Does Medicare or Medicaid Cover Medical Alert Devices or PERS?
The first question many people ask when looking for the perfect medical alert device is whether or not Medicare or Medicaid will cover the cost. Medical alert devices, also known as personal emergency response systems (PERS), are wearable buttons that allow seniors to contact emergency services (or friends and family) with the press of a button if they fall or experience an accidental injury. While these devices are simple solutions, they can be life-saving in situations where your loved one is unable to get to a phone. They offer more peace of mind and can even help your loved ones to remain more independent for longer. However, many people are worried about the associated costs.
The prices of medical alert devices vary from company to company. Some only charge a one-time equipment fee, like us. Others may charge a one-time equipment rental fee in addition to a separate fee for monitoring the device with a central station. Some even ship a free device, but charge for monitoring services and may require a long-term contract, which we advise against.
With that in mind, the question still remains: will Medicare or Medicaid pay for any of it? Below we break down the different levels of Medicare and Medicaid as well as a few other options that can help you pay for a PERS device.
Does Medicare cover the cost of PERS devices?
There are three parts to Medicare, though only one of them covers medical alert devices. Here's a breakdown of Medicare Parts A, B, and C.
When you first enroll in Medicare, you will be automatically enrolled in Medicare Part A. Medicare Part A pays for hospital expenses as well as nursing home stays, hospice and in-home healthcare, and inpatient care. However, it only pays for a percentage, and it will not cover doctor's fees or the full cost of your care or stay. Overall, Medicare Part A is a little lacking. It doesn't cover a medical alert device or its associated costs.
Medicare Part B is an option you can add to Medicare Part A. Medicare Part B requires a monthly premium, and the average cost is $134 per month. However, this number fluctuates depending on your income and whether or not you are on Social Security. It may also go up each year when rates are renegotiated.
Medicare Part B covers everything Part A covers in addition to doctor's fees, lab work, x-rays, diagnostic services, and medical equipment. Medicare Part B also covers some preventative care services like detecting and treating the flu as well as clinical research, ambulance rides, prescription drugs, and mental health treatment. Unfortunately, PERS devices aren't considered to be medical equipment, so neither part A or part B will cover the cost of medical alert devices.
While Medicare Parts A and B are lacking, you can cover the cost of a PERS device by using a Medicare supplement plan. Medicare Part C is also known as Medicare Advantage. It is a private plan limited to those who are enrolled in both Medicare Part A and Medicare Part B. Like Part B, Part C fluctuates in price based on your income. In addition to everything covered in Parts A and B, Medicare Part C includes additional benefits like vision, dental, and hearing. Since Part C is funded by private insurance companies, some plans will help cover the cost or associated monthly fees. However, you will be limited to a few devices that each provider covers. You will also have to verify that Medicare Part C includes these devices in your state. Check your Medicare Advance coverage or call your insurance company to be sure.
If you have a question about what your Medicare coverage will actually cover, you can enter it on Medicare.gov.
So Medicare is (pretty much) out. What next?
Many private insurance companies see medical alert devices as nonessential peripherals, therefore refusing to pay for them. If paying for Medicare parts A and B isn't affordable enough, there are many options available in your community. There are hundreds of senior assistance programs in place that help seniors with a variety of different expenses, including PERS devices. To find out which services are in place in your area, be sure to contact your local Department of Human Resources. You can also touch base with the Department of Aging Services and similar departments that are tasked with serving the elderly.
Does Medicaid Cover PERS Devices?
Medicaid is a complicated web of supporting programs. Some will pay for medical alert devices or monthly fees. In fact, there are four programs in place that are funded by Medicaid that will pay for a PERS device. If you qualify for Medicaid, you'll likely be eligible for one of these programs. However, each program operates a little differently state by state, so be sure to get information first.
1. Consumer Directed Services: In these situations, Medicaid covers funding for the elderly and allows them to use the stipend for whatever they like, as long as the expenses related to health. Funding from this program can be used for PERS devices as well as additional services, like monitoring, fall-detection, and medication management. Check the National Conference of State Legislature site for more detailed information on your state's policy.
2. HCBS Programs: Home and Community Based Services (HCBS) offer waivers for PERS devices and medical alert systems, though the options will vary from state to state. Additionally, most waivers only cover the initial fee and not the monthly subscription. In other states, you can get as much as $75/month for your monitoring subscription. This program also goes by different names in different states. In Alaska, this program is called Alaskans Living Independently Medicaid Waiver, and it only covers the start-up costs. In Massachusetts, It's called MassHealth Frail Elder Home and Community Based Services. You can find your state's HCBS waiver policy by clicking here.
3. Medicaid State Plan Personal Care Attendant Programs: Attendant programs cover the costs of caregiving. If you're caring for your loved one in any way, Medicare may reimburse some of the costs. Much like the HCBS programs, they vary from state to state and pay around the same. Learn more about Personal Care attendant programs in your state by clicking here.
4. Money Follows Program: This program is typically used by people who live in nursing homes or assisted living facilities and want to go back home. This program is designed to make it easier for these people to return to their own homes or with a relative by covering the cost of associated services, like medical alert devices. Like the other programs, this one may go by a different name in your state, or not exist at all. Currently, there are six states that don't have this program, including Alaska, Arizona, New Mexico, Oregon, Utah, and Wyoming.
It's Complicated, But Medicare Part C and Medicaid Can Cover the Cost of PERS Devices
It may be difficult to get cost assistance for medical alert devices, but don't give up. Through some parts of Medicare and Medicaid, you can get support covering the costs and fees of a PERS device. While it may be a hassle, these devices save lives in medical emergencies.
If these options don't work for you, you can always ask the medical alert companies directly what discounts are available for free or low cost. Most are happy to offer discounts for AARP members, veterans, and advance payers. Think of a medical alert device like insurance, and the price will mean nothing in comparison to all of the benefits of having a medical alert device handy brings. If you have any questions about our PERS devices, please get in touch with us today.