Are Medical Alert Systems Covered by Insurance in 2021?
COVID-19 Update: Since the medical alert industry is considered to be “essential” during the COVID crisis, monitoring and customer service centers are still open and ready to help. To learn more about how a medical alert device can help keep you or your elderly loved one safe and connected during this pandemic, take a look at our list of essential products for seniors during COVID-19.
Nonfatal falls cost Medicare nearly $30 billion per year, and Medicaid spends approximately $9 billion. These figures cover direct costs, such as hospital bills or rehabilitation therapy, but they don’t account for costs related to long-term complications. Seniors often take on these expenses themselves, which is difficult for those on fixed incomes from retirement funds or Social Security payments. Approximately 133,000 elderly adults file bankruptcy each year in the United States, and this is partly due to high medical expenses.
Seniors can potentially prevent some fall-related injuries — and the expenses that accompany them — with medical alert systems. Unfortunately, these helpful devices are rarely covered by insurance companies. We realize it can be difficult to navigate the benefits offered by different insurance providers, so we’ve compiled some essential info below for seniors hoping to receive coverage for their medical alert systems.
Does Medicare Cover Medical Alert Systems?
Approximately 64 million seniors receive insurance coverage via Medicare, a federal health insurance program for citizens who are elderly or disabled. This national insurance program covers essential expenses, such as prescription medication and hospitalization, but it generally doesn’t provide coverage for medical alert systems at this time. Seniors pay a monthly premium for Medicare Part B and Medicare Part C, and some Medicare recipients are also responsible for paying for Part A coverage.
Medicare Part A
Medicare Part A covers qualifying hospitalization costs and assisted living expenses. Elderly adults receive assistance with inpatient hospital care, surgeries, nursing home services and hospice care. Medicare Part A recipients can also receive reimbursement for in-home health services, such as the cost of a home health aide, though this is generally just provided for short-term care.
Medicare Part B
Medicare Part B provides coverage for expenses considered medically necessary, including X-rays, CT scans, MRIs, prescription medications and visits to primary care providers and specialists. Some seniors qualify for medical device reimbursement, but this generally doesn’t include any of the best medical alert systems.
Medicare Part C
Medicare Part C is also known as Medicare Advantage. This is a supplemental health plan rather than a standalone Medicare plan, so you can only get it if you’re an existing policyholder. Out of all the Medicare plans available, Medicare Part C is generally the one most likely to cover medical alert systems.
There is no guarantee that seniors can receive coverage for an alert system through Medicare Part C, but they may qualify if they can prove it’s medically necessary. You can work on verifying the need for a medical alert system by getting recommendations from doctors or showing you have a condition, such as dementia or post-concussion syndrome, that may benefit from the use of a device.
Medicare Part D
Medicare Part D focuses on prescription drug reimbursement. You cannot use it for medical alert systems or other medical devices.
Does Medicaid Cover Medical Alert Systems?
Low-income seniors may qualify for Medicaid and Medicare coverage. Medicaid plans generally do not cover medical alert systems, but you can request assistance from a Medicaid waiver through the Home and Community Based Services program or the Personal Care Attendant program. Participation varies by state, so you may have different waivers available in your area.
Medicaid recipients can also contact their insurance program or local social services agency for information about Money Follows the Person. This program is offered in most states, and it provides coverage for medically necessary devices. The program strives to help seniors transition from nursing home facilities back into their own homes so they can age in place. It goes by different names, including the Kentucky Transition Program, Colorado Access to Community-Based Transitions & Services (CO-ACTS) and My Place Louisiana.
Before qualifying for a Money Follows the Person program, a senior must reside in a nursing home for at least 90 days and maintain active Medicaid enrollment. Once these qualifications are met, potentially eligible seniors must undergo an assessment to determine which services or home modifications they need to age safely at home. The agency may determine an elderly adult needs a wheelchair ramp, adaptive lighting or other essential safety modifications. Seniors may also receive reimbursement for a service animal.
Can Seniors Receive Financial Assistance for Medical Alert Systems?
Contact your local Area Agency on Aging for help locating a senior center near you. Senior centers offer free or reduced meals and socialization opportunities, but some of them also provide grants and scholarships for medical necessities.
You may also find assistance options by contacting your state’s Department of Mental Health. This agency connects disabled adults with resources for personal care and general living expenses as well as costs associated with health-related essentials.
A veterans’ affairs office is an option for seniors who previously served in the military or married a spouse who did. Dial 2-1-1 on your telephone for help locating the agencies referenced above as well as other potential options for financial assistance.
Contact Medical Alert System Providers
Numerous medical alert system providers, including MobileHelp and Medical Guardian, offer discounts for new subscribers after they commit to a subscription. Monthly fees aren’t free for these subscriptions, but you may qualify for a free device. Call a few different medical alert system providers and ask what options they have for budget-minded seniors. You may discover that monthly service costs are less than you anticipated, even after you factor in fees for shipping or activation.
Watch out for companies that require a long-term subscription if you’re on a tight budget. Life Alert is a reputable company known for its top-notch customer service and prompt medical attention, but it requires a 3-year commitment. This isn’t ideal for seniors who may struggle with the monthly cost of the subscription, so consider a plan with a monthly or quarterly option instead. You may also want to look for a company that offers a free trial or a fee-free cancellation period.
Do You Need a Medical Alert System?
If you don’t qualify for reimbursement from your insurance company, you might be wondering whether you truly need a medical alert system. Medical alert systems provide around-the-clock monitoring for active seniors, which gives you the freedom to age at home — even when caretakers are unavailable. When you need assistance, press the button and request emergency care. Many systems are equipped with automatic fall detection, so you still receive help if you are unconscious or unable to press the call button.
Medical alert systems help prevent the complications that stem from unexpected falls. Every second counts when you’re in pain, whether you’re suffering a heart attack or struggling to move a dislocated hip. Ensure that you get the help you need when an issue arises by equipping yourself with a medical alert system.