How Can I Get Medicare Reimbursement for a Lift Chair?

Understanding Medicare Coverage for Lift Chairs

Medicare may provide partial reimbursement for lift chairs if certain conditions are met. However, it’s important to understand that Medicare typically only covers the motorized lifting mechanism, not the entire chair itself. The reimbursement amount is usually around $280-$300, with some secondary insurance potentially covering an additional $50.

Steps to Obtain Medicare Reimbursement

To pursue Medicare reimbursement for a lift chair, follow these steps:

Consult your doctor: Schedule an appointment to discuss your need for a lift chair. Your doctor must determine it’s medically necessary and provide a prescription.

Obtain a Certificate of Medical Necessity: Your doctor will need to complete this form, detailing your medical condition and why a lift chair is required.

Find a Medicare-approved supplier: Locate a local supplier that accepts Medicare assignment. You can use Medicare’s online directory to find approved vendors in your area.

Purchase the lift chair: Buy the chair from the approved supplier. You’ll likely need to pay the full amount upfront.

Submit for reimbursement: Work with your supplier to submit the necessary paperwork to Medicare, including your prescription and Certificate of Medical Necessity.

Qualifying for Medicare Coverage

To be eligible for Medicare reimbursement, you must meet specific criteria:

• Have severe arthritis of the hip or knee, or a severe neuromuscular disease
• Be unable to stand up from a regular chair in your home
• Be able to walk independently or with the aid of a walker once standing
• The lift chair must be part of your doctor’s treatment plan

Maximizing Your Reimbursement

• Consider secondary insurance: If you have a Medicare Supplement (Medigap) plan, it may cover the 20% coinsurance that Medicare doesn’t pay.
• Keep detailed records: Maintain copies of all prescriptions, medical necessity forms, and receipts.
• Follow up: If you don’t receive reimbursement within a reasonable timeframe, contact Medicare or your supplier to check on the status of your claim.

Additional Considerations

• Medicare Advantage plans: If you have a Medicare Advantage plan, contact your plan provider directly to understand their specific coverage and reimbursement process for lift chairs.
• Out-of-pocket costs: Remember that you’ll be responsible for the cost of the chair itself, as Medicare only covers the lifting mechanism.
• Explore alternatives: If Medicare reimbursement isn’t sufficient, consider other options like rental programs or financial assistance from local organizations.