Medicare Advantage plans (Medicare Part C) are health insurance options offered by private companies that contract with Medicare. These plans provide all the coverage of Original Medicare (Parts A and B) and often include additional benefits, such as prescription drug coverage or vision services. Medical Alert Systems (MAS), also called Personal Emergency Response Systems (PERS), are devices that allow users to call for assistance during an emergency. This article explores which Medicare Advantage plans may offer coverage for these alert systems.
Original Medicare and Medical Alert Systems
Original Medicare (Parts A and B) does not cover the cost of Medical Alert Systems. This is because the Centers for Medicare and Medicaid Services (CMS) does not classify these devices as durable medical equipment (DME). DME must meet specific criteria, including being medically necessary and having a primary medical purpose, which MAS do not meet under current guidelines.
A typical Medical Alert System includes a wearable transmitter, such as a pendant or wristband, and a base station. When the button is pressed, or if an advanced system detects a fall, the device contacts a monitoring center. Since these systems are considered safety and convenience tools rather than equipment used to treat a specific illness or injury, the costs for the device, installation, and monthly monitoring are not covered by Original Medicare.
Medicare Advantage Supplemental Coverage
Coverage for a Medical Alert System is exclusively available through the enhanced benefits provided by some Medicare Advantage plans. These private plans have the flexibility to offer supplemental benefits that go beyond the coverage baseline of Original Medicare. The inclusion of MAS is a plan-specific, optional benefit designed to support safety and independent living for members.
Coverage for these alert systems falls into the category of non-traditional supplemental benefits, sometimes offered under the Special Supplemental Benefits for the Chronically Ill. This category allows plans to cover items or services that are not primarily medical in nature, provided they have a reasonable expectation of improving health or function. Since the benefit is optional, coverage for MAS is not guaranteed and varies significantly between different plans, carriers, and service areas.
Verifying Specific Plan Coverage
Since coverage is not universal, it is necessary to take specific steps to determine if a current or prospective Medicare Advantage plan includes a Medical Alert System benefit. Current plan members should consult their official plan documents, specifically the Annual Notice of Change (ANOC) and the Evidence of Coverage (EOC). The ANOC, which is sent out around September, summarizes all changes in coverage and cost for the upcoming plan year.
The Evidence of Coverage is a comprehensive document that fully details the plan’s benefits, cost-sharing, and rules for the year. Users should search the EOC for terms like “Personal Emergency Response System” (PERS), “medical alert system,” or “emergency response device” to find the exact benefit details. For those shopping for a new plan, the official Medicare Plan Finder tool is a valuable resource during the annual enrollment period. This tool allows prospective members to filter plans based on included supplemental benefits, helping to identify those that specifically list coverage for personal emergency response systems.
Coverage Limits and Device Restrictions
Even when a Medicare Advantage plan does cover a Medical Alert System, the benefit is subject to certain restrictions and limitations. Coverage is rarely unlimited and is frequently structured as an annual dollar allowance, which may range from $100 to $300 toward the cost of equipment and monitoring fees. This allowance may only partially cover the total cost, leaving the member responsible for the remaining balance or any monthly service fees.
Plans may also impose limitations on the type of device or service provider a member can use. Some plans may only cover basic in-home systems, while excluding more advanced, mobile units with features like GPS tracking or automatic fall detection. Furthermore, a plan may require the member to use a specific, in-network vendor to obtain the equipment at the covered rate. In some cases, a physician’s recommendation or prior authorization may be required before the benefit can be utilized.