Most Medicare Advantage plans do not cover medical alert systems as a standard benefit
Medicare Advantage plans are run by private insurance companies, not Medicare itself, so each plan decides what it covers. Medical alert systems — the wearable devices that let you call for help with one button — are rarely included in the basic coverage that all plans must offer. Some plans do cover them, but only if your doctor writes an order saying you need one for a medical reason, and only through specific vendors the plan has contracted with.
The difference between plans matters. A plan that covers medical alert systems as durable medical equipment (DME) will pay part or all of the cost if your doctor orders it. A plan that does not cover them at all means you pay the full price yourself, which typically runs $25 to $50 per month plus an initial setup fee. Before you buy a system or ask your doctor for an order, you need to know what your specific plan covers.
Key Takeaways
- Medical alert systems are not a standard Medicare Advantage benefit, so coverage depends entirely on which plan you have and what your doctor orders.
- Plans that do cover them usually treat them as durable medical equipment and require a doctor's written order stating a medical need.
- You must use a vendor that your plan has contracted with, or you will pay out of pocket even if your plan covers the device.
- The fastest way to find out what your plan covers is to call the customer service number on your insurance card and ask specifically about medical alert systems.
- If your plan does not cover medical alert systems, you can buy one independently, and some community programs offer them at reduced cost.
How to learn about your plan covers medical alert systems
Call the customer service number on your Medicare Advantage insurance card. Tell them you want to know if your plan covers medical alert systems as durable medical equipment. Write down the answer and ask for the name of the plan's contracted vendor or vendors — this is important because even if your plan covers the device, you must order through their approved provider.
If the representative says your plan does cover them, ask what your out-of-pocket cost will be (copay, coinsurance, or deductible), whether your doctor needs to write a specific type of order, and how long the approval process takes. If they say your plan does not cover them, ask whether there are any other programs through the plan that might help, such as supplemental benefits for seniors at risk of falls.
Keep the name of the representative and the date you called. If you later need to dispute a claim or prove you asked about coverage, this record helps.
What your doctor needs to do to get coverage
If your plan covers medical alert systems, your doctor must write an order that explains why you need one. The order is called a prescription or order for durable medical equipment. Your doctor needs to document a medical reason — for example, a history of falls, a heart condition that causes fainting, or living alone with a chronic illness that could cause sudden symptoms.
You do not need to ask your doctor to write the order first. Instead, contact the plan's contracted vendor directly. The vendor will tell you what information they need from your doctor and often will contact your doctor's office themselves to request the order. This saves you a step and speeds up the process.
Your doctor's office may charge a small fee to send medical records or write the order, though many do not. If cost is a concern, ask the vendor whether they can work with your doctor's office to keep fees down.
Plans with supplemental benefits that may help
Some Medicare Advantage plans offer supplemental benefits beyond the standard coverage. These vary widely by plan and by region. A few plans in some areas cover medical alert systems under a fall prevention or senior safety benefit, even if they do not cover them as standard DME.
To find out whether your plan has supplemental benefits that could help, call customer service again and ask specifically: "Does my plan offer any supplemental benefits related to fall prevention, home safety, or senior wellness programs?" If the answer is yes, ask whether medical alert systems are included or whether the benefit could help you pay for one.
Supplemental benefits change each year, so even if your plan did not cover medical alert systems last year, it may this year. If you are shopping for a new plan during open enrollment, this is a question worth asking about each plan you are considering.
What to do if your plan does not cover medical alert systems
You can buy a medical alert system on your own. Monthly costs range from about $25 to $50, depending on the company and the features you choose. Some systems require a landline; others work with cell service or WiFi. Most charge an initial setup fee of $50 to $100, though some waive it for new customers.
Before you buy, compare what different companies offer. Some systems include fall detection (the device automatically calls for help if it senses a fall), while others require you to push the button yourself. Some let you talk to the dispatcher through the device; others just send an alert. Read reviews from other seniors and ask whether the company offers a trial period.
If cost is a barrier, contact your local Area Agency on Aging. Some agencies have partnerships with medical alert companies or can direct you to community programs that offer systems at reduced cost or for free. You can find your local agency by calling the Eldercare Locator at 1-800-677-1116.
Costs and what you pay out of pocket
If your Medicare Advantage plan covers medical alert systems as DME, your out-of-pocket cost depends on your plan's structure. Most plans charge a copay per visit or item (often $0 to $50), or they explore coinsurance (you pay a percentage of the cost after your deductible is met). A few plans cover DME with no copay at all.
The monthly monitoring fee — the cost to have someone answer your call when you press the button — is almost never covered by Medicare or Medicare Advantage, whether the device itself is covered or not. You will pay this fee separately to the medical alert company, usually $20 to $40 per month.
If you buy a system independently, you pay the full cost yourself: the device cost plus the monthly monitoring fee. Some companies offer discounts if you pay several months in advance or if you are a veteran or member of certain organizations.
Questions to ask your doctor before requesting an order
If you think you need a medical alert system, talk to your doctor before you contact your insurance plan. Your doctor can tell you whether a medical alert system is appropriate for your situation and what type might work best for you. They can also explain whether the device would help with your specific health concerns.
Ask your doctor: "Do you think a medical alert system would help me?" If the answer is yes, ask: "What should I look for in a system?" and "Will you write an order for my insurance company if I need one?" This conversation helps your doctor understand what you need and makes it easier for them to write the order quickly when your insurance company or the vendor asks for it.
Frequently Asked Questions
Does Medicare Part B cover medical alert systems?
Original Medicare (Part A and Part B) does not cover medical alert systems. Medicare Advantage plans may cover them, but it depends on the individual plan. If you have Original Medicare and want a medical alert system, you must pay for it yourself.
Can I use any medical alert company, or does it have to be the one my plan contracts with?
If your plan covers medical alert systems, you must use a vendor the plan has contracted with, or your plan will not pay for it. Using an out-of-network vendor means you pay the full cost yourself. Always ask your plan which vendors they work with before you buy or order a device.
What if my doctor refuses to write an order for a medical alert system?
Your doctor decides whether a medical alert system is medically necessary for you. If your doctor does not think you need one, your insurance plan will not cover it. You can still buy a system on your own, or you can ask your doctor to explain their reasoning and discuss whether there are other options that might help.
How long does it take to get approved and receive a medical alert system?
If your plan covers medical alert systems and your doctor writes an order, approval usually takes one to two weeks. Receiving the device typically takes another one to two weeks after approval. The total time from calling your plan to having the system in your home is usually three to four weeks, though it can be faster or slower depending on your plan and the vendor.
Will my Medicare Advantage plan cover a medical alert system if I have already fallen?
Yes. A history of falls is one of the strongest medical reasons for a doctor to order a medical alert system. If you have fallen recently, tell your doctor about it when you ask for an order. This information helps your doctor justify the order to your insurance company.