TRICARE, a health insurance plan for current military members, retirees and their dependents, helps cover the cost of certain health care and medical needs. Most health insurance plans have restrictions in place as to what expenses are covered. For seniors who want to protect themselves and feel safer while they’re home alone or out and about in public, a medical alert system can be a great tool to have. It’s important to understand what kind of health care insurance plans cover this expense so that seniors can choose the right medical alert system, budget accordingly and prepare for potential out of pocket expenses before getting a surprise bill.
This guide will help individuals better understand whether TRICARE covers the cost of medical alert systems and will offer more insight into what expenses are covered by this health care plan. The information below will also make it easier to decide whether to buy a medical alert system and plan how to pay for it and monthly monitoring services.
TRICARE Covers Durable Medical Equipment
Durable medical equipment (DME) is covered by TRICARE when prescribed by a doctor. For DME to be covered, it must meet all of the following criteria:
- Can withstand repeated use
- Serves a proven medical purpose
- Is not useful to an individual in the absence of an illness or injury
For TRICARE to cover DME, the equipment must improve, restore or maintain certain functions or prevent deterioration of a condition. It must also improve an individual’s functioning medically or physiologically. Finally, DME must not be excluded by regulation and policy to be covered.
TRICARE also covers medically necessary services but not voluntary expenses. To be considered medically necessary, the expense must be appropriate, reasonable and adequate for a specific condition or medical issue.
TRICARE doesn’t cover nonmedical equipment. The program also doesn’t cover safety medical supplies, like bath or toilet rails and sleep safe beds, and nor does it cover medical alert systems — they are not considered medically necessary, and they are not classified as medical equipment under its guidelines.
Other Programs May Help
Since TRICARE doesn’t cover medical alert systems, they need to be paid for with other health insurance coverage or paid for outright. For seniors who don’t want to pay for the full costs on their own or can’t afford to do so, they may want to look into other options.
- Medicare Advantage (Part C), also known as Medicare Advantage, may cover some of the costs associated with purchasing a medical alert system. If they agree to cover the costs, individuals will likely need to pay upfront and get reimbursed for the expense.
- Another option to explore is using other private medical insurance coverage to pay for this expense. Some private health care plans may cover the cost of medical alert systems. It’s a smart idea to check with private insurance plans to inquire about coverage before ordering a medical alert system.
- Seniors who are on Medicaid may be able to get help paying for some of their medical alert system costs. There are four programs in place that could help:
Home and Community-Based Services (HCBS) may offer waivers to cover some of the costs associated with medical alert systems. Waiver amounts and rules vary from state to state — some waivers only cover initial activation and equipment fees. In contrast, other states allow for waivers to be used for ongoing monthly subscription costs.
Consumer-Directed Services are available in some states and allow the consumer to decide how to use the funding, rather than dictate how they can spend the funds. This program may help pay for part of the costs associated with a medical alert system but vary from state to state.
Money Follows the Person is a program for Medicaid beneficiaries who reside in nursing homes. The program aims to help individuals get out of nursing homes and back home, and they may cover some of the costs associated with a medical alert system. Again, this varies by state.
Medicaid State Plan Personal Care Attendant (PCA) programs are available in some states, and they help cover the costs associated with caregiving. In many cases, they will help pay for medical alert system costs. Program rules vary by state.
If a senior has TRICARE, they shouldn’t expect medical alert systems to be covered. It’s worthwhile to explore other solutions to cover the cost of this essential expense and always ask about potential discounts before purchasing a device or system. Even though this system or tool may not be required and may not be covered by insurance, it’s an excellent safety feature for seniors and their loved ones. There are many top-rated medical alert systems on the market.