Does Medicare Cover Medical Alert Systems?

Medicare coverage for medical alert systems

Original Medicare does not cover medical alert systems. Though Part A plans cover durable medical equipment (DME), medical alert systems do not fall under its definition of DME.

Medicare defines DME as equipment that is used for medical purposes, can stand up to repeated use and is used in the home. Since medical alert systems are not technically necessary and don’t treat sickness or injury, they aren’t covered. They’re considered convenience items, even if a doctor recommends you purchase one.

Original Medicare plans have never considered medical alert systems to be DME, so the equipment has never been covered. However, you might be able to get help paying for a system if you have Medicare supplemental insurance.

Medicare Advantage coverage for medical alert systems

Part A and Part B Medicare insurance plans don’t cover medical alert systems, but you might be able to get coverage through a Part C plan.

In 2017, the Centers for Medicare and Medicaid Services (CMS) introduced the Medicare Advantage Value-Based Insurance Design model, which allows private Medicare insurance companies to offer non-medical coverage. This opened the door for private insurers to offer additional perks, like coverage or discounts for medical alert systems, through Part C Medicare plans.

Part C Medicare coverage for medical alert systems

Part C plans, also called Medicare Advantage plans, are available through private insurance companies. They combine Part A and Part B benefits, but most include additional perks and coverages you can’t get from an Original Medicare plan.

Eligibility for medical alert system coverage depends on your provider and the specific plan, so you’ll have to reach out to your private insurance company to see if your plan covers the equipment or monthly subscription fees. Here are some examples of insurers that provide Medicare supplemental insurance (Part C) plans that also help cover medical alert systems:

• AARP offers Part C plans that may cover medical alert systems. Plus, AARP members can get 15% off monthly subscription fees and have access to free shipping and activation.
• Humana has Part C plans that may cover fall detection equipment or provide discounts on equipment and monthly service fees.
• Some medical alert systems, like LifeStation, offer discounted monthly fees to Aetna and WellCare Health policyholders.

Your Part C plan may cover some or all of the upfront cost of your equipment, some or all of the monthly subscription fees or both. Coverage is never guaranteed, so always contact your provider to see if you have access to benefits.

PACE program coverage for medical alert systems

The Program of All-Inclusive Care for the Elderly (PACE) is a program available in some states that may also cover all or part of the cost of a medical alert system. Your PACE team will need to decide if a medical alert system is a necessary part of your home care, and if it does, you’ll likely receive benefits.

If you have a PACE team as a part of your Medicaid or Medicare coverage, or you enrolled in PACE yourself, speak with a member of your team to see if the benefits cover a medical alert system.

Medicaid and VA help for alert systems

If you have Medicaid coverage or are eligible for benefits from the Department of Veterans Affairs (VA), you may also be able to get help paying for medical alert systems upfront and/or over time.

Medicaid coverage for medical alert systems

It’s possible that optional services under your Medicaid plan cover medical alert systems, and in some states, Medicaid plans use Home and Community-Based Service waivers to waive limitations from the federal government to account for additional services the state deems necessary. That can include medical alert systems and other non-medical coverages.

Unfortunately, since Medicaid is a program funded by both the federal and state governments, covered items and services vary based on your location. You should reach out to your state’s Medicaid agency and ask if a medical alert system might be covered by your plan.

VA coverage for medical alert systems

If you are a veteran and qualify for VA benefits, you may be eligible for full or partial coverage for medical alert systems. Much like with Medicaid, VA benefits related to alert systems vary by location and your circumstances. The VA will need to assess your situation and determine if a medical alert system is necessary for your particular case.

You can contact your local VA branch or call the VA health benefits hotline at 1-877-222-8387 to get more information about potential coverage.

Medical alert system types and features

There are three primary types of medical alert systems, each with different features and levels of reliability. Only two of the three system types are likely to get coverage under Medicare, Medicaid or VA benefits.

Understanding how they compare is a good place to start if you’re trying to get coverage and decide what system is right for you. You can also ask medical alert companies directly for help in deciding which system is best.

• Landline systems: Landline systems include a base station in your home connected to a landline that lets you contact a call center or emergency services by voice or through a wearable device. These are the most reliable systems, but they only work in your house.
• Cellular network systems: These can work in your home just like landline systems, but they use a SIM card to connect to a wireless cellular network instead. This flexibility also means you can get fully mobile devices that work outside of your home.
• Internet-dependent systems: These are the least dependable options because they require an internet connection. Since they’re less reliable, most medical alert companies don’t make dedicated products that fall into this category. However, things like smart home bases and smartwatches can provide some basic functionality for safety.

Medical alert system features

In addition to choosing the right type of system, you should make sure the product you choose has the features necessary to keep you safe based on your lifestyle. Below are some of the most beneficial features you might see available from different products. Note that these can affect the cost of your medical alert system equipment.

• Two-way communication: The best in-home medical alert systems have a home base that connects you to a phone network, plus a wearable device that you can use to call for help. The wearable device has a limited range, so pay attention to the communication capabilities.
• Fall detection technology: Some devices can detect a fall and automatically call for help. This is beneficial if you get into a situation where you can’t press the button to call manually.
• Caregiver connectivity: Some systems allow family members to monitor your system remotely. They can get things like low-battery alerts and notifications about emergencies for added peace of mind.
• Battery life: Wearable devices usually have limited battery life, and you’ll need to recharge it regularly. Choosing a device with a multi-day battery life can help reduce the risk of your device dying when you need it.
• Waterproof rating: Most wearable medical alert devices are fully waterproof, meaning you can wear them in the shower, where many falls occur. If yours isn’t waterproof, consider purchasing a waterproof, standalone help button for your shower area.
• Call center: Many modern medical alert systems connect you with a call center rather than calling authorities directly. This can be beneficial for avoiding calls to authorities for false alarms, accidental button presses or non-life-threatening issues.
• Health monitoring: Some devices, like wearable watches and smartwatches, can also monitor your heart rate and blood pressure, potentially helping you avoid problems before they occur.

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