Original Medicare and Medical Alert Systems
Original Medicare (Parts A and B) does not cover medical alert systems, also known as Personal Emergency Response Systems (PERS). This is because Medicare does not consider them to be "medically necessary durable medical equipment" (DME), a category that typically includes items like wheelchairs or oxygen equipment. This exclusion applies to all types of medical alert systems and services, including monthly monitoring fees, even with a doctor's prescription. Therefore, individuals with only Original Medicare will need to find alternative payment methods.
Potential coverage through Medicare Advantage
Medicare Advantage (Part C) plans, offered by private insurers, provide at least the same coverage as Original Medicare and can include additional benefits. Some Medicare Advantage plans may cover medical alert systems as a supplemental benefit. The extent of coverage, which could include equipment costs, monthly fees, or discounts, varies by plan. It is important to contact your specific Medicare Advantage provider to confirm coverage details.
Other avenues for securing a medical alert system
Beyond Medicare, several other resources can help cover the cost of a medical alert system:
- Medicaid: State Medicaid programs may offer coverage for medical alert systems through Home and Community-Based Services (HCBS) waivers. Contact your state's Medicaid office for information on eligibility and waiver programs.
- Veterans Affairs (VA) benefits: Qualifying veterans might receive benefits that cover medical alert systems. Consult your local VA chapter for details.
- Long-Term Care Insurance: Many long-term care insurance policies include coverage for medical alert systems.
- Health Savings Accounts (HSAs) and Flexible Spending Accounts (FSAs): These accounts can be used for qualified medical expenses, which include medical alert systems.
- Area Agencies on Aging (AAA): Local AAAs may offer programs or resources for discounted medical alert systems.
- Company discounts: Many medical alert system providers offer various discounts.
Comparison of coverage options
| Coverage Provider | Typical Coverage for Medical Alert Systems | How to Check Coverage |
|---|---|---|
| Original Medicare (Parts A & B) | No coverage. Not considered medically necessary durable medical equipment. | N/A (Standardized policy) |
| Medicare Advantage (Part C) | Varies by plan. May offer partial or full coverage, or discounts, as a supplemental benefit. | Contact your specific Medicare Advantage plan provider. |
| Medicaid | Varies by state. Potential coverage through Home and Community-Based Services (HCBS) waivers. | Contact your state's Medicaid office. |
| Veterans Affairs (VA) | May cover medical alert systems for qualifying veterans. | Contact your local VA chapter or medical facility. |
| Long-Term Care Insurance | Often provides partial or full coverage, depending on the policy. | Review your policy documents or contact your provider. |
| Health Savings Accounts (HSA) / Flexible Spending Accounts (FSA) | Yes, considered a qualified medical expense. | Confirm with your plan administrator and save receipts. |
Making an informed decision
To make an informed decision, review your current insurance policies, especially if you have a Medicare Advantage plan. Explore other options like Medicaid waivers, VA benefits, and the use of HSA or FSA funds. Compare different medical alert providers and their features, and look for potential discounts. Taking these steps will help you find a suitable and affordable medical alert system.
Conclusion
While Original Medicare does not cover medical alert systems because they are not classified as durable medical equipment, Medicare Advantage plans may offer coverage as a supplemental benefit. Other options for covering costs include state Medicaid waivers, VA benefits, long-term care insurance, and using HSA/FSA funds. By researching and exploring these various avenues, individuals can find a medical alert system that provides the necessary safety and fits their financial situation.
