“Will Medicare pay for medical alert systems? Is a personal emergency response durable medical equipment? Will Medicare Part B pay for a personal emergency response system for Mom?”
These are common questions among older Americans, their families and friends looking for an extra layer of safety, security, and peace of mind as they age in place.
For the vast majority of seniors, as of 2019, the short answer is, “No. Original Medicare does not cover personal emergency response systems.”
But the short answer isn’t comprehensive, nor is it complete. That’s because many older Americans have opted to participate in a Medicare Advantage plan that may offer additional coverages, discounts, and benefits beyond those offered to beneficiaries under original Medicare.
In the past two years, the number of plans offering coverage for PERS systems has risen.
Medicare coverage: Part A and Part B
Original Medicare consists of two Parts, A and B, which cover two types of medical expenses. Medicare Part A covers hospitalization, while Part B covers expenses related to medical services, durable medical equipment, and supplies—everything from blood sugar test strips to hospital beds, and hundreds of items in between.
Older adults and their families are frequently confused and frustrated when they inquire about coverage for whether medical alert systems are covered by Medicare (also known as personal emergency response systems [PERS]), only to discover these potentially life-saving devices are not considered durable medical equipment and are therefore not eligible for reimbursement or coverage by the Centers for Medicare and Medicaid Services under 2019 guidelines.
Defining "durable medical equipment" and "medically necessary"
Under Medicare Part B, physician-prescribed durable medical equipment (DME) meets the criteria for coverage if it meets the following criteria:
- It is durable (it can withstand repeated use)
- It is used for a medical reason
- The equipment is not usually useful to someone who is not injured or sick
- The equipment is used in the home (but may be taken outside the home, as in the case of mobility aids)
- Has a general lifetime expectancy of at least three years
But original Medicare is not the beginning and end of Medicare.
Medicare Advantage: More Medicare coverage, more benefits
Medicare Advantage Plans, also sometimes known as Medicare Part C, are private insurance plans that extend and enhance original Medicare coverage.
Beginning in 2017, some Medicare Advantage plans began offering expanded supplemental coverage that would pay for medical alert systems, which include paying for the original equipment purchase and monthly monitoring fees. By 2019, in a span of just two short years, the number of plans offering some form of coverage for PERS alarm systems rose from only 1.2% of Medicare Part C plans to 14.5% of Medicare Advantage Plans, indicating significant interest in these systems among insurers and seniors alike.
And there are good reasons: The longer the wait for help in an emergency, the more significant the consequences—and the higher the costs of recovery (medical, monetary, psychological and emotional).
Ultimately, the purchase price and monthly monitoring costs associated with incorporating a PERS in the independent living plan of a senior living alone are relatively insignificant compared to potential for the permanent loss of independence, or the cost of a lengthy hospitalization and rehabilitation.
It only takes one unattended, undetected fall to change everything.
Find out if you are covered
If you or your loved one participate in Medicare Part C, call your plan provider to find out whether your benefits include medical alert systems covered by Medicare Advantage.