Will my insurance company pay for the cost of a medical alert system? Will Medicare or Medicaid reimburse me for my monthly expenses? Do you offer any member discounts?
We get these questions a lot from our customers. In the following article, we’ll examine your insurance options and breakdown the answers to these questions
Are Medical Alert Systems Covered By Medicare?
Original Medicare generally does not pay for medical alert systems, but Medicare Advantage plans, Medicaid programs, veterans’ benefits, and some private insurance or community assistance programs may help with the cost.
Most medical alert systems are not covered by Original Medicare (Parts A and B). Although these devices can help older adults remain independent and get assistance after a fall or other emergency, Medicare generally classifies them as personal safety or monitoring products rather than covered medical equipment.
Medical alert systems can greatly increase seniors’ quality of life. Although Medicare doesn’t consider them “medical necessities,” medical alert systems help seniors age-in-place in their own homes, where help can be summoned with just the push of a button. Operators promptly dispatch emergency help over to the home promptly and save hundreds of lives per day.
That doesn’t mean every Medicare beneficiary must pay the full cost out of pocket. Depending on the type of Medicare coverage they have, where they live, and which benefits are available to them, there may be ways to reduce the cost of a medical alert system. Here’s how to find out if your Medicare plan covers a home medical alert system – and tips for saving money on a medical alert if you have to pay out-of-pocket yourself.
What about Medicare Advantage plans?
Medicare Advantage, also known as Medicare Part C, is a different story. These plans are offered by private insurance companies approved by Medicare, and some include extra benefits that Original Medicare does not provide. Depending on the plan, those benefits may include a medical alert system or personal emergency response system (PERS).
Coverage varies. A plan might provide a system at no additional charge, pay part of the cost, offer a discount through a preferred supplier, or impose limits on the devices and services available. A benefit may also be available only to members who meet specific eligibility requirements.
If you have Medicare Advantage, check your plan’s Summary of Benefits or Evidence of Coverage, or call the member services number on your insurance card. Ask specifically whether personal emergency response systems are covered and whether the benefit includes the equipment, monthly monitoring fees, fall detection, or mobile GPS service.
Does Medicaid cover medical alert systems?
Medicaid, a separate federal and state program that helps cover healthcare costs for eligible individuals, may provide another route to assistance. Some state Medicaid programs cover medical alert systems through Home and Community-Based Services (HCBS) waivers or other programs designed to help people remain safely in their homes.
Eligibility, available services, and funding vary by state. Some programs require an assessment demonstrating that the person needs assistance to live independently, and some limit coverage to particular devices or approved suppliers. Contact your state Medicaid office or local aging-services agency to learn what is available.
Will my Insurance Company Cover a Medical Alert System?
It depends. We encourage our customers to call their insurance provider to check if they qualify for reimbursement. Occasionally, insurance companies will pay for the alert system if the individual’s circumstances merit it. Usually, a doctor’s recommendation is required before an insurance company will issue a reimbursement.
Long-Term Care Insurance and Medical Alert Systems
If you have Long-Term Care Insurance, you may qualify for reimbursement of your medical alert service. Long-Term Care Insurance helps aging seniors with medical disabilities pay for home care services.
Long-Term Care Insurance includes the cost of durable medical devices. Call your insurance provider to see if you qualify for medical alert coverage.
Other Payment Options if Your Insurance Doesn’t Cover Your Medical Alert System
If you can’t get your system covered with no out-of-pocket costs or co-pays, you may still qualify for discounts or be able to purchase your system with pre-tax money.
- Medical alert discounts: Some providers offer discounts and deals that will save some money. For example, Bay Alarm Medical offers special deals throughout the year. Check out their current deal here.
- Flexible payment plans: Most medical alert companies offer flexible payment styles. These plans allow you to pay month-to-month, three months at a time, or the ability to prepay for half a year or a full year.
- Health savings accounts (HSA): At least one family member must be covered by an HSA-approved, high-deductible health insurance plan in order to open a health savings account (HSA). However, any member of the family can use the HSA to cover approved medical expenses.
- Health reimbursement arrangement (HRA): Some employers offer an HRA benefit. HRAs are employer-funded plans that reimburse employees for some medical expenses not covered by insurance.
- Flexible spending accounts (FSA): Flexible Spending Accounts allow employees to set aside money from their salaries and use it to pay for specific qualified expenses. Ask your plan provider if your plan covers a medical alert system purchase.
Other Medical Alert System Resources
If you’re considering a medical alert system for yourself or a family member, the best first step is to check the benefits available through your existing coverage before paying for a service privately. Even partial assistance with equipment or monitoring fees can make a meaningful difference in the long-term cost.
Before choosing a provider, find out what your total upfront costs. Be wary of any hidden device fees, activation fees, shipping fees, or security deposits. Carefully read any contracts or service agreements so that you’ll be aware of any cancellation fees and special clauses. Ask what will happen if you should need to cancel the service abruptly.
If you would like to know more about what to expect when signing up for medical alert service, check out our FAQ page to get answers to our most commonly-asked questions.
Our friendly senior care consultants are available to discuss your options. We will answer all your questions honestly and thoroughly. No surprises here! Just give us a call toll-free at 1-877-522-9633 or open an online chat with a representative. Talk to you soon!
About the Author
As Bay Alarm Medical CMO, Alan Wu is deeply involved in the design of our products, from the hardware we use, to service pricing, to the feedback we receive from our customers so we can improve what we offer. He understands the questions and problems seniors may have, from weak cell signal in rural areas, to memory issues that can cause wandering. He works to find solutions to these and find ways our technology can make lives better and longer. Read his full credentials here.
