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.
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.
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.