Does Medicare Cover Hoyer Lifts ?

If you are a caregiver, and you have a weak elderly loved who can no longer get in and out of bed without a lot of physical assistance, you may have been looking at patient lifts, such as a Hoyer lifts. And once you have seen the price, you may be wondering how you are going to pay for one. Well…

Original Medicare Part B typically offers 80% coverage for manual full-body, or stand-assist Hoyer lifts, if they are prescribed for you by a Medicare-enrolled physician, and bought from a Medicare-enrolled supplier. Medicare will usually rent the Hoyer lift, rather than buy it.

What are Hoyer lifts ?

Hoyer is a popular brand of patient lift.

A patient lift is designed for individuals who are bed bound, and would otherwise require the assistance of several carers to move them from their bed.

Patient lifts can transfer individuals to a chair, a wheelchair, a bedside commode or another location.

Hoyer makes a number of different types of lift, of which Medicare partially covers certain manual full-body patient lifts and the stand-assist patient lifts.

The Hoyer ceiling lifts are considered to be a home modification, and are not covered by Medicare.

It is perfectly possible to use a patient lift to lower a disabled person onto a toilet, or into a bathtub, but patient lifts are not to be confused with a bath lift or toilet lift, which are separate devices which attach to the toilet, or sit in the bath, and are not capable of transferring a patient from location to another.

You can find the coverage determination for all the devices at CMS.gov – Center for Medicare and Medicaid Services – in the National Coverage Determination (NCD) for Durable Medical Equipment Reference List (280.1) which you can read here.

Hoyer patient lifts can be either manual or electric (some models can have both).

What are the Medicare guidelines for patient lift coverage ?

Medicare’s guidelines for awarding coverage apply to any brand of patient lift, not just a Hoyer lift.

Original Medicare Part B will typically offer 80% coverage for a manual/hydraulic full-body lift, or a stand-assist lift, as durable medical equipment “for use in the home”, so long as the lift has been prescribed by a Medicare-enrolled physician and certified as “medically necessary” as defined in the Medicare guidelines for a patient lift.

You will likely qualify for Original Medicare Part B coverage for a patient lift –

If you cannot get from your bed to a chair, a wheelchair or a commode without the use of a lift, and would otherwise be confined to the bed.

The codes for the patient lifts covered if you qualify under the first set of basic criteria –

E0630, E0635, E0639, E0640

You will likely qualify for Original Medicare Part B coverage for a multi-positional patient transfer system –

If you meet the criteria above, and also need to be transferred in a supine position, which simply means lying horizontally and face up.

The codes for the multi-positional covered by the two different sets of criteria –

E0636, E1035, E1036

Hoyer Lift Medicare documentation

If you want to see the exact Medicare guidelines under which they will grant coverage for a patient lift, you can find that here.

Hoyer lift rentals

Hoyer lifts, and all other patient lifts, are in what Medicare calls their  “Capped Rental” category.

You can choose to purchase, or rent, from a Medicare-approved supplier.

You will pay your annual deductible (if you haven’t already),  your 20% co-insurance of the Medicare-approved price and maintenance – if you used a Medicare-enrolled equipment supplier who accepts assignment. If your supplier does not accept assignment, you may pay up to 15% more.

For rental –

After Medicare has made 10 monthly rental payments, you will be given the option to buy the patient lift.

You will be notified in the 9th month about the “purchasing option”, and you will need to reply inside 30 days.

If you decide to buy the lift, Medicare will make 3 more payments and the lift is yours – Medicare will cover 80% of the maintenance costs, and you will need to find a supplier for that.

If you want to continue renting, Medicare will pay until it has reached 15 payments, and you can use it as long as you wish – the patient lift will belong to the supplier, and they will also be responsible for its maintenance.

How much does it cost to rent a Hoyer lift ?

The patient lifts that Medicare covers cost between roughly $900 – $1600.

