While many people deem a medical alert device medically necessary, not every insurance plan covers every make and model, and some devices may not be covered at all.
Medical alert systems can help the elderly and those with limited mobility or chronic health conditions maintain a higher level of independence. By incorporating technology, these devices allow constant monitoring, no matter where the wearer is, whether in their home or out and about.
Although some insurance plans do cover a medical alert device, each policy is different. We’ll address some of the insurance policies that could cover the devices, explore financial aid that can help pay for a medical alert system and address some of the frequently asked questions about obtaining one of these life-saving devices.
A medical alert device is a wearable technology that alerts emergency responders or a caretaker if the user is in trouble. For example, if someone has fallen and can’t get up, has dangerously low blood sugar or is feeling symptoms of a heart attack or stroke, the medical alert device can signal for help if the wearer isn’t near a phone.
Some devices have GPS tracking or WanderGuard technology that can track those with dementia or Alzheimer’s disease and ensure they haven’t wandered into an unsafe area or gotten lost. Also, some assisted living communities and memory care facilities issue medical alert and emergency response pendants to residents to protect them and monitor those prone to wandering.
Medical alert devices and their monthly or annual subscriptions can sometimes cost as much as a cell phone plan. For people on a fixed income or who have a limited budget, this extra bill may not be feasible.
A basic 911 alert device may only cost about $30, with subscriptions that start around $10 per month. However, some devices, such as those with embedded GPS, those that allow contacts to call the wearer directly and have a conversation and those with fall alert sensitivity, can cost close to $100 for a new unit, with monthly subscription plans around $40 per person.
Supplemental Medicare (also known as Medicare Advantage) plans are optional plans available to individuals enrolled in traditional Medicare (Medicare Part A or Part B). These plans are purchased separately from private insurance companies, and often the only requirement for acceptance is current Medicaid coverage.
Medicare Advantage plans cover a wide variety of health and wellness services not paid for by the regular Medicare insurance plan. Services provided can include dental and vision, hearing aids, gym memberships and, sometimes, medical alert devices.
Supplemental Medicare plans vary from region to region and state to state. Sometimes, the coverage available in one city isn’t available in another. This is something that senior snowbirds may need to take into account when paying for their medical alert devices. If they have coverage in their winter home but not their summer home, they may have to consider budgeting for the out-of-pocket expense of the device in the area not covered.
The best way to determine if a unit is covered is to call your insurance company. For people who have more than one kind of insurance coverage, such as VA Medical health care, TriCare, traditional Medicare and Medicaid, or Supplemental Medicare, only one plan may offer coverage for a wearable medical device, or more than one plan may cover part of the cost.
All coverage plans are different, so medical alert device owners should look for a plan that meets their needs today and their anticipated future to ensure coverage is in place should circumstances suddenly change.
The most likely government-affiliated insurance plan that would cover a medical alert device is Medicare Part C, although these plans vary depending on which insurance company issues the policy. If the plan doesn’t explicitly state that it covers a wearable emergency device, individuals may be able to get coverage by documenting that the device is medically necessary.
Medical conditions such as Alzheimer’s disease or dementia, risk of heart attack or stroke, and diabetes or hypoglycemia are common conditions that may require constant monitoring. For those with limited mobility or who suffer from osteoporosis, having a medical alert device with fall alert technology can help in emergencies.
Each state or municipality operates a local Agency on Aging. These community outreach programs specifically address the needs of the elderly in the community and may offer financial assistance for a wearable medical device.
Each state’s Department of Mental Health may offer financial aid to pay for medical devices for those who have memory conditions and are prone to wandering or may be a danger to themselves.
Military veterans and their spouses may be able to get a medical device through their VA Medical Benefits Package or with the financial assistance of local charities that help veterans. The local VA center or town’s Agency on Aging might be able to help with applying for programs offered by the Department of Veterans Affairs.
Medicaid waiver coverage varies by state, but it usually helps offset the costs of assisted living fees or to pay for caretaker services in the recipient’s own home. In addition, many waivers cover the cost of home modifications, such as handicapped access, walk-in showers or extra grab bars, so a wearable alert tool may also be covered as part of the in-home care coverage provided by these waivers.
Many communities have independent charities that collect gently used durable medical equipment and lend it to members of the community who have a demonstrated need and are unable to purchase their own. However, these loan closets often rely on donations, so there’s no guarantee that your area will have a medical alert pendant available when you need it.