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Are Medical Alert Systems Covered by Medicare?

Written by | Updated September 9, 2020

Aging in the home brings doctor visits, changes to your home, and other expenses. Add a medical alert system to that list, and you have quite a few costs to consider. 

If you have a condition that makes a medical alert system necessary, your device may be covered by a private insurer or Medicare Part C. But in most cases, Medicare unfortunately does not cover medical alert systems.  

Does Medicare cover medical alert systems? 

No, not usually.

Original Medicare (Part A and B) won’t cover your medical alert device, but Part C (also called the Medicare Advantage Plan) might through the right private company. 

What is Medicare?

Medicare is a federal program designed to help aging Americans over 65 and those under 65 who have received Social Security Disability Insurance (SSDI) or have End-Stage Renal Disease (ESRD).
This complex system is divided into several parts that cover hospital costs, doctor visits, prescription drugs, and medical devices like wheelchairs.

What are Medicare parts?

Medicare is a four-part system divided into Part A, Part B, Part C, and Part D. 

Medical alert systems covered by Medicare generally fall under Part C rather than Part A or Part B. Here’s a quick overview to help you get a better understanding of each:

  • Part A covers hospital, hospice, and some nursing facility costs. 
  • Part B is medical insurance. 
  • Part C combines Part A and Part B but is available through private insurance. 
  • Part D covers prescription drugs. 

What are Original Medicare and Medical Advantage Plans?

Original Medicare is made of Part A and Part B coverage, while Medicare Advantage Plans are Part C.

You can add Part D to Original Medicare or a Medicare Advantage Plan if you need to cover prescription drug costs.

How does the Medicare Advantage Plan work?

Medicare Advantage Plans (also known as Part C) is coverage provided by Medicare-approved private companies.

That means you can get Medicare coverage (Parts A, B, and sometimes D) through a private insurance provider. The big differences boil down to network size, cost, and coverage. 

You’ll generally get more coverage for things like vision and dental through Medicare Advantage than you would through Original Medicare.

Organization determination

Medicare Advantage Plans usually don’t cover medical alert systems, but you can request an “organization determination.” An organization determination can amend your policy if your need for a medical alert system is great enough.1

Can Medicaid cover my medical alert system costs? 

Like Medicare, Medicaid doesn’t cover medical alert systems or personal emergency devices. 

Medicaid helps low-income Americans cover medical costs with funding from state and federal governments. It’s different from Medicare and can vary from state to state.

Simply put, the federal government provides a budget for each state to use as they wish. So coverage, eligibility, and laws will depend on where you live. 

What are the Medicaid programs in my state for seniors? 

Again, the Medicaid coverage available depends on the state you live in. But the Programs of All-Inclusive Care for the Elderly (or PACE) include a wide range of care options. Check to see if PACE is available in your state.2 

So even if you can’t get your medical alert system covered by Medicaid, you’ll be able to access care programs like these for yourself or your loved ones:

  • Adult day care 
  • Home care
  • Nursing home care
  • Physical therapy
  • Transportation 

The following states have active PACE programs:

ArkansasMissouri
CaliforniaNebraska
ColoradoNew York
ConnecticutOhio
DelawareOregon
FloridaPennsylvania
IllinoisRhode Island
KentuckyTexas
MarylandUtah
MichiganVirginia
MinnesotaWisconsin

Can private insurance cover my medical alert system?

In some cases, yes. But it depends on your insurance provider. 

If you have a Medicare Advantage Plan, your private insurance company might cover your medical alert device out of necessity. But you’ll need at least a doctor’s note to prove your need for one.

For older adults prone to falling injuries, a medical alert device with automatic fall detection can be a lifesaver. Ask your doctor if this is a risk for you. 

These conditions increase your risk for falling injuries:4 

  • Visual impairments
  • Neuropathy
  • Cardiac arrhythmia 
  • Congenital heart disease
  • Dementia 
  • Parkinson’s disease

Learn about how to prevent falls in your home and avoid injuries as you or your loved one ages. 

Are there discounts for medical alert systems? 

Yes, members of organizations like AARP and USAA or veterans may be eligible for discounts off their systems. 

When you find a medical alert system that works for you or your loved one, call to order and ask the company about any discounts. They will vary from company to company, but it doesn’t hurt to ask. 

Final word 

Unfortunately, Medicare, Medicaid, and private insurers don’t usually cover medical alert systems. But there are exceptions. If you have a medical condition that makes these devices a necessity, you may get partial coverage.

Thankfully, there are affordable medical alert companies out there, and many medical alert companies offer discounts and free devices. 

For many aging Americans, a medical alert system isn’t a necessity. But these devices can send help quickly in a scary situation. If you or your loved one is prone to falling, getting lost, or other medical emergencies, a medical alert device is worth purchasing. 

Sources

  1. Medicare.gov, “Understanding Medicare Advantage Plans,” September 2019. Accessed August 25, 2020. 
  2. Medicaid.gov, “Programs Of All-Inclusive Care For Elderly Benefits,” Accessed August 25, 2020. 
  3. Pace Nation, “PACE Programs,” Accessed August 25, 2020. 
  4. Philips Lifeline, “5 Diseases That Increase Your Risk Of Falling,” April 2014. Accessed August 28, 2020.

Written by Katie McEntire

Katie McEntire has tested home security systems in her own apartment, installed GPS trackers in her own car, and watched her cat, Toki, nap all day through a live nanny cam feed. As an expert reviewer, she believes that firsthand experience is the best way to learn about new products (even if it requires being the guinea pig). She specializes in pet safety and DIY security and has contributed to publications like DigitalCare.org and TechGuySmartBuy. Learn more

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