Medical Alert Systems Covered by Medicare Medical alert systems can save lives, but that doesn’t mean these personal alarms are covered by Medicare

Are Any Medical Alert Systems Covered by Medicare?

Medical alert systems help seniors and vulnerable adults age in place by ensuring their safety and wellbeing in the event of an emergency. These personal alarms alert medical personnel in the event of an emergency. Unfortunately, they aren’t cheap. Users can expect to sign long-term contracts and pay set-up fees, equipment fees, mobile system fees, and/or monthly monitoring costs that can rack up into the tens of hundreds of dollars.

Because these personal emergency response systems (sometimes referred to as Medicare alert systems) provide a critical and potentially life-saving service, it seems logical that they would be covered by Medicare—our country’s health insurance program for seniors. But, think again; medical alert systems are not covered by Original Medicare.

Luckily some programs, including Medicaid and private insurance, provide coverage for personal alarms.

Medicare versus Medicaid

Because of their similar names, Medicare and Medicaid are often confused. Though they’re both government-run programs, they’re operated and funded by different areas of government, and, for the most part, serve two different populations.

Medicare is a federal program that provides health coverage for people who are 65 years or older or those younger than 65 with disabilities, regardless of income.

Medicaid is a federal program administered by individual states that provide health coverage for people with very low incomes.

It’s possible to be eligible for both Medicare and Medicaid, in which case, the two programs work together to provide health coverage at a lower cost.

Medicare and Medicaid look at medical alert service coverage differently.

Medicare Coverage of Medical Alert Systems

Original Medicare coverage includes Part A and Part B. Medicare Part A covers inpatient hospital stays, care in a skilled nursing facility, hospice care, and some home health care. Medicare Part B covers certain doctors’ services, outpatient care, medical supplies, and preventive services. Neither Part A or Part B cover medical alert systems.

There are a few reasons why, explained Dr. Rizza Joyce Mira, medical doctor and writer. “Although these gadgets can provide peace of mind and assistance in an emergency, Medicare does not consider them ‘essential medical devices,’” she said. They are also not considered “medically required,” meaning they do not directly benefit a person’s health in any way.

Medicaid Coverage of Medical Alert Systems

Medicaid is administered by individual states, so what’s covered by Medicaid varies from state to state. Generally speaking, Medicaid plans do not cover personal emergency response systems. “But for seniors who need assistance paying for medical alert systems, Medicaid has many options,” Dr. Mira said. Assistance is provided through Medicaid’s Home Community Based Services and Consumer Directed Services programs.

In some states, Medicaid’s Home Community Based Services program provides waivers for the elderly to receive long-term care services at home rather than in a long-term nursing care facility. These waivers provide modest monthly funding (about $20-$75), which covers the monthly fee of typical medical alert systems.

Medicaid also provides Consumer Directed Services, which provide funding for assistive care. Medicaid does not specify that these funds be used for medical alert monitoring but leaves the decision up to the consumer on how best to use the funds.

What Other Options Do I Have Since Medicare Does Not Cover Medical Alert Systems?

Here are some other programs beyond Original Medicare and Medicaid that may offer coverage for medical alert systems:

Medicare Advantage

Medicare Part C (also referred to as Medicare Advantage), offered by some major private health insurance companies, provides the same coverage provided by Medicare Part A and Part B, plus other benefits such as vision and dental. Depending on the provider, these plans may cover medical alert systems.

For example, we found that Aetna’s Medicare Advantage members have access to the LifeStation discount program, which provides medical alert systems and 24/7 monitoring with no long-term contract for about $20-30 per month.

All Cigna-HealthSpring plans provide discounts on several products and services, including medical alert systems. And, eligible Humana’s Medicare Advantage customers can receive the Philips Lifeline medical alert equipment and monthly services for free.

Contact your Medicare Advantage provider to find out if medical alert system options are included with your plan.

