Medical Alert and Insurance

It may be impossible to over-emphasize the benefits of an in-home medical alert system, also known as a personal emergency response system (PERS). Anyone experiencing a life-threatening condition, dementia or Alzheimer’s, or who is a fall risk needs a MAS. According to the National Council on Aging (NCOA), falls are especially common for those 65+ and are the most common cause of fatal or near-fatal injuries in that age group.

Both the NCOA, and the Center for Disease Control, agree about these fall-related statistics:

  • On average, one out of four seniors falls each year.
  • These falls often result in broken bones or head injuries.
  • On average, every 11 seconds a senior is being treated for a fall in an emergency room.
  • Every 19 minutes, a senior dies from a fall.

Statistics show that if a senior falls once, the odds of falling again are doubled. That fear of falling can curtail one’s activities and socializing, further compounding any preexisting anxiety due to other health conditions, often leading to isolation and depression.

In short, falls and the fear of falling adversely affect the quality of life and can impact longevity. Though many people prefer aging-in-place, falls often land older adults in assisted living, nursing homes, or rehabilitation facilities.

There is good news here, though. There are things that can help a loved one avoid becoming a statistic.

A medical alert system is a safety net.

A medical alert system can lessen the likelihood of a fall. Should a fall – or any other health crisis – occur, a medical alert can ensure rapid treatment. Prompt medical attention will not only lessen the possibility of serious long-term effects from the incident but, if a fall occurred, may also reduce the probability of another fall.

Even if the senior is unable to speak, the press of a button (whether on a bracelet, necklace/pendant, attached to a belt, or wall-mounted) will summon help. If fall detection is added to their purchase, this would greatly increase the odds that – even if the user is unconscious – a message would automatically be transmitted to the call center. The call center would then proceed with the agreed-upon list of contacts, such as the fire department, Emergency Medical Technicians (EMTs), and family.

Some seniors may argue that getting a PERS is tantamount to sacrificing their freedom and privacy. In fact, having a personal emergency response system that covers them in the home and – should they travel – out on the road would free them up to go where they want, when they want. Additionally, the need for constant supervision by a caregiver is greatly reduced.

Simultaneously, it also gives caregivers peace of mind. Thanks to current technology, a medical alert system may include a GPS, permitting a caregiver to be aware of where the senior is at any time. Some medical alert systems also keep track of and report – whether to the senior, to doctors, or to daily caregivers – pertinent health data such as heart rate, blood sugar levels, steps taken, and blood pressure.

Some will contend that a smartphone or digital assistants like Amazon’s Alexa or Google Home should be enough. However, no one has their phone with them all the time. As for Alexa and the like, they are limited; for one thing, they can’t call 911, which a medical alert device can and will.

A well-chosen medical alert system provides a much more effective and reliable safety net than a smartphone. Rather than limiting the user, it liberates the individual from being utterly reliant on others for constant, in-person surveillance, meaning the senior can age in place and with a greater degree of privacy.

Does insurance cover the cost of a medical alert system?

Once it’s been decided that a personal emergency response system is needed, it’s natural to wonder how to pay for it. Will Medicare, Medicaid, or some other form of insurance cover all or at least part of the cost of a medical alert?

Let’s look at the possibilities:

  • Medicare – Medicare Parts A and B do not cover the cost of a medical alert system. Medicare Supplements (Medigap) can help with copays, coinsurance, and deductibles, but generally will not cover vision, dental, or hearing loss.
  • Medicare Advantage – Unlike Medicare, Medicare Advantage plans may provide at least a partial reimbursement for a medical alert system. Note that each state determines what Medicare Advantage packages it will offer. When signing up for Medicare, look at Medical Advantage to see if the added benefits provided are worth the cost of the deductibles and copays. An MA policy could cover dental, vision, hearing and/or a medical alert.
  • Long-term Care Insurance (LTCI) – Most likely long-term care insurance will cover all or part of the cost. It is meant to help seniors stay in their homes. To make that possible, LTCI tends to cover the cost of architectural modifications as well as safety features like a medical alert. To find out if you are covered, call and ask your insurer.
  • Local Area on Aging Office – If you find you cannot get assistance through your insurance coverage, contact the nearest Area on Aging Office (AAO). These offices keep track of local resources available to seniors. To find the AAO closest to you, visit the National Association of Area Agencies on Aging.
  • Your Hospital System – At least some hospital systems (e.g., Providence, Kaiser Permanente) have help desks where people of all ages can get information on what the community has to offer in the way of support. You need not be a patient or in any way related to the hospital to obtain advice or resources.

What features can a medical alarm system provide?

As technology advances, the options available expand. Here are the key features currently available:

  • The necklace/pendant or a bracelet not only allows the wearer to request help with the push of a button but may also serve as two-way voice communication.
  • GPS – Monitor the wearer’s whereabouts while communicating information about falls, sudden movements, or wandering outside proscribed areas.
    Depending on the needs of the senior, a medical alert can protect users in the home as well as away. Whether going into the local community or traveling significant distances, the right medical alert system provides the protection needed.
  • Motion sensors – Within the home, a system of motion detectors can be set up, keeping track of movements and relaying – whether to the central office and/or to a loved one – information regarding anything out of the ordinary.
  • Monitoring of basic health signs including heart rate and blood pressure.
  • Fall detection – For an average of $15 a month (less for some providers; more for more advanced forms) a user can add fall detection. Know, though, that the technology for this feature is far from perfected. Any senior with a high fall-risk will still require certain amount of monitoring by caregivers.
    Voice-activated devices – Some companies also offer voice-activated, wall-mounted “button” devices. These buttons respond to specific commands such as “Call 911.” They can be programmed to call, upon command, the medical alarm company, the police, fire department and/or a designated caregiver.
  • Depending on how functional the senior is, this might be a viable option for those who don’t want to attach anything to their belt or wear a pendant or bracelet. And any senior, concerned their jewelry isn’t waterproof, might want a voice-activated device in the shower area where accidents are most likely to occur.
  • Carbon monoxide and fire detection add-on options may also be available.
  • Fall prevention devices – Distinct from GPS, this development comes in the form of a thin pad that can be placed on a bed or a chair. When the occupant of the furniture either gets up, moves abruptly, or gets too close to the edge of the bed or chair, a message is sent to the caregiver that a fall might be imminent. This protection comes in two forms: either a sensor pad that comes into contact with the body or in the form of infrared lights that are carefully aimed at the chair or bed and that, if tripped by the resident’s movements, will alert the caregiver.
  • Some companies offer incentives such as a free lockbox similar to what realtors use. The box attaches to your front door and opens with a code that the senior shares with family and first responders, in case the senior is unable to get to the door.

How much does a medical alert system cost?

It depends on the company, of course. Depending on the features chosen, the cost can range anywhere from about $19.95 a month for a basic system to around $50 a month. (Of course, any of these prices could be less if a discount or some other special offer is involved; more on this below.)

Pros and cons of medical alert systems

Although the competition is fierce among MAS providers, they are not all