Does Insurance Cover Medical Alert Systems?

Private insurance coverage for medical alert systems

Most private health insurance plans don’t cover medical alert systems. Unfortunately, the devices are not considered durable medical equipment (DME) or deemed medically necessary. You might get partial coverage or reimbursement if your doctor writes a letter of medical necessity, but most insurers will deny claims related to these systems.

Long-term insurance plans, which are designed to meet the needs of elderly patients, are often the exception. These plans typically cover or help with the costs of nursing homes, in-home care or assisted living facilities, but may instead cover medical alert systems.

If you have a long-term insurance plan, speak with a representative to see if you can get reimbursed for a medical alert system. There are a few important things to consider about coverage:

• You’ll usually need a letter of medical necessity from a doctor explaining why the system will benefit you.
• Your insurance is unlikely to cover all associated costs, so you may need to pay out of pocket for ongoing monthly subscription fees, which average between $20 and $60.
• Some long-term insurance providers, like Mutual of Omaha, have flexible coverage amounts or cash benefits that you can use toward your medical alert system.

» MORE: How much do medical alert systems cost?

Medicare coverage for medical alert systems

Medicare may provide full or partial coverage for medical alert systems, but coverage depends on your plan and whether you have supplemental insurance.

Original Medicare Parts A and B

Original Medicare plans (Parts A and B) don’t cover medical alert systems. Part A plans cover hospital expenses, and Part B plans cover preventive care, visits to specialists, lab services and DME. Since medical alert systems aren’t classified as DME, they don’t qualify for coverage.

Medicare Advantage Part C benefits

Medicare Advantage plans, also called Part C plans, may cover medical alert systems. As of 2017, the Centers for Medicare and Medicaid Services (CMS) allows Part C plans to include optional benefits.

The additional benefits under Part C plans can include non-medical equipment, such as medical alert systems. Coverage varies by provider and plan, so check with your insurer to see whether you can get coverage or reimbursement.

If you can get a medical alert system, coverage may include all or some of the following:

• Upfront equipment and activation costs
• Monthly expenses for subscriptions
• Additional fees, like upcharges for automatic fall detection

Medigap and medical alert systems

If your Part C plan doesn’t cover a medical alert system, but you have Medicare supplemental insurance (Medigap), you may still be able to get partial reimbursement.

Medigap is an optional add-on for Medicare plans that covers out-of-pocket costs your core plan doesn’t. It’s typically used for copayments, coinsurance and deductibles, but you should check whether you can get reimbursed for a medical alert system. Have a letter of medical necessity from a doctor ready to submit, if necessary.

Medicaid coverage for medical alert systems

Medicaid sometimes covers medical alert systems, but it depends on your specific circumstances and what your care team deems necessary for your safety and health.

PERS coverage through Medicaid

Medicaid doesn’t automatically cover Personal Emergency Response Services (PERS), also known as medical alert systems. However, if you have a letter of medical necessity from your doctor, your care team may determine that the system is necessary — and offer full or partial coverage for the equipment and/or ongoing subscription costs.

Medicaid is funded by both the federal government and your state government, so coverage varies based on your location. States can use Home and Community-Based Service (HCBS) waivers to add PERS coverage to your core Medicaid plan, especially if it helps you live on your own, rather than in a nursing home or long-term care facility.

Speak with a member of your Medicaid care team to see if coverage is an option in your area, or contact your state’s Unit on Aging (UA) to see if it uses waivers to cover medical alert systems.

» RELATED: Questions to ask a medical alert company

PERS coverage through the PACE program

Most states have a Program for All-Inclusive Care for the Elderly (PACE), which is designed specifically to help seniors who have Medicare or Medicaid coverage age at home rather than move to a care facility. PACE may cover all or a portion of expenses related to a medical alert system if it allows you to live on your own.

Get a letter of medical necessity from your doctor since it’s helpful for obtaining coverage. Even then, your PACE care team will review your specific situation and determine if you’re eligible for a medical alert system. You must also meet the following criteria:

• You are 55 or older
• You require living assistance
• A medical alert system can help you live on your own

PACE programs exist in the following states, but policies on what is and isn’t covered vary by location. Speak with your care team to get more information about coverage in your state.

• Alabama
• Arkansas
• California
• Colorado
• Delaware
• Florida
• Illinois
• Indiana
• Iowa
• Kansas
• Kentucky
• Louisiana
• Maryland
• Massachusetts
• Michigan
• Missouri
• Nebraska
• New Jersey
• New Mexico
• New York
• North Carolina
• North Dakota
• Ohio
• Oklahoma
• Oregon
• Pennsylvania
• South Carolina
• Tennessee
• Texas
• Virginia
• Washington
• Washington, D.C.
• Wisconsin

Other coverage options and ways to save

While getting a free medical alert system isn’t always possible, you may still want the safety and peace of mind that PERS equipment can provide. Discounts on equipment and subscription costs, as well as reimbursement options, are available, depending on your situation.

Coverage for veterans is usually funded through VA Aid and Attendance and Veteran-Directed Care.

While getting a free medical alert system isn’t always possible, you may still want the safety and peace of mind that PERS equipment can provide. Discounts on equipment and subscription costs, as well as reimbursement options, are available, depending on your situation.

Your options might include:

• Coverage for veterans: Veterans may be eligible for coverage through their Department of Veterans Affairs (VA) benefits. Speak with your care team about your situation and have a letter of medical necessity from your doctor ready.
• Private insurer Part C plans: Certain private insurers, such as Humana, may include coverage as an added benefit in their Medicare Part C plans.
• Partnerships with insurance companies: Several insurance companies partner with specific medical alert system brands, which can mean discounts on equipment or subscriptions. Examples include discounts on LifeStation alert systems through Aetna and WellCare Health.
• Discounts as part of membership benefits: Some membership programs for elderly care offer discounts on PERS equipment. 
• Health savings accounts (HSAs): If you have funds in an HSA, you can likely use those to offset upfront and ongoing costs related to your medical alert system.
• Annual payment plans: Even if you have no coverage from insurance, memberships or programs, you can usually save on subscription fees by choosing annual plans rather than month-to-month plans.
• Seasonal sales and promotions: Look for discounts and promotions on medical alert systems to reduce upfront or ongoing costs.

» RELATED: Lifeline medical alert systems

You may also be able to get benefits that help pay for a medical alert system from your county or town. For more options, contact your local Area Agency on Aging (AAA) location and use tools like BenefitsCheckUp to find other programs and savings opportunities.

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