How much does it cost to buy a Hoyer lift ?

 
If you are buying a Hoyer lift from a Medicare-enrolled Participating supplier (this means he accepts assignment, meaning the Medicare-approved price only) the cost of a Hoyer lift is between roughly $900 – $1,600.

If you are buying it from a Medicare-enrolled supplier, who does not accept assignment, it can cost up to 15% more.

If you have Medicare coverage, you will pay your co-insurance of 20% of the price, and Medicare will pay 80% of the Medicare-approved, and if you have not paid your deductible already for the year, you will have to pay that as well.
 

Does Medicare cover electric Hoyer lifts ?

Should you qualify with Original Medicare Part B for coverage of a patient lift, it will be for a manual patient lift, as Medicare does not offer coverage for electric patient lifts – they are listed as being convenience items which are to be “denied”.

Medicare approved Hoyer lift dealers

Medicare works with Medicare-enrolled suppliers that Medicare has pre-approved, and who have been shown to work to a certain standard.

To find a Medicare-enrolled supplier, you can get to the Medicare website and use their supplier locator to find one near you.

Click here to go to the Medicare.

Just enter your zip code, as you can see on the screenshot of their web page below, and you will get a list of suppliers in your area.

Does Medicare cover lift chairs ?

Lift chairs come under the category  “seat lifts” for Original Medicare.

Only mechanical/hydraulic seat lifts may be considered if all the criteria are met.

Original Medicare Part B only partially covers lift chairs – they will typically give 80% coverage for the mechanical part of a lift chair for use in the home, and only when it has been prescribed as “medically necessary” by a Medicare-enrolled physician.

The Medicare guidelines for coverage for a seat lift mechanism are the following –

“Indications and Limitations of Coverage

Reimbursement may be made for the rental or purchase of a medically necessary seat lift when prescribed by a physician for a patient with severe arthritis of the hip or knee and patients with muscular dystrophy or other neuromuscular diseases when it has been determined the patient can benefit therapeutically from use of the device. In establishing medical necessity for the seat lift, the evidence must show that the item is included in the physician’s course of treatment, that it is likely to effect improvement, or arrest or retard deterioration in the patient’s condition, and the severity of the condition is such that the alternative would be bed or chair confinement.”

Source: National Coverage Determination (NCD) for Seat Lift (280.4) – which you can find here.

More simply, the criteria for coverage for a Seat Lift are –

• you must have severe arthritis of the hip or knee or neuromuscular disease
• you must be incapable of standing up from a standard chair with or without arms in the home
• the seat mechanism must be part of the physician’s course of treatment for you to “effect improvement, or to arrest or retard deterioration” in your condition
• once you stand, you are able to walk

Lastly, Original Medicare Part B does give coverage to seat lifts mechanisms with a spring release mechanism, and which “jolt you up to a standing position”, and which do not have a recliner which can return you smoothly and gently to a seated position.

How to find a lift chair supplier ?

Your physician will doubtless indicate to you equipment suppliers who are approved by Medicare.

But you can also go here to the Medicare.gov website and use their Medicare-enrolled supplier locator tool.

Just enter your zip code into the area as seen on the screenshot below, and you will get a list of suppliers in your area.

Will Medicare pay for a stair lift ?

Original Medicare Part B does not cover stair lifts, as they are classed as electric seat lifts which are classified as a “convenience“, and are not considered durable medical equipment, or as “medically necessary“.

You can find the coverage determination in the National Coverage Determination (NCD) for Durable Medical Equipment Reference List (280.1) which you can read here.

Some Medicare Advantage plans may soon cover stair lifts as an extra benefit they will be allowed to offer as part of the new policies for individuals with chronic illnesses and diseases.

Will Medicare pay for a wheelchair lift ?

Original Medicare Part B does not offer any coverage for wheelchair lifts for use in the home, as they are not considered “medically necessary” and so are not included in the category of durable medical equipment by Medicare.

