Are Medical Alerts Systems Covered by Medicare?

While Medicare provides coverage for some care needs, it's important to know whether or not your plan will cover medical alert systems. We break down the difference between Medicare plans and how the cost of medical alert systems may be covered.

Are Medical Alert Systems Covered by Medicare?

We’ve all seen the commercials: “Help, I’ve fallen and I can’t get up!” These commercials are important because they advertise the need for medical alert systems, which are a crucial component of making sure seniors who are living alone can call for help when or if they need to. 

If you’re unfamiliar with the term “medical alert systems,” here’s the gist: these systems are essentially life-saving devices that are worn by the infirmed and elderly populations to help call for help in cases of emergency. How they work is this: they can be activated either by the push of a button or when a fall is detected to alert emergency responders of the need for help.  

“The majority of the time with our elderly patients who fall at home or have a stroke or lose consciousness, a caregiver finds them after hours or days, and it impacts the type of care and how well their outcome is depending on the intervention,” says Kelani White, a critical care nurse from Rockport, Texas, who also works with the aging population.

“For example, an elderly person who lives alone falls and breaks their legs and can’t get up. They sometimes lie there for days before someone finds them,” White said. “They usually come in with broken legs, but also acute kidney injury secondary to Rhabodmyolisis — the breakdown of muscle tissue — from dehydration. If they had a medical alert device, we could get to them immediately and completely prevent the kidney injury. These devices positively increase the type of outcome patients have.” 

Given the critical time frame that exists while treating the elderly, these devices can mean the difference between life and death. They also offer seniors security and peace of mind to live alone without having to worry that they’ll be unable to call for help in a medical emergency. They help provide seniors with the tools they need to be independent in their later years while reassuring their families that their loved ones will be able to get help if and when they need it, all with the push of a button.

Does Medicare Pay for Medical Alerts?

 The short answer to this question is no, but there are exceptions to that rule. 

What we mean by that is this: Medicare will not pay for medical alert devices, but Medicare Advantage Plans, which are offered by private insurance companies and cost customers an additional monthly premium on top of the standard Medicare premium, may cover some costs for medical equipment and services that Medicare doesn’t cover. While Medicare Advantage is technically a Medicare program, it costs more each month, so not every senior can afford it.

Let’s break this information down so it’s easier to understand.

 

Medicare Part A

When you enroll in Medicare, you are automatically enrolled in Medicare Part A, which is responsible for paying for hospital expenses, inpatient care, nursing home stays, hospice and in-home health care. It does not cover doctor’s fees, nor does it cover medical alert devices.

 

Medicare Part B

You are not automatically enrolled in Medicare Part B — it is optional and there is an added monthly premium to be enrolled in Part B. The average Part B premium is $135.50, but it can fluctuate depending on your circumstances. Medicare Part B covers expenses like doctor fees, lab work, X-rays, medical equipment, services used to diagnose or treat your medical condition and preventative services. It also covers clinical research, ambulance rides, mental health treatment and outpatient prescription drugs, but not medical alert devices.

 

Medicare Part C

Unlike Medicare Parts A and B, Medicare C is a private health insurance plan and requires an additional monthly premium, which varies by the plan and your income. This is the part of Medicare that pays for additional benefits, including dental, vision, hearing coverage, and — you guessed it — medical alert devices. Medicare Advantage can assist you with helping cut down the monthly fees of a medical alert device, but it will depend on your plan.

 

Private Insurance

The other option for paying for medical alert devices is through private insurance, which may offer some coverage for this type of device, but it will depend on what your plan is and what it covers.

How to Find Free Or Low-Cost Medical Alert Devices

If your medical alert device isn’t covered under your insurance plan or Medicare, don’t get discouraged. There are programs available to help with the cost of these devices. If you need help paying for a medical alert device, look into:

Insurance Assistance Programs

Some insurance companies may assist with purchasing a device for patients who are deemed to have a medical need for one. In most cases, you can appeal to the insurance company by asking your doctor or another health care professional to submit a medically necessary authorization form, which will be reviewed by your insurance company. If the insurance company deems it a medical necessity, they’ll most often cover the cost of the device but not the monthly monitoring costs.

State Or Local Assistance Programs

A handful of social service agencies offer help with emergency response systems for seniors who qualify as low-income. Whether these resources are available will depend on what state you live in. You may also be able to get financial assistance through local agencies or nonprofits that provide services for the elderly.

Hospital Programs

Some hospitals set aside funds to help provide emergency response systems for seniors who qualify. If your doctor deems it necessary for you to have a medical alert system, they may be able to help you apply to receive funds through these assistance programs.

Medical Alert System Options

As important as they are, not all medical alert systems are created equal. There are a large number of medical alert systems available on the market, and each one varies in terms of the equipment and the services they offer. Some connect via cell phone or through a home security system like ADT Healthcare, while others are standalone systems. Some connect to friends or loved ones, while others alert health professionals instead.

How to Pick the System That’s Right for You

If you’ve decided that it would be in your best interest to invest in a medical alert device, or if your doctor has mentioned that it would be beneficial for you to do so, it’s important to find a system that works with your needs. 

Medical alert systems vary greatly from company to company, according to White, who works with the aging population and has seen first hand the need for quick assistance for seniors in medical crises.

“We see a lot of pretty devastating injuries that could have been more easily treated had the person been able to call for help earlier,” White said. “These devices can mean the difference between long term mobility or immobility, or sometimes even life or death. It’s important to make sure that the device you’re investing in is the right one for you and your lifestyle.”

According to White, the main things to look for are:

 

  • The type of device – “Medical alert devices vary — they can be a bracelet, pendant or they can be connected by your cell phone. If you’re active and on the go, it’s important to choose one that works with your lifestyle. Pick a device that can determine your location and help emergency responders pinpoint exactly where you are when you need help,” White said.
  • A risk-free trial – “It’s hard to know what device works best for you by just reading reviews. Sometimes it’s trial and error,” White said. Start by looking devices that offer a risk free trial so you aren’t losing money if the device isn’t right for you.
  • Waterproofing – “A ton of accidents happen in the shower,” White said. Slips and falls happen where it’s wet, which means it’s imperative to wear your alert device in the shower or bathtub. Choose a device that is waterproof or water resistant for this reason.
  • Fall detection – “One of the main reasons people choose to wear a medical device is because of falls. The statistics for injuries that happen during falls with the elderly are really high, so if you’re going to invest in a medical alert device, make sure it has fall detection,” White said.
  • Battery life – “A medical alert device won’t work if it isn’t charged,” White said. Choose one with a long battery life to be sure that there isn’t an issue with a dead battery and useless device in a medical emergency.

 


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