Are Medical Alert Systems Covered By Insurance?
The simple answer is yes, depending on your insurance policy, eligibility and state, you may be able to get your medical alert system covered by insurance. Medicare Part C, Medicaid, Veteran Affairs and some Long Term Care policies may completely cover the costs of your medical alert system.
Medical alert systems allow seniors to call for help in the event of a fall or medical emergency. The ability to get help fast has been shown to reduce hospitalization rates and the severity of injuries in the elderly.
In fact, medical alert systems have proven to reduce hospitalization rates after a fall, and shorten stays in the event hospitalization is required. As such, they continue to be recommended by many hospitals, doctors and professional caregivers as a means of protecting seniors who live alone.
Which Insurance Covers Medical Alert Systems?
Medical alert systems are not generally covered by insurance. However, there are insurance plans which do cover it, and sometimes the coverage may vary by state. Here's a partial breakdown:
- Private Long Term Care Insurance (depends on company and policy, but your best shot if you're depending on private insurance)
- Medicare Parts A & B (as of this time, Original Medicare does not cover medical alert systems under "durable medical equipment" coverage - although we think it should)
- Medicare Part C (some Medicare part C plans cover some or the entirety of the medical alert system, check with your provider)
- Medigap / Medicare Supplemental Insurance (does not cover medical alert systems
- Medicaid (can cover medical alert systems, depending on the state)
- Veteran Affairs (can cover the cost of medical alert systems, if you're eligible)
What Does Medicaid Cover?
Medicaid can cover the cost of a medical alert system through three different programs including:
- The Home and Community Based Services Program
- Consumer Directed Services Program
- Personal Care Attendant Program
- Money Follows the Person Program
The Home and Community Based Services Program (CBSM)
People can get full coverage for medical alert systems under the authority of the Federally approved waiver plans through the Home and Community Based Services programs offered by Medicaid. Potential waiver plans that can be applied against the cost of a medical alert system (called a Personal Emergency Response System by Medicaid) include:
- Elderly Waiver
- Brain Injury Waiver
- Community Alternative Care Waiver
- Community Access for Disability Inclusion
- Developmental Disabilities Waiver
Coverage for one of the waivers mentioned above is defined under the Specialized Equipment and Supplies Service.
You may also want to check with your state, as some have Alternative Care programs or Essential Community Support Services which cover the cost of Personal Emergency Response Systems.
What Medical Alert Services Are Covered by CBSM?
Medicaid's Home and Community Based Services Program covers up to three separate medical alert service and equipment fees:
- Up to $1,500 for the purchase of medical alert system equipment, and any required training or instruction
- Up to $500 for the installation of medical alert system equipment
- up to $110 monthly for monitoring fees.
The total maximum one can receive is $3,000 in any given year for all three services.
What Medical Alert Services Are Not Covered by CBSM?
The Medicaid fee waivers, do not include the following products or services that may be offered by a medical alert system provider:
- Sensor or monitoring technology that automatically sends health data to a remote server or person, but is not activated by the wearer
- Monitoring activities of daily living (eating, dressing, medications, bathing, toileting)
- Digital video equipment (home security cameras, "nanny" cams, etc...)
- Telemedicine monitoring services
- Equipment used to deliver Medical Assistance services (medication dispenser)
Moreover, if the patient is on Elderly, Brain Injury or a Community Access for Disability Inclusion waiver and is receiving 24 hours customized support, they are not eligible for any medical alert funding.
Who Is Eligible to be Covered by CBSM?
Any Medicaid waiver has to take what's called a person centered approach. That means, to determine whether Medicaid will cover you, they will assess your eligibility based on your needs. The following needs are taken into account:
- Can the person themselves recognize their need for the service? Medicaid doesn't want service providers forcing equipment on cognitively impaired people, for their own profit.
- Can the person actually use the system?
- Does the service provider offer preferences, choices and safeguards, for how the persons data will be stored and used?
- What are the risks that are being managed and how good is the system at addressing those risks? For example if it's a fall, how quickly does the medical alert system get help once the button is pressed.
Fortunately, the VA covers the cost of medical alert systems for our country's veterans. If you are looking for a medical alert system covered by the VA, you'll have to purchase your system through them. They offer two types of systems:
- LiveLife Personal Mobile Alarms (press button and it goes directly to 911 - we're not fans)
- MedEquip Alert (monitored service, works in or outside the home and comes with free fall detection) 844-HELP-808
To get either system, you can get it for free through your VA primary care doctor or VA clinician at your local VA hospital. For the MedEquip, which we recommend over the LiveLife, ask them to submit a consult to prosthetics for the Med Equip Alert, using GSA order number GS-35F-202GA.
If you're looking for a medical alert system with options like medication reminders and caregiver apps, you may want to look into something like MobileHelp or Medical Guardian, both of whom offer discounts for veterans.
Check With Your State
It should be noted, many states manage coverage for Medical Alert Systems, or Personal Emergency Response Systems, on their own. We recommend you reach to to your state Health and Human Services Department, Area Agency on Aging, Community Services, Medicare or Medicaid department to determine what your state covers, the eligibility requirements and which medical alert companies are eligible for coverage. You may get surprised!