Medigap

Medigap is a Medicare supplement insurance sold by private health insurance companies that helps fill the “gaps” in Original Medicare, such as copays and deductibles. However, like Original Medicare, Medigap does not consider personal emergency response systems to be durable medical equipment; therefore, it does not cover the service.

Long-term care insurance

Long-term care insurance is a private health insurance plan that helps pay for the costs associated with long-term care. Similar to Medicare Advantage plans, coverage of personal emergency response services varies depending on the provider. If you have long-term care insurance, call your provider to see if they reimburse you for medical alert services.

HSA

According to the IRS, medical alert systems are eligible for reimbursement with Health Savings Accounts (HSAs), Flexible Spending Accounts (FSAs), and Health Reimbursement Arrangements (HRAs).

Special discounts

Discounts may be available for different populations, such as military veterans and those with low incomes.

“For retired military personnel and their families, TRICARE may cover the cost of a medical alert device, although coverage is not guaranteed,” Dr. Mira said. “LiveLife Personal Mobile Alarms or MedEquip Alert can provide a medical alert system to veterans who apply for VA support.”

AARP does not endorse any brand of medical alert system, but some manufacturers provide AARP discounts. For example, Philips Lifeline offers AARP members a 15 percent discount on monthly monitoring fees as well as free shipping and activation of equipment.

Many medical alert manufacturers, including LifeFone, Medical Guardian, and MobileHelp, have promotions throughout the year that offer a free month or two of monitoring, free shipping of equipment, or free services such as fall detection. Check each manufacturer’s website to find their current promotions.

Finally, there are some medical alert systems that don’t require a monthly fee. Instead of putting users through to a call center staffed by professional attendants, these devices put users in touch with a selected personal contact or their local 911 operator. This may be a viable option for those who need minimal monitoring.

Assistance programs

Seniors can also get help from Area Agencies on Aging (AAA) chapters nationwide. “For assistance in obtaining a free medical alert system, contact your local Area Agency on Aging. The agency may connect you with other organizations or provide information on grants and scholarships for seniors,” Dr. Mira said.

Why You Can Trust Our Expertise in the Medical Alert System Space:

Our experts independently research and recommend products we believe provide value in the lives of our readers. We’ve spent collectively more than 1,700 hours conducting in-depth research on medical alert systems. In our review process, we:

• Engaged in ongoing independent research
• Consulted with geriatricians and adult caregivers
• Mystery shopped the brands
• Surveyed medical alert system users
• Tested various medical alert systems
• Interviewed experts in the field
• Read hundreds of verified customer reviews from trusted third parties such as Better Business Bureau and Consumer Reports

Bottom Line

Medical alert systems provide a critical service that helps people live independently. “These medical alert systems are crucial for timely intervention,” Dr. Mira said, and they should be considered an investment in an individual’s wellbeing.

For example, “falls are the most common cause of fatal and non-fatal injuries among the elderly. They can substantially affect one’s capacity to live independently,” she said. People who are at risk for falls may want to look for one of the best medical alert systems with fall detection to ensure timely response in the event they fall and need help.

However, emergency alert systems can come at a steep price, especially when you factor in the cost of equipment and shipping along with the monthly fee for 24-hour monitoring. It seems logical that the cost of these personal emergency response systems be covered by Medicare. But, because they’re not considered durable medical equipment, the devices aren’t covered by Medicare.

If you’re investigating medical alert systems for yourself or a loved one, consider whether you may qualify for other cost-saving options, such as partial coverage or reimbursement through Medicare Advantage or long-term care insurance. Fees associated with medical alert systems also qualify as HSA-, FSA-, and HRA-reimbursable expenses.

Additionally, be aware that many manufacturers offer limited promotions that can dramatically reduce your initial investment in the equipment and monthly services. Military veterans and those with limited financial means may also qualify for assistance programs through various government and charitable programs.

The bottom line is that medical alert systems help vulnerable individuals live more independently and age in place longer. The peace of mind they offer the user and the caregiver are priceless, but it does pay to investigate ways to save money on these systems even if Medicare doesn’t cover the cost.