Family Caregiver Practical Guide

Medicare & Benefits

Does Medicare Cover Medical Alert Systems?

By Ellen Carter. Published . Publisher: Family Caregiver Practical Guide.

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Key Takeaways

  • Original Medicare (Part A and Part B) doesn't pay for medical alert systems. CMS's durable medical equipment list denies "telephone alert systems" because they are emergency communication systems that don't serve a diagnostic or therapeutic purpose.
  • Medigap generally won't help either, because it helps pay costs for services Medicare covers.
  • Some Medicare Advantage plans may offer an in-home personal emergency response system (PERS) as a supplemental benefit. CMS guidance allows it if it's primarily health related. It can't be a cell phone.
  • Medicaid waiver programs in some states cover PERS, sometimes including installation and the monthly monitoring fee.
  • If no program pays, compare systems on monitoring, fall detection, coverage area, contract terms and total yearly cost, using each manufacturer's published specs.

This guide is general information, not medical or insurance advice. Coverage depends on your parent's specific plan and state. Always confirm with the plan or agency before buying.

The call usually comes after a scare. Your dad slipped getting out of the tub and couldn't reach the phone for an hour. He's okay, mostly bruised and embarrassed, but you aren't okay. You start looking at medical alert buttons that night, and almost immediately you wonder: Shouldn't Medicare pay for this?

It's a fair question. Unfortunately, for most people on Original Medicare, the answer is no. But there are a few other places to look before you pay out of pocket.

Why Original Medicare says no

Medicare Part B covers durable medical equipment (DME) such as walkers, wheelchairs, and hospital beds when they're medically necessary. To count as DME, an item has to be primarily used for a medical purpose, among other rules.

CMS keeps a national reference list of equipment and whether it's covered. On that list (National Coverage Determination 280.1), the entry for "Telephone Alert Systems" reads: "Deny - these are emergency communications systems and do not serve a diagnostic or therapeutic purpose."

That's the federal policy that applies to Original Medicare nationwide. Medical alert systems fall into the same bucket as grab bars and raised toilet seats, which the same list also denies as not primarily medical in nature.

What about Medigap?

Medicare Supplement Insurance (Medigap) helps pay your parent's share of costs for services Original Medicare covers, like deductibles and coinsurance. Since Original Medicare doesn't cover medical alert systems, there's generally no share for Medigap to pay. See Medicare.gov's Medigap overview.

Where coverage may exist

1. Medicare Advantage plans (Part C)

Medicare Advantage plans can offer supplemental benefits beyond what Original Medicare covers. CMS's Medicare Managed Care Manual says plans may provide enrollees with in-home Personal Emergency Response devices designed to notify appropriate personnel of an emergency, such as a fall, as long as they're primarily health related. The same guidance says a PERS may not include cell phones.

What that means for your parent:

How to check: Look in the plan's Evidence of Coverage or Summary of Benefits for "personal emergency response system," "PERS," or "medical alert." Or call the member services number on your parent's plan card. During Open Enrollment (October 15 to December 7), you can also compare plans on Medicare's Plan Finder.

If you're weighing Medicare Advantage against Original Medicare with Medigap, don't let one small benefit decide it. Doctors, drug coverage, and out-of-pocket limits matter much more.

2. Medicaid

If your parent has Medicaid, check here next. Federal rules let states offer extra services in their home- and community-based services (HCBS) waivers, and the Congressional Research Service lists personal emergency response systems among the "other" services waivers may include.

Some state waivers list PERS explicitly. For example, according to Medicaid.gov's state waiver fact sheets:

Waivers usually require that your parent qualify for Medicaid and need a certain level of care. Call your parent's state Medicaid office or case manager and ask directly.

3. Other places to ask

Coverage at a glance

Coverage type Pays for a medical alert system? Source
Original Medicare (Part A & B) No; "telephone alert systems" are denied CMS NCD 280.1
Medigap Generally no (only helps with Medicare-covered costs) Medicare.gov
Medicare Advantage Maybe, if the plan offers an in-home PERS supplemental benefit CMS Medicare Managed Care Manual, Ch. 4
Medicaid HCBS waivers Maybe, in states and waivers that include PERS Medicaid.gov; CRS

If you're paying out of pocket: what to compare

When no program pays, the choice comes down to features and total cost. Companies market these systems hard, and advertised prices often leave things out, so compare based on each manufacturer's published specs and written terms. We haven't tested these devices ourselves.

