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June 21, 2014 at 9:38 am, stephen r lyles said:

does medicaid pay for a lift chair

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October 29, 2014 at 11:44 am, Ashley Plauche said:

Stephen, Medicaid programs also cover the lift mechanism, not the entire chair. In Tennessee, we have MCOs who manage the TennCare program (our version of Medicaid). Depending on where you live, I would recommend you contact your local Medicaid office for information on how to proceed. Good luck!

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June 26, 2014 at 10:42 am, Lois Rados RN said:

I am an RN at Three Rivers Medical Center.I’m trying to gather information for a patient’s wife in regards to how she can get the motor part of a lift chair covered. Please email me with a contact number to one or more companies that might be able to help. I’ve called our local DME companies,but they cannot help.
Thank You, Lois Rados RN Discharge Planner
my work cell # 541-621-1851

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October 29, 2014 at 11:11 am, Ashley Plauche said:

Lois, the coverage criteria for seat lift chairs are written in the LCD that will explain the requirements for Medicare covering the lift mechanism. While I don’t have a listing of companies in your area, perhaps you can contact one of the commercial payors to see what local companies provide seat lift chairs in their networks. If, for example, BCBS has a network of suppliers who provide seat lift chairs, perhaps those same companies would be able to bill Medicare. Best of luck!

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June 27, 2014 at 10:05 pm, Karen said:

will medicare pay for the chair if someone just had Lumbar spine surgery-{L1-S1} He can walk with a walker but has a hard time getting in and out of chairs plus he needs something comfortable.

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October 29, 2014 at 11:47 am, Ashley Plauche said:

Karen, that depends on the reason for surgery. Medicare will only cover the seat lift mechanism for those who have severe arthritis of the hip or knee or who have a severe neuromuscular condition. If your friend had surgery as result of one of these conditions, it may be covered.

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August 20, 2014 at 11:15 am, Vickie Reul said:

Could you provide a list of vendors or companies that we can go through for purchase of a lift chair for my mother who has severe rheumatoid arthritis, that also will assist with Medicare billing?

Thank you in advance.

Vickie Reul

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October 29, 2014 at 9:37 am, Ashley Plauche said:

Vickie, thanks for your inquiry. While I don’t have a comprehensive listing of medical equipment companies that offer seat lift chairs, I would recommend that you contact your mother’s insurer for a list of companies in your mother’s geographic area. Although this is a good starting place, please note that not all home medical equipment companies offer all product categories. Also, not all of them “take assignment” for Medicare, meaning some have their own rates that they charge that Medicare pays up to its allowable and the rest is owed by the patient. Most home medical equipment companies will help you submit a claim to Medicare so long as they have a Medicare billing number, even those who don’t “take assignment”.

Seat lift chairs are a unique item since Medicare doesn’t cover the entire chair, only the lift mechanism. (Medicare considers the chair surrounding the lift mechanism to be furniture.) If you are not able to find any resources through 1-800-Medicare (which oftentimes people don’t), you could always Google “home medical equipment” “[your mom’s city]” and call those in her area to see if they offer seat lift chairs. If they don’t, perhaps they can refer you to another local company that does. Best of luck to you and your mom!

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September 17, 2014 at 5:54 am, Rita Salley said:

bought a lift chair, w/partial reimbursement from Medicare about six years ago — warranty has expired. The chair malfunctioned, the manufacturer referred us to the technician who came to the house three times and finally replaced the remote and billed $370.00 Can you advise on possible reimbursement from Medicare and what the process might be? Thank you, Rita Salley

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October 29, 2014 at 9:27 am, Ashley Plauche said:

Rita, that’s a great question with a tricky answer. Medicare pays for the lift mechanism only; the rest of the seat lift chair is considered non-covered furniture. Since the problem is with the remote (an accessory to the furniture), I don’t believe Medicare will will cover the repairs. The “useful life” of the equipment is 5 years per Medicare guidelines, so the person may qualify for a new mechanism at this point as long as he/she meets the medical necessity needs. This is confusing for some, though, since Medicare is paying 80% of the allowable for the mechanism (fee schedule determined by region), and the 20% copay and cost of the “chair” above and beyond this is paid out of pocket by the beneficiary. Hope this helps!

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September 26, 2014 at 3:38 pm, JE Schneider said:

Will they cover a second chair after a lapse of time?

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October 29, 2014 at 9:19 am, Ashley Plauche said:

Medicare will pay for medically necessary equipment after the original equipment’s useful life, which for a seat lift chair is considered to be 5 years.

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November 19, 2014 at 9:56 pm, Judy Smith said:

My mother is 79. She has rheumatoid arthritis and osteoarthritis. She had a hip implant in 2005 which is degenerating. She has a very hard time pushing herself up from the couch or a chair. Sometimes, she just can’t do it on her own. She has a Humana/ Medicare Replacement Card. Is this the same as having just Medicare in getting a lift chair or would she maybe be able to get more help from Humana also? It’s hard watching her use all of her energy and strength just trying to stand up. She is able to use a walker once she is on her feet but it tires her out.

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November 20, 2014 at 9:34 am, Ashley Plauche said:

Judy, based on what you shared, I would think that Humana would cover the seat lift mechanism for your mother. Please note, insurers are looking for “severe arthritis of the hip or knee”, so those particular body parts would have to be affected as part of her general rheumatoid arthritis and osteoarthritis. The fact that she can ambulate once standing helps her show the need as well.

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