Does Medicare Pay for Patient Lifts?
When I am doing a home assessment with a client, one of the #1 questions I get asked when making a recommendation for a piece of medical equipment, is “Does my insurance cover that?” If you are looking at purchasing a patient lift system, this is an important detail to consider when making your decision. All the information in this blog post is specific to Medicare coverage. Most Medicare supplement plans and private insurances also follow these rules, but it is best to contact your insurance provider for specific plan coverage prior to making a decision. The medical supplier or vendor can often help with this information as well.
Does Medicare pay for Hoyer lifts?
The quick answer to “Does my Medicare pay for a patient lift?” is, yes. But only under certain circumstances and only for specific types of lifts. Medicare will cover 80% of the cost for a manual Hoyer lift. You will be responsible for the 20% coinsurance, unless you have a secondary insurance that covers this amount. If you have secondary insurance, you will likely not have any cost associated with the lift. To learn more about the types of patient lifts that are available, please visit our posts on “What are the Different Types of Hoyer Lifts?”, “What are the different types of Sit-to-stand Lifts” and “What is the Difference between a Hoyer Lift and a Sit to Stand Lift?”
When you use your Medicare benefits to obtain a Hoyer lift, you will be receiving the lift as a “rental,” initially. This rental period is a 13 month period. This means, that when you get the lift, you will pay an initial fee, and then will a small monthly payment for 13 months to spread out the cost of the 20% coinsurance. Once the 13 week “rental” period is over, you will officially own the device and will no longer make any payments.
If you are looking to get an electric lift, or a sit-to-stand lift, You can still use your insurance benefits, but Medicare will only cover the amount approved for a manual Hoyer lift. You will be responsible for paying the “upgrade fee” to cover the difference in cost. This upgrade free varies by vendor and by the type of device you want to upgrade to. The vendor will be able to tell you what the fee will be, depending on your specific insurance and the type of device.
What qualifies someone for a Hoyer lift?
For Medicare to pay for a Hoyer lift, the patient must meet certain criteria. Medicare guidelines state that “A patient lift is covered if transfer between bed and a chair, wheelchair, or commode is required and, without the use of a lift, the beneficiary would be bed confined.” This means that if the patient did not have a lift, that they would not have a safe means of getting from the bed to their wheelchair, toilet, or chair. This information must be thoroughly documented in the patient’s medical record by a doctor and/or therapist. It takes a team to get a lift. There is a coordinated effort between the doctor’s office, the vendor, the insurance company, and sometimes a therapist. The vendor will help coordinate these efforts to make sure that all the documentation is in place for the insurance company, for approval.
What if I only need the lift for a short time?
If you anticipate that you will only need the lift for a short time (a few months), you may not need to go through the process of getting it through your insurance. Many vendors have the option to do a private-pay short-term rental. This gives you the option to pick whatever device you want to use, only for the time you need it. No one wants to be stuck with a bulky device taking up space in their home if you only need it temporarily. Insurance, in most cases, does not cover equipment rentals.
What are my options if the lift is not covered?
If you are trying to get a lift that is not covered by your insurance plan, you may still have some options. For example, Medicare does not cover ceiling lifts. Many vendors have the ability to forego charging sales tax on a device, as long as you have a doctor’s prescription for it. If you are looking to buy a fancier lift, this can save you a significant amount of money. This is a question you will want to ask the vendor before you purchase.
Do I have to use insurance benefits to get a lift?
No. You have the right to use your insurance or pay out of pocket for a lift. You can talk to a vendor and get the estimated cost of the 20% coinsurance or the upgrade fee and do the math to see if the coinsurance cost is less than purchasing one outright. In some cases, it may be cheaper to pay out of pocket, but if you have a secondary insurance policy, insurance benefits can really save on costs.
What if I have questions?
There are several people who can help you make decision in this process:
Primary Care Doctor: They can help determine how long someone may be in need of a device, and can help by providing documentation and a prescription for the device
Therapist: An occupational therapist or physical therapist can help by completing a home assessment to evaluate the patient and their home environment to determine which type of lift will best meet your needs.
The Vendor: They can provide detailed information on what is covered by your individual insurance policy and what costs will look like. Some vendors take insurance, and some vendors are private pay only. Some will offer both options. Feel free to shop around and ask lots of questions. Questions to ask:
Do you accept insurance?
What will my coinsurance payment look like?
What is the upgrade fee if I choose to upgrade?
What will be the estimated timeframe of delivery?
For more information, feel free to check out our other blogs on:
What is the Difference Between a Manual and Electric Patient Lift?
What is the Difference Between a Hoyer Lift and a Sit-to-Stand Lift?
If you have questions about how to provide safe care in the home and choosing adaptive equipment, also feel free to check out our publication A Therapist’s Guide to Caregiving for a comprehensive guide on medical equipment and caregiving techniques. Also, feel free to check out our full video training course for detailed video instruction, or our mini-courses for step-by-step training for how to use Hoyer Lifts or Sit-to-Stand Lifts.
Resources:
https://www.medicare.gov/coverage/patient-lifts
https://www.cms.gov/medicare-coverage-database/view/lcd.aspx?LCDId=33799
This course provides you with all the information that you need to safely and effectively use a hoyer lift in the home. This course includes 40 minutes of comprehensive video instruction along with electronic access to the 20-page PDF guide. This course will teach you how to properly position and adjust a hoyer lift sling at bed and chair level, how to determine the loop setting, and how to complete safe, smooth transfers to the bed, wheelchair, recliner, and bedside commode.
This course provides you with all the information that you need to safely and effectively use a sit-to-stand lift in the home. This course includes 18 minutes of comprehensive video instruction along with electronic access to the 15-page PDF guide. This course will teach you how to properly position and adjust a sit-to-stand lift sling, how to determine the sling loop setting, and how to complete safe, smooth transfers to the bed, wheelchair, recliner, and bedside commode.
This is your comprehensive guide to giving you with the skills you need to provide safe, effective, and compassionate care to family members, friends or clients in the home. This course includes 6 hours of instructional video covering client basic adaptive equipment, functional mobility, lifting techniques, transfers, self-care skills, bed level care, use of client lifts and transfer devices, and managing falls. Click "Preview Caregiver Course" below to preview the lessons and descriptions.
A Therapist’s Guide to Caregiving
The book includes 170 pages of full-color, step-by step instructions, to provide you with all the skills you need to provide safe, thorough, and compassionate care at home.