Does Medicare cover bathroom equipment  ?

The following items for bathroom safety are just some of what is not covered by Medicare –

• grab bars
• raised toilet seats 
• bath lifts
• floor to ceiling poles
• shower chairs
• bath chairs
• toilet safety frames

This is because bathroom safety equipment is not “medically necessary” according to Medicare, and is stated to be “primarily not medical in nature” and either for “convenience”, or “for comfort”.

The result of this is that you are not going to be able to find much bathroom equipment that Original Medicare Part B does give coverage to.

There is though equipment that Medicare will typically give 80% coverage to under Original Medicare Part B that you can use in the bathroom to help with safety, if you have serious mobility issues, and you qualify.

Medicare covers –

• walkers
• bedside commodes
• crutches

Walkers –

• can also be used in the shower as an aid to standing if they are waterproof – don’t use in the shower if they are not
• can be used as an aid for getting into and out of a shower which has a step – something which my mom has been doing for over a year
• can be used to help sit down and stand up from  the toilet
• can be used to stand at different counter tops in front of a mirror

Bedside commodes –

• can be used as a bedside commode
• can be used as a raised toilet seat
• can be used as a safety frame for the toilet
• waterproof models only – can be used as a shower chair
• can be used as a simple chair to sit on in the bathroom for personal grooming

Luckily for some, Medicare Advantage Plans, or Medicare Part C, is different from Original Medicare, in that they are now being allowed to offer more benefits.

Medicare Advantage Plans are being permitted to offer benefits for individuals with chronic illnesses, and some of which include bathroom safety equipment for certain illnesses. You will of course have to find the plans with the benefit you are looking for, but they are now out there.

I have an article about bedside commodes being used as shower chairs in which I explain that there are certain multifunctional bedside commodes which are for use as a shower chair, and I outline those in the article and give examples of the different types and models. You can find that here.

You can find out about the Medicare and bedside commodes in this article, and if you don’t qualify for a bedside commode, I have outlined some other programs such as Medicaid, HCBS waivers, State Assistive Technology Projects and non-Medicaid State Financial Assistance Programs here.

Crutches – these can obviously be used to help you stand anywhere you may be – but having had 6 years experience with them, I would make sure you have special no-slip ferrules (tips) if you or a loved one will be using them anywhere there are slippery surfaces and water.

I would never use them in a shower and if you cannot stand without them, I would use some form of shower chair, or bath chair, you could really hurt yourself.

What type of equipment will Medicare Part B cover ?

Original Medicare Part B will cover certain durable medical equipment for use in the home if it is “medically necessary”.

Durable Medical equipment is equipment which is not disposable, such as gloves and bandages, which are classed as disposable medical supplies.

So long as all the Medicare criteria are filled and rules are followed, Medicare Part B will typically give a coverage of 80% to those who qualify.

There is a list in this article of qualifying Durable Medical Equipment typically covered by Original Medicare Part B, which you can jump down to see here.

For Medicare to cover Durable Medical Equipment, the equipment must meet the following criteria :-

• Durable (can withstand repeated use)
• Used for a medical reason
• Not usually useful to someone who isn’t sick or injured
• Used in your home
• Generally has an expected lifetime of at least 3 years

Source: Medicare.gov website – here

Medicare gives coverage to equipment like wheelchairs, crutches and walkers, which are seen as “medically necessary”.

For equipment which gets coverage, Original Medicare Part B typically covers 80 % of the cost of any durable medical equipment, and you will be responsible for your coinsurance of 20% of the medicare-approved price, and, if it applies, your annual policy deductible.

The equipment that Original Medicare Part B won’t give any coverage, is that which it refers to as “comfort or convenience items“, such as shower chairs, air purifiers or a wigs. 

Many times electric versions of equipment are all labelled as “convenience items” and not covered by Medicare, but the manual version may well be covered.

How do you qualify for coverage from Medicare Part B for DME ?

