Does Medicare Cover Medical Alert Systems?

Does Medicare Cover Medical Alert Systems

Without prompt treatment, a fall, heart attack, or stroke could cause permanent disability - or even death. A life alert system helps ensure you receive prompt medical attention.

Life alert systems are a popular type of personal medical alert device used by many seniors throughout the world. The basic idea behind these devices is that they function as a help button to be worn on your person at all times and, when pressed, will trigger a call to emergency services. This offers a great extra level of security for seniors who live alone and want to be able to stay in their own homes but are worried about being able to contact emergency services.

But are they covered by Medicare? The short answer is no, but there are options available if you’re a Medicare beneficiary. Let’s take a look at all of the options available to you.

Life Alert Systems: An Overview

Before getting into the coverage details, let’s take a look at how life alert systems work and exactly what type of service they offer. The functionality can vary widely, with some systems using more advanced functions like automatic fall detection, while others focusing purely on allowing you to call medical emergency services with a click of a button. Even if you can't find coverage, it's worth looking into personal emergency response systems to provide peace of mind for you or your loved one.

Many of these services will function as subscriptions, where you pay a monthly fee to use their functionality. In the past, these systems would connect to your landline, but these days it’s more common for them to connect to a mobile network. The cost of a medical alert system can vary depending on the details of that specific service. There are several medical alert companies out there, so make sure to compare.

Although life alert systems seem like they would fall into the category of durable medical equipment or DME, the situation is a bit more complicated. We’ll get into the details below.

Does Part A Cover Medical Alert Systems?

Medicare Part A is the standard part of Medicare that you will be automatically enrolled in when you become eligible for Medicare. Part A offers coverage for hospital treatments and other forms of inpatient care, including long-term care. It also notably covers in-home care some of the time.

Although life alert systems may seem like they fall under in-home care, they aren’t covered by Medicare Part A. Medicare Part A will only cover in-home care under certain very specific circumstances, and unfortunately, life alert systems do not qualify.

Part B: Does it Cover Life Alert?

Medicare Part B functions as the second half of Original Medicare, along with Part A. Part B will cover most of your outpatient care when you receive Medicare. These will be things like doctor visits and diagnostic tests. Part B is also notable in that it covers durable medical equipment (DME).

DME refers to things like wheelchairs, oxygen tanks, and so on, that are required for use outside of a care facility. Part of the qualification for DME is that it is medically necessary. This designation can be a bit complex, but it means that it directly contributes to the medical care that you are receiving.

Unfortunately, life alert systems aren’t considered medical equipment. The reason for this is that although they are medical in nature and can help people in medical situations, they don’t directly contribute to your physical health in the way that something like a wheelchair or hospital bed does. For this reason, Part B won’t cover life alert systems, even though they may seem like durable medical equipment at first glance.

Part C: Medicare Coverage is Available!

Medicare Advantage, also known as Medicare Part C, is a way of receiving your Medicare benefits through a private insurance company. The way that this works is that individuals who are eligible for Original Medicare may choose to purchase a private health insurance plan that offers at least that same amount of coverage. These plans must cover at least what Original Medicare covers, but many Medicare Advantage plans also offer a bit more coverage than Original Medicare.

Because life alert systems are popular among seniors, it’s not uncommon for Medicare Advantage plans to cover them. Depending on your area, you should be able to find a plan that covers life alert systems without looking too hard.

However, the entire situation may or may not be worth it, depending on your unique situation. Part C plans that offer life alert coverage may end up costing so much more that it would make more sense to just pay for the life alert system directly. They may also include or exclude other features that you need in your insurance plan, such as prescription drug coverage.

For this reason, make sure to not let life alert systems be the only thing you look for. Examine the plans available to you in detail and compare quotes and coverage details, so you can make sure you get exactly what you need. It’s not worth choosing a plan that covers life alert if it doesn’t work for you in other ways.

Can Medicare Supplement Plans Help?

Medicare Supplement Insurance, also known as Medigap insurance, is a type of private insurance plan that offers supplemental coverage. Although some people initially assume that these plans offer additional healthcare coverage, this is not the case.

Instead, Medigap plans help to pay for your out-of-pocket costs under Medicare. This means that you pay a premium each month, and the Medigap plan pays for things like your deductibles and coinsurance fees. Although Medigap plans may be useful, they won’t help with life alert systems, and you won’t be able to purchase one if you have a Part C plan.

Medicaid and Other Options

Although your coverage options are somewhat limited under Original Medicare, Medicaid is a bit more flexible. It’s important to keep in mind that Medicaid coverage varies from state to state. Rather than being a federally central system, it is more like a web of programs that overlap in many ways.

Various Medicaid programs are available to help with the cost of life alert systems. If you are eligible for Medicaid, then you’ll likely be able to take advantage of one of these to receive life alert systems.

Make sure to investigate Home and Community Based Services (HCBS), as well as consumer-directed services, and the Money Follows program. Keep in mind that this coverage will vary depending on your situation, but it is worth a try.

For most people who are eligible for Medicaid, most if not all of the cost of a life alert system will be fully covered.

Some companies may also offer discounts for AARP members, or other types of discounts. If you're dealing directly with the medical alert system companies, make sure to ask about discounts.

Things to Keep in Mind if You Need a Life Alert System

As you can see, getting coverage for a life alert system is much more complicated than other types of medical coverage that many seniors need. Although it can be frustrating to not receive coverage under Original Medicare, you still have options.

If getting a life alert system is a high priority for you, compare the costs of Medicare Advantage plans that offer life alert to the cost of buying life alert services on your own. And, if you’re eligible for Medicaid, make sure to explore every option available. In short, you should be able to get some coverage if it is a top priority, but there are so many options available that it can be hard to say what is best without looking at each individual’s situation.

Additional resources

Florida native Eric Ruge lives by one rule: Do the right thing. His goal as a Medicare agent is helping people find the right Medicare coverage for their unique medical needs and budget. He believes everyone deserves the peace of mind they get knowing they made the right decision about their Medicare coverage. When he's not working, Eric enjoys spending time with family and friends, watching Tampa sports, and playing the occasional round of golf.


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