Does Medicare/Medicaid Pay for a Medical Alert Device?

Medicare and Medicaid users frequently bring up questions related to the use of medical alert devices, and their eligibility for coverage under corresponding programs. Medical alert devices come in various designs, but the underlying principle is the same. Worn around the neck, the device allows senior citizens and others living in difficult circumstances to summon help easily, usually by just pressing a button. Some fall detection devices are more advanced and come with extra features, such as automatic fall detection.

In any case, the main question of coverage under Medicare and Medicaid remains complicated. This is partly because of the complex pricing schemes on the medical alert device market. Some companies only charge an initial fee, while others require users to engage in a contract for a specific term.

Here’s what you should know about your coverage for medical alert devices under Medicare and Medicaid, and some additional information about the options available to you in general.

Medicare

Medicare is split into three parts – A, B, and C – depending on the type of coverage you’re interested in. Part A is the default level for everyone enrolled in Medicare, though it provides limited features compared to parts B and C. Typically, a person can expect to have their hospital expenses covered by this level, in addition to stays at nursing homes and similar facilities, and inpatient care. However, Part A does not usually cover doctor’s fees. It also does not provide coverage for medical alert devices.

The more expensive Medicare Part B includes additional coverage not provided by Part A, though it comes with an additional fee as well. The exact fee varies according to certain factors, and those with a higher income could generally expect to pay more. It’s important to note that Medicare Part B still does not provide coverage for medical alert devices, despite the higher premium.

Part C is the one that you might be interested in if you want to get coverage for a medical alert device on top of everything else. It’s the most expensive option for Medicare users, and it provides additional coverage for specific types of personal emergency devices. Keep in mind that not every medical alert device is going to be covered by default, so you’ll need to consult with your provider to ensure that you’ll be eligible.

Medicaid

There are several Medicaid programs that provide coverage for medical alert devices. You will want to look into those if you’re using Medicaid, and you should explore their differences in as much detail as you can.

– Home and Community Based Services programs – in some states, these are great for users who need a medical alert device, though this is not a universal rule and you’ll have to check the situation in your own specific state. In addition, you may still have to pay some part of the fees even if you’re enrolled in a program like this. Typically, you can expect the initial fee to be covered, but you’ll have to pay the ongoing subscription costs yourself.

– Consumer Directed Services can also be great for medical alert devices, because they are often less restrictive than other programs and allow for free spending of the provided money, as long as it goes towards health expenses. A medical alert system falls in that category and is therefore eligible for coverage under the program.

– Money Follows the Person is a program specifically aimed at people living in nursing homes or assisted living facilities. The ultimate goal is to allow those people to move back in with relatives for ongoing care, providing them with the funding needed for the various aspects of that, including coverage for a medical alert device.

– Medicaid State Plan Personal Care Attendant Programs are offered in some states to assist with caregiving costs. You can expect similar coverage to an HCBS program, at the same financial levels, more or less.

The Importance of Evaluating All Options Carefully

As you can see, the situation is quite complicated. You have many options to pick from, and some are going to work better for you than your peers. You have to draw your own conclusions based on the information available. In some cases, spending a bit more for a premium package can be a worthwhile investment if you get full coverage for medical assistance devices. Even when you don’t get complete coverage, you can still improve your situation quite a bit with the right coverage plan.

Don’t be afraid to look outside of your current comfort zone either. Just because you’re used to working with a certain plan, doesn’t mean that you should stick with it in the long term if it doesn’t meet your ongoing needs. And when that’s the case, the sooner you make that change, the better your results are going to be in the end.