Partial coverage from Original Medicare Part B for Durable Medical Equipment for “use in the home” is typically only given if you meet the following criteria –

• you are enrolled in Original Medicare Part B
• you have your Medicare-enrolled doctor sign a prescription certifying that the equipment is a “medically necessary”
• you purchase or rent the DME through a Medicare-enrolled supplier

For Original Medicare coverage, what is “living at home” ?

Original Medicare defines “living at home” as –

• living in your own home
• living in the family home
• living in the community, such as assisted living

Now you have a signed prescription what do you do with it ?

If your physician decides that your condition qualifies for coverage, they will give you a signed prescription for a patient lift which you will take to get your lift –

• to start with, you’ll need to find a Medicare-enrolled DME supplier – your physician will know of some, but you can also use the link to the supplier locator in the next section of this article
• as far as suppliers go, only use a Medicare-enrolled “participating” supplier who accepts “assignment” – it will keep your financial participation as low as possible
• with the supplier’s help you are going to choose the equipment which corresponds to your prescription – the prescription will have special codes which indicate the type of equipment you are allowed
• be careful to make sure that you have done all the paperwork with the supplier correctly, and in line with Medicare’s guidelines

Original Medicare part B typically covers 80% of the Medicare-approved price for your DME if you follow the process correctly and use the right equipment supplier.

If you do purchase or rent your DME from a Medicare-enrolled “participating” supplier who accepts assignment, you are responsible for paying your Medicare 20% coinsurance payment of the Medicare-approved price of the DME, and also your annual policy deductible if that applies.

Use the Medicare locator to find a Medicare-enrolled supplier near you

You can use this link to Medicare.gov to find a Medicare-approved supplier who is local to you –  here.

Do Medicare Advantage Plans cover Hoyer lifts ?

Medicare Advantage plans, also known as Medicare Part C, will cover everything that is covered by Original Medicare Parts A and B.

Advantage Plans are offered by private companies who are contracted by Medicare to provide, as a minimum, the same services as Original Medicare Parts A and B.

If you pass the Medicare criteria for receiving partial coverage for a Hoyer lift, you will get the same cover from an Advantage plan.

With regard to how to get coverage, which doctor to use, where to find a supplier, and co-payments, this all depends on who your provider is, and who is in their network, and it’s with them, that you will need to discuss how to proceed.

This is the list of durable medical equipment which is typically covered by Medicare

To qualify you will need to have Original Medicare Parts A and B.

Air-Fluidized Bed
Alternating Pressure Pads and Mattresses
Audible/visible Signal Pacemaker Monitor
Pressure reducing beds, mattresses, and mattress overlays used to prevent bed sores
Bead Bed
Bed Side Rails
Bed Trapeze – covered if your loved one is confined to their bed and needs one to change position
Blood sugar monitors
Blood sugar (glucose) test strips
Canes (however, white canes for the blind aren’t covered)
Commode chairs
Continuous passive motion (CPM) machines
Continuous Positive Pressure Airway Devices, Accessories and Therapy
Crutches
Cushion Lift Power Seat
Defibrillators
Diabetic Strips
Digital Electronic Pacemaker
Electric Hospital beds
Gel Flotation Pads and Mattresses
Glucose Control Solutions
Heat Lamps
Hospital beds
Hydraulic Lift
Infusion pumps and supplies (when necessary to administer certain drugs)
IPPB Machines
Iron Lung
Lymphedema Pumps
Manual wheelchairs and power mobility devices (power wheelchairs or scooters needed for use inside the home)
Mattress
Medical Oxygen
Mobile Geriatric Chair
Motorized Wheelchairs
Muscle Stimulators
Nebulizers and some nebulizer medications (if reasonable and necessary)
Oxygen equipment and accessories
Patient lifts (a medical device used to lift you from a bed or wheelchair)
Oxygen Tents
Patient Lifts
Percussors
Postural Drainage Boards
Quad-Canes
Respirators
Rolling Chairs
Safety Roller
Seat Lift
Self-Contained Pacemaker Monitor
Sleep apnea and Continuous Positive Airway Pressure (CPAP) devices and accessories
Sitz Bath
Steam Packs
Suction pumps
Traction equipment
Ultraviolet Cabinet
Urinals (autoclavable hospital type)
Vaporizers
Ventilators
Walkers
Whirlpool Bath Equipment – if your loved one is home bound and the pool is medically needed. If your loved one isn’t home bound, Medicare will cover the cost of treatments in a hospital.

Prosthetic and Orthotic Items

Orthopedic shoes only when they’re a necessary part of a leg brace
Arm, leg, back, and neck braces (orthotics), as long as you go to a supplier that’s enrolled in Medicare
Artificial limbs and eyes
Breast prostheses (including a surgical bra) after a mastectomy
Ostomy bags and certain related supplies
Urological supplies
Therapeutic shoes or inserts for people with diabetes who have severe diabetic foot disease.

Corrective Lenses

Prosthetic Lenses
Cataract glasses (for Aphakia or absence of the lens of the eye)
Conventional glasses or contact lenses after surgery with insertion of an intraocular lens
Intraocular lenses

Important: Only standard frames are covered. Medicare will only pay for contact lenses or eyeglasses provided by a supplier enrolled in Medicare, no matter who submits the claim (you or your supplier).

Free help understanding Medicare

SHIP – State Health Insurance Assistance Programs 

If you are having trouble with understanding your benefits you can get free counseling for Medicare, Medicaid and Medigap are available from your SHIP program.

To find your SHIP just follow my quick guide – “Free Help Understanding Medicare And Medicaid ? Here’s Where You Get It”.

Is a Hoyer lift covered by Medicaid ?

Medicaid is funded both federally and by the individual states, which makes it a very different system from Medicare.

Due to its funding structure (the fact that the states are contributing funds), Medicaid will often agree to let a state waive some qualifying requirements for its different programs.

“Waivers” is the name given to such programs.

Waivers are designed by the different states to offer assistance to a new demographic which otherwise be missing out – many waivers across the US are specifically helping the elderly to remain living independently in their homes, and they will offer, amongst other things, financial assistance with DME.

Due to the hundreds of different waivers, what can be considered Durable Medical Equipment on the waivers can vary greatly state by state.

Health Care in the home – Medicaid and state programs

The programs aimed specifically at low income families, the disabled and the elderly for “in the home” care, and designed to help the beneficiary maintain their independence are called “Home and Community Based Services” (HCBS), “Waivers” or “1915 Waivers”.

To help with the maintaining of independence in the home, the programs and waivers, offer assistance with “home medical equipment” – DME – and often cover as much as 100% of the cost.

You can check your eligibility for any programs by contacting your State Medicaid Agency here.

If you want more in depth information on HCBS programs, or waivers, you can go here on Medicare.gov –  https://www.medicaid.gov/medicaid/hcbs/authorities/index.html

These programs use the term “home”  to mean the following –

• their own home
• their family home
• a group home
• an assisted living facility
• a custodial care facility

Programs and waivers which  may offer greater breadth in their interpretation of DME covered for care in the home

Two types of state programs which are often more generous with durable medical equipment are  –

HCBS programs and waivers which employ a particular system of participant budget management called, either –

“Consumer Direction”

or

“Self Direction” 

To find out more about Medicaid Self Direction, click here.  

The Medicaid program “Money Follows The Person”

The program was initially set up by Medicaid to give help to elderly adults who were transitioning from living in nursing homes, back to living in their own homes.

The program’s goals remain the same, but it now funds individual states to either build their own new “Money Follows The Person” program in their state, or to modify one of their existing programs.

“Money Follows The Person” funds what is necessary for the program participants to make the transition back to their homes and to live safely and independently in them again.

Funding can go as far as remodeling parts of the home to make program participants safer and their lives easier, or it may just provide the most basic DME needed.

The range of DME is really determined by what is needed for the transition to be made.

How to find the HCBS programs, waivers and 1915 waivers in your state

If you are interested in finding out which Medicaid HCBS waivers and programs are available for seniors in your state, check my guide listing all programs and waivers by state.

You will also find the Money Follows The Person Programs and PACE Programs (Programs of All-inclusive Care for the Elderly).

The guide is here – “Medicaid Home and Community Based Services Waivers and Programs For Seniors Listed By State”.

What is the procedure for applying to Medicaid, state waivers and HCBS programs for DME coverage ?

Step 1

– the doctor, or therapist, has to provide a medical justification letter, stating it is medically necessary

Step 2

–  find a Medicaid-approved DME supplier, and give them the medical justification letter

Step 3

– the Medicaid-approved supplier fills out a Prior Approval Application form for Medicaid

Step 4

– the Prior Approval Application is sent to the Medicaid State Office

Step 5

– if you are unsuccessful you will be contacted  and given the reasons as to why, as well as advice on how to make an appeal

Step 6

– if approved, you will receive the DME

If your income is a bit too high to qualify for Medicaid

Spend Down Programs

Spend Down programs serve as a way of helping people to lower their income, or income + assets, to become eligible for Medicaid coverage.

The programs use several methods –

• Income Spend Down
• Asset Spend Down

I have an article on how it works, which you can find here – What is Spend Down ?

To locate your Medicaid State Agency

If you want to discuss things, or to email someone, you can contact your state Medicaid Agency here.

Step 1 –

Click the link to Medicaid.gov and look for the section that I have outlined in red.

Step 2 –

Select your state and click on the button they have marked “GO” – it will take you to your State Medicaid Agency with all their contact info.

State assistance and funding for the elderly

State Assistive Technology Programs

State Assistive Technology Programs are funded by a federal grant for all states to improve access to assistive devices in the home, with the primary focus groups being elderly and disabled individuals.

The programs will maintain a number of services throughout the state, and those which are of the greatest interest to us here, are  –

• online equipment exchanges on which you can post assistive devices and medical equipment for sale, donating or exchanging – state residents can all register on their state exchange website and participate
• your state will have  central State Assistive Technology Program website where you can make contact to find out about who is eligible for help, and on how to gain access to free or low cost equipment (there are usually a lot of demonstrations of equipment in centers and information on community groups)
• equipment reuse, recycling and refurbishment programs and centers run by the state project, or by their partners – usually community groups and non-profit organizations – providing free, or low cost used equipment for the disabled, the elderly and other disadvantaged individuals
• equipment loan closets can also be part of the programs, and the loans can be short or long term loans, or both, depending on the loan closet

Assistive Technology Programs will also help to find equipment for elderly and disabled individuals who make contact and enroll with the programs.

All the information will be on your State Assistive Technology Program website.

Find out about your State Assistive Technology Project here.

Follow the steps outlined below once you have clicked on the link to find out about what is on offer in your state.

Step 1/

Pick your state on the map or the drop-down menu, and click on “Go to state”

– I chose Florida for this example

Step 2/

Click on the link “Program Title” – for my example, I outlined it in red.

Step 3/

The AT Program state website will come up, and you can sign up, or use their contact info.

State Financial Assistance Programs

In the US there are also, in a number of states, non-Medicaid state programs which are designed to assist the elderly and the disabled financially to maintain their independence in their own homes – these are usually known as State Financial Assistance Programs.

State Financial Assistance Programs can cover quite a range of assistive devices, safety equipment and home modifications, to help the elderly beneficiary maintain their independence, and they can do this by giving grants or loans, or a combination of the two.

To get more information on whether your state has a State Financial Assistance Program contact your local Area Agency on Aging – you can locate one near you here.