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Lifts and Medicare

Lifts and Medicare

Does Medicare Cover Patient Lifts?

Medicare partially covers full-body or stand-assist patient lifts as durable medical equipment (DME), if it has been prescribed by your doctor. In order to get covered by Medicare you must take the following steps:

  • Work with your doctor to obtain a prescription for a patient lift.
  • For manual hydraulic patient lifts: your doctor may advise you about a Medicare participating DME dealer near your location.
  • If you get Medicare coverage through a Medicare Advantage Plan (like a HMO or PPO), follow the plan's gudielines 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 Manual Patient Lift?

In order for Medicare to help pay for a hydraulic full body lift:

  • You need the help of at least two people to be safely transferred from bed to a chair, wheelchair, or commode.
  • You would be confined to the bed without the use of a patient lift.

 

How Do I Qualify For a Lift Chair?

Medicare will only cover the seat lifting mechanism part, but not the entire chair itself. The reimbursement amount is around $300, depending on the state. The patient would be responsible for paying the rest of the cost. In some cases it may be cheaper to purchase the lift chair without using Medicare assistance.

In order for Medicare to pay for a seat lift mechanism, you must have one of the following:

  • The patient must be suffering from severe arthritis of the hip or knee, or have severe neuromuscular disease.
  • The patient must be completely incapable of standing up from any chair.
  • Once up, the patient can walk either independently or with the aid of a walker or cane.

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.
  • The supplier keeps ownership of the chair and is responsible for maintaining it.


Where Do I Purchase Lifts?

You can work with a Medicare-approved provider to obtain a manual hydraulic patient lift. 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 get Medicare coverage through a Medicare Advantage Plan (like a HMO or PPO), follow the plan's gudielines 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.


Will Medicare Pay for Electric Lifts and Stand-Up Lifts?

Medicare does not cover electric patient lifts. They are considered a convenience device. 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. In some cases it may be cheaper to purchase an electric patient lift directly from the medical equipment store.

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. In some cases it may be cheaper to purchase a lift chair directly from the medical equipment store.

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.