Medicare's stance on covering a lumbar chair: Guidelines and qualifications examined
Lift chairs, electronic reclining armchairs designed to help individuals move from a seated position to a standing position or vice versa, may be covered by Medicare under certain conditions. Here's a guide to help you understand the qualifying medical conditions, requirements, and costs involved in receiving Medicare coverage for a lift chair.
To qualify for Medicare coverage, a person must have a doctor's order and complete the Certificate of Medical Necessity CMS-849. The primary qualifying medical conditions for Medicare coverage are severe arthritis of the hip or knee and severe neuromuscular diseases that impair standing from a regular chair.
The functional criteria that must be met include:
- The individual cannot stand up from a regular chair unassisted.
- They must be able to walk independently or with a walker or cane.
- The physician must recommend the lift chair to improve the person’s condition or slow deterioration.
It's worth noting that Medicare usually does not cover lift chairs if the person transfers directly from a chair to a wheelchair.
Medicare typically covers only the lift mechanism (the part that moves the chair), not the entire chair. Coverage depends on Medicare plan types (Part B or C), the state, and provider. For example, Medicare Part B covers 80% of the lift mechanism cost after meeting deductibles, with the patient responsible for premiums, coinsurance, and the cost of the chair itself.
Out-of-pocket costs can vary based on Part B or Part C coverage. Medicare Part C costs depend on the specific plan. The annual deductible for Medicare Part B in 2025 is $257.
A person has the option to rent a lift chair, with Medicare paying its share of the rental cost for 13 months, after which the person becomes the owner. Lift chairs are not typically provided for free, as they can range in cost from hundreds to thousands of dollars.
Medicare supplement insurance (Medigap) may help cover some out-of-pocket costs related to purchasing a lift chair. However, it's important to note that Medigap does not cover the Part B deductible. Also, a person cannot use their Medigap plan with a Medicare Advantage plan.
The lift chair must be purchased from a Medicare-participating supplier that accepts assignment. Medicare Part B covers durable medical equipment (DME), which includes the lifting mechanism in a lift chair.
In summary, to receive Medicare coverage for a lift chair, a person must have a doctor's prescription, meet specific medical conditions and functional criteria, and purchase the lift chair from a provider who accepts Medicare assignment. Out-of-pocket costs can vary based on the Medicare plan, and Medigap may help cover some additional costs.
| Condition / Criteria | Medicare Coverage Eligibility | |--------------------------------------------------------|--------------------------------------------| | Severe arthritis of hip or knee | Yes, if other criteria met | | Severe neuromuscular disease | Yes, if other criteria met | | Cannot stand up from a regular chair unassisted | Required | | Able to walk independently or with walker/cane | Required | | Transfer directly to wheelchair from chair | Not covered | | Physician recommendation to improve or slow decline | Required |
[1] Source: Medicare.gov
- To receive Medicare coverage for a lift chair, individuals should ensure they have a doctor's prescription and complete the Certificate of Medical Necessity CMS-849.
- Severe arthritis of the hip or knee, as well as severe neuromuscular diseases that impair standing from a regular chair, are the primary qualifying medical conditions for Medicare coverage.
- The lift chair must meet functional criteria, including the individual's inability to stand up from a regular chair unassisted, and their ability to walk independently or with a walker or cane.
- Medicare covers only a portion of the lift mechanism cost, with the patient responsible for deductibles, premiums, coinsurance, and the cost of the chair itself, depending on the Medicare plan type and location.
