Many Medicare Advantage plans cover medical alert systems — also called PERS (Personal Emergency Response Systems) — as a supplemental benefit. Original Medicare does not cover them at all, which is one of the reasons many people choose Medicare Advantage. But whether your specific plan covers one depends on the plan you are enrolled in, not Medicare overall.
Here is what you need to know.
What Is a PERS / Medical Alert System?
A Personal Emergency Response System (PERS) is a device — typically a wearable button or pendant — that connects you to an emergency response center when you press it or when a fall is detected. The monitoring center can dispatch emergency services, contact family members, or simply talk you through a situation.
PERS devices range from simple home base-station-and-pendant systems to GPS-enabled mobile devices that work anywhere. Most Medicare Advantage plans that cover PERS will specify which devices or which monitoring services are approved.
Does Medicare Advantage Cover PERS?
Many plans do, but not all. PERS coverage is a supplemental benefit that individual plans choose to offer. When your plan covers it, the device and monitoring fees are typically covered up to a set amount per month or year. Some plans cover both the device and monitoring fees. Others cover only one or the other.
To find out if your plan covers PERS, check your plan's Summary of Benefits document or call Member Services. The benefit is sometimes listed as "Personal Emergency Response System," sometimes as "Medical Alert System," and sometimes under a broader "Safety" benefit category.
Which Medicare Advantage Plans Typically Cover Medical Alert Systems?
PERS coverage is most common in plans offered by larger insurers including Humana, UnitedHealthcare (AARP), and Aetna, particularly in competitive urban and suburban markets. Coverage varies significantly by county and plan type. A plan in one state may include PERS while the same insurer's plan in another state does not.
The only way to confirm coverage is to check your specific plan's Summary of Benefits for the current year.
What Does the Coverage Include?
When a plan covers PERS, the coverage typically includes:
- The cost of the device (one-time or amortized)
- Monthly monitoring fees, up to a dollar limit
- In some plans, automatic fall detection as an included feature
Some plans require you to use an approved vendor. Others allow you to choose your own PERS provider and reimburse up to the covered amount.
What If My Plan Does Not Cover a Medical Alert System?
If your plan does not cover PERS, you have a few options:
- OTC benefit: Some plans include wearable PERS devices in their OTC (over-the-counter) benefit catalog. This covers the device cost but not necessarily the monthly monitoring fee.
- Pay out of pocket: Most PERS devices cost $25 to $50 for the device and $25 to $35 per month for monitoring. This is a meaningful safety investment even without coverage.
- Switch plans at next enrollment: If PERS coverage matters to you, it is worth checking whether a different plan in your area offers it during the Annual Enrollment Period (October 15 to December 7 each year).
How to Claim the PERS Benefit
Step 1: Call Member Services and confirm you have a PERS benefit. Ask for the coverage amount, approved devices or vendors, and any required documentation.
Step 2: If your plan uses approved vendors, contact one from the list they provide. If your plan allows any vendor, choose a PERS provider and contact them directly.
Step 3: Set up service and submit receipts if reimbursement is required. Keep records of your monthly monitoring bills if your plan reimburses ongoing fees.
Does My Loved One Need a Doctor's Order to Get a Medical Alert System?
Usually not. PERS coverage under Medicare Advantage typically does not require a physician prescription. It is treated more like a supplemental safety benefit than a medical device. Call your plan to confirm the specific requirements for your policy.
What Features Should I Look For in a Medical Alert System?
The most important features depend on the person's situation. For someone who lives alone and is at fall risk, these are the highest priorities:
- Waterproof design: Falls happen most often in the bathroom, where a non-waterproof device cannot be worn. Make sure the device is rated for shower use.
- Automatic fall detection: If the person cannot press the button after a fall, automatic detection is critical. This is especially important for anyone with loss of consciousness risk or significant mobility impairment.
- GPS or mobile capability: For active seniors who leave the house regularly, a mobile PERS that works outside the home provides protection beyond a home-only system.
- 24/7 monitoring: All reputable PERS services include round-the-clock professional monitoring. Confirm this before committing to a device.