The questions that matter most

  1. In-home or on-the-go? In-home systems work around the house. Mobile systems use cellular service and often GPS so they work outside too. If your parent still drives, walks, or gardens, that matters.
  2. Who answers? Some systems connect to a 24/7 monitoring center. Others call family members only. Ask what happens if no family member picks up.
  3. Fall detection. Usually an add-on with its own fee. Ask the company what it says about falls the device may not detect, and make sure your parent knows to press the button anyway.
  4. Coverage. For cellular systems, which network does it use, and does it work where your parent lives? For in-home systems, how far from the base unit does the button work?
  5. Water resistance. Many falls happen in the bathroom. Check whether the button can be worn in the shower.
  6. Battery. How long it lasts and how your parent will know it needs charging.
  7. Total yearly cost. Monthly fee × 12, plus equipment, activation, shipping, fall-detection add-on, and any lost-device fee.
  8. Contract and cancellation. Is there a long-term contract? What happens if your parent moves to assisted living or passes away? Get it in writing.

Brands you'll commonly see

Brands you'll often see advertised include Medical Guardian, Bay Alarm Medical, Lively, and MobileHelp. Before you compare them, get each company's current answers to the eight questions above from its website or a written quote.

Listing a brand here isn't a ranking or an endorsement. Prices and features change often; check the company's site.

Getting your parent to actually wear it

The best system does nothing in a drawer. A few things help:

Frequently asked questions

Will Medicare pay for a medical alert system if a doctor prescribes it?

Original Medicare's national equipment list denies telephone alert systems because they don't serve a diagnostic or therapeutic purpose (CMS NCD 280.1). A prescription doesn't change that category. Check a Medicare Advantage plan or Medicaid instead.

Which Medicare Advantage plans cover medical alert systems?

It depends on the plan and changes yearly. Check the plan's Summary of Benefits or Evidence of Coverage for "PERS," or call the plan.

Does Medicaid pay for medical alert systems?

In some states, through home- and community-based services waivers. Alabama and Michigan are two examples listed on Medicaid.gov. Ask your state Medicaid office.

Is a medical alert system tax-deductible?

Possibly in some situations. Ask a tax professional.

Can a smartwatch replace a medical alert system?

Some smartwatches offer fall detection and emergency calling. Whether that's enough depends on your parent: whether they'll charge it, wear it, and use it. Note that a Medicare Advantage PERS benefit can't include a cell phone, per CMS.

Plan for safety as a family

My book, When You're Caring for a Parent: A Practical Workbook for Adult Children, has fill-in worksheets for making the home safer room by room and organizing medical visits, plus a directory of U.S. help lines, so everyone knows the plan before the next scare. Find it on Amazon: Kindle · paperback.

Sources

  1. CMS, National Coverage Determination 280.1, "Durable Medical Equipment Reference List": https://www.cms.gov/medicare-coverage-database/view/ncd.aspx?ncdid=190
  2. CMS, Medicare Managed Care Manual, Chapter 4 (supplemental benefits, PERS): https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/downloads/mc86c04.pdf
  3. Congressional Research Service, "Medicaid Section 1915(c) Home- and Community-Based Services Waivers": https://www.congress.gov/crs-product/R48519
  4. Medicaid.gov, Alabama waiver fact sheet: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/AL
  5. Medicaid.gov, Michigan waiver fact sheet: https://www.medicaid.gov/medicaid/section-1115-demo/demonstration-and-waiver-list/Waiver-Descript-Factsheet/MI
  6. Medicaid.gov, "Home & Community-Based Services 1915(c)": https://www.medicaid.gov/medicaid/home-community-based-services/home-community-based-services-authorities/home-community-based-services-1915c
  7. Eldercare Locator: https://eldercare.acl.gov
  8. Medicare.gov, "Medigap (Medicare Supplement Health Insurance)": https://www.medicare.gov/health-drug-plans/medigap

About the Author

Ellen Carter writes practical, plain-language guides for adult children caring for aging parents. She learned most of what she shares the hard way, through her own family's caregiving. Read more about Ellen.