Does Medicare Pay for a Stair Lift in North Carolina?

Medicare’s Policy on Stair Lifts

Does Medicare cover the cost of stair lifts? It is logical to begin here, as it is a common question relevant to most American seniors. The short, uncomplicated answer is, for all practical purposes, original Medicare does not pay for stair lifts. But Medicare Advantage plans may cover the cost.

There is one possible exception to this rule in regards to original Medicare. Original Medicare might pay for a small portion of the cost if the stair lift has an elevating seat, which helps the rider to sit down and get up from the chair safely. However, such a feature would only be available in a high-end stair chair, which would cost considerably more than the amount original Medicare would reimburse the purchaser. In other words, the amount of financial assistance would be less than the extra cost for a stair lift that has that feature.

Medicare supplemental insurance policies also do not cover stair lifts. These policies are intended to help with co-payments and deductibles for goods and services covered by original Medicare. Since original Medicare does not help, neither would a Supplemental or Medigap policy.

However, as of 2019, Medicare Advantage (MA) plans can offer supplemental healthcare benefits in addition to the already available supplemental benefits, such as vision, dental, and hearing. Previous to this new ruling, services and items that were intended for “daily maintenance” were not allowable benefits. That said, while CMS does not clearly define the term “healthcare benefits,” items and / or services must be medically necessary for the senior in question and advised by a licensed healthcare professional. An item that assists with a functional need due to an injury or health issue, or reduces probable need for emergency care, may fit the bill for an allowable supplemental healthcare benefit. In April of 2019, the Centers for Medicare and Medicaid Services (CMS) brought more good news with the announcement that Medicare Advantage plans in 2020 will be able to offer supplemental benefits for persons with chronic illnesses. These supplemental benefits, which may be tailored to the specific needs of the chronically ill MA recipient, do not necessarily have to be health related. They only need to provide “a reasonable expectation of improving or maintaining the health or overall function” of that individual. Therefore, it is our interpretation that some 2019 Medicare Advantage plans will pay for stair lifts. And that even more MA plans will cover stair lifts in 2020. More clarity will be gained as the new MA plans roll out.

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