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Does Medicare Cover Patient Lifts?
Medicare will help cover the cost for a patient lift if it has been deemed medically necessary by your doctor. There are a number of different types of lifts and each will have different criteria for you to qualify for coverage. In order to get covered by Medicare you must take the following steps:
- Only your doctor can prescribe the equipment for you, so do not order anything until you have visited your doctor, no matter what the sales person tells you.
- The doctor must document the need in your medical records and give you a signed and dated order (prescription) for the equipment.
- The order must be received by the supplier before Medicare is billed and it must be kept on file by the supplier.
- If you receive your Medicare through a Medicare Advantage Plan (like a HMO or PPO) it is likely you will have to follow the plan's steps for approval and purchase. Make a point of calling your plan's customer service number and ask about their steps for coverage of a patient lift.
How Do I Qualify For a Lift?
You must have Medicare Part B coverage and you must be assessed by your doctor. Your doctor needs to document the need in your medical records, and write an order (prescription) for the equipment. The supplier must have the order on file before billing Medicare for the chair. Each type of lift will have its own set of criteria for you to qualify. For example:
In order for Medicare to help pay for a bed lift:
- You must need the help of at least two people to be transferred from the bed to a chair, wheelchair, or commode.
- You would be confined to the bed without the use of a lift.
In order for Medicare to pay for a seat lift mechanism, you must have one of the following:
- You must be suffering from severe arthritis of the hip or knee
- You have a severe neuromuscular disease.
- You must be completely incapable of standing up from any chair, but once up, you can walk either independently or with the aid of a walker or cane.
- Your doctor must believe that the lift will help improve, slow down, or stop the deterioration of your condition.
Lifts require a Certificate of Medical Necessity. Your doctor and the Medicare supplier will know when that documentation is required.
How Much Does it Cost to Rent or Buy a Lift?
After you have paid your annual deductible, you will pay 20% of Medicare-approved amounts for the lift purchase or rental and maintenance. Those costs may be higher if the supplier doesn't accept assignment. Patient lifts are in the "Capped Rental" category, which means you may choose to rent or purchase it.
Once Medicare has made 10 monthly rental payments you will be given an opportunity to purchase the lift. The supplier will send you a "Purchase Option" letter in the ninth month of the rental. You will have 30 days to reply.
If you reply and want to buy your lift:
- Medicare will make three more payments, and the lift is yours.
- Medicare will cover 80% of maintenance costs, but it is your responsibility to find a Medicare-approved supplier to cover the costs.
If you do not answer or choose to continue renting:
- Medicare will make a total of 15 rental payments, and the lift is yours to use as long as you need it.
- The supplier keeps ownership of the chair and is responsible for maintaining it.
Where Do I Purchase Lifts?
You will save money if you order your items from a Medicare-approved provider. Suppliers must meet strict standards to qualify as a Medicare supplier and will have a Medicare supplier number. You may also buy your lift from any store that sells them. However, if the supplier from which you order your lift is not enrolled in Medicare, Medicare will not pay for it.
Things you should know about before you choose a supplier:
- There are two types of Medicare suppliers: participating suppliers and those who are enrolled but have chosen not to participate.
- Participating suppliers will not charge more than the Medicare allowed amount.
- A Medicare-approved supplier who does not want to participate can charge more than the Medicare-approved amount. However, they cannot charge more than 15% above the Medicare-approved amount. They may also ask you to pay the entire bill when you pick up your lift. In this situation, Medicare will send the reimbursement directly to you. However, be prepared to wait; it may take a couple of months to receive payment.
- If you receive your Medicare coverage through a Medicare Advantage Plan (like an HMO or PPO), it is likely that the plan will have its own steps for the purchase. In addition, the plan may have restrictions on the supplier from which you can buy. It is important to know that your health plan must supply at least what Medicare covers -- they cannot supply less. It is wise to call your Medicare Advantage Plan's customer service and ask about your coverage before you order your lift.
Will Medicare Pay for Electric Lifts and Accessories?
Medicare does not cover electrical lift devices. They are considered a convenience feature. However, you can apply the cost of the manual lift towards the purchase price of an electric model by using an Advance Beneficiary Notice (ABN). You will have to pay the difference between the two items.
Medicare will only pay for the lift mechanism portion of chair lifts. The chair portion of the package is not covered, and you will be responsible for paying the full amount for the furniture component of the chair.
Options/accessories for lift devices are covered when:
- The lift itself is considered medically necessary; AND
- The options or accessories are necessary for the member to get full use of the lift.