Does Medicare Cover Medical Alert Systems

Medicare is the federal government program that provides health care coverage for seniors aged 65 and over, qualified individuals receiving Social Security disability benefits and others with specific diseases. According to the Kaiser Family Foundation, over 69 million Americans were enrolled in the program in 2018. Seniors receiving Medicare who want to maintain their independence and ensure their well-being with a medical alert system naturally want to know if these potentially life-saving devices are covered by their health insurance.

Understanding Medicare Coverage

Whether or not medical alert systems are covered under Medicare seems like a simple enough question, but the details of what’s covered under the various types of Medicare plans can be confusing. The answer depends on the Medicare plan a senior is enrolled in, so here we’ll look at the different plans Medicare offers to help clarify which ones may cover medical alert equipment and services.

Medicare Part A

Part A, or hospital insurance as it’s also known, is one of the two parts of original Medicare. Most seniors automatically become eligible for Part A Medicare coverage when they reach age 65. Adults approved for Social Security Disability insurance and those diagnosed with amyotrophic lateral sclerosis (ALS) or end-stage renal disease (ESRD) may also qualify. The plan covers care received while an inpatient in a hospital, during a follow-up stay in a skilled nursing or hospice facility and in some cases, once a senior has returned home from one of these facilities. Depending on the setting and circumstances, the plan may pay for various services and supplies such as nursing care, physician services, physical therapy, meals, medical supplies and medications. Part A Medicare doesn’t cover equipment and services such as medical alert systems in any setting under any circumstances.

Medicare Part B

Part B Medicare, also called medical insurance, makes up the other part of original Medicare. Seniors aged 65 and over and others eligible for Medicare Part A also qualify for Part B coverage. Coverage is optional, and those who choose to enroll must meet a modest annual deductible and pay a monthly premium amount based on their income. The program pays the entire cost for certain preventive care services along with 80% of the cost of various medically necessary services and supplies. These can include outpatient services, ambulance trips, rehabilitative services, required home health care and durable medical equipment.

Medicare defines durable medical equipment as an item prescribed by an enrollee’s doctor that:

• Serves a medical purpose
• Is durable enough to withstand repeated use
• Will last three years or longer
• May be used at home

Although it may seem logical that medical alert systems would fall under Medicare’s durable medical equipment category, this isn’t the case. Only specific types of equipment qualify as DME under Medicare’s strict guidelines, and these include:

• Wheelchairs
• Hospital beds
• Walkers
• Portable oxygen equipment
• Power scooters
• Continuous positive airway pressure (CPAP) machines
• Prosthetics
• Orthotics
• Blood glucose monitors

Medicare Supplemental Insurance

Supplemental or Medigap insurance is a range of Medicare-approved, standardized plans offered by private insurance companies to seniors who qualify for Part A and B coverage. As the name implies, Medigap insurance is designed to help seniors pay the deductible and coinsurance costs not covered by original Medicare. Depending on the coverage provided by the Medigap plan a senior chooses, it may pay the 20% coinsurance portion of approved durable medical equipment. Since medical alert systems don’t qualify as DME, Medicare supplemental insurance plans won’t cover any portion of their cost.

Medicare Part C

As with Medigap insurance, Part C or what are commonly called Medicare Advantage plans are offered by private insurance companies. However, what’s covered and the potential costs are key distinctions between the two types of insurance:

• The coverage available through Part C plans is completely different than with Medigap insurance because Medicare has contracted with Advantage insurers to provide Part A, B and D prescription drug coverage to enrollees. The plans may also include additional benefits, such as dental, hearing and vision coverage.
• The cost of Part C coverage also differs significantly because seniors must still pay their Part B premiums, annual deductible, applicable coinsurance and possibly a monthly Medicare Advantage plan premium as well.

The available coverage options and Advantage plan monthly premiums vary depending on where a senior lives, the provider and the plan chosen. However, some Medicare Advantage plans do provide discounts or reimburse enrollees for the cost of medical alert system equipment and monitoring services. Seniors and their loved ones should check with local Medicare Advantage insurance providers to find out if coverage is available in their state.

Medicare Part D

Part D provides coverage for medications prescribed on an outpatient basis for those enrolled in Medicare. It’s only available from Medicare-approved insurers as a stand-alone policy or as part of a Medicare Advantage plan. Part D plans only cover medications and don’t pay any portion of the cost of equipment, even if it’s prescribed by a doctor, so they don’t cover medical alert systems.

What to Do if Medicare Doesn’t Cover Medical Alert Systems

If Medicare Part C plans available where you or your loved one live don’t offer coverage for medical alert systems, there may be programs available at the state level to help with the cost, depending on income and other factors. Options to investigate include Medicaid Home and Community-Based Services waivers and Managed Care, Money Follows the Person and Consumer Directed Care programs. In many locales, there are also non-Medicaid programs that may pay a portion or all of the cost for those who meet income and other eligibility criteria.

While receiving help to cover the cost of a medical alert system through Medicare or other sources can help seniors get more room in their monthly budget for other expenses, it may not have to be the deciding factor about affordability for seniors and their loved ones. The wide range of choices available in medical alert systems, devices and monitoring services include options to suit most budgets.If you or a family member learns that coverage for medical alert systems isn’t offered through Medicare Advantage plans or other programs in your state, it’s still worth comparing the cost of different systems through reputable providers in your area. You may discover there’s a medical alert system option available that can provide enhanced safety and peace of mind at an affordable monthly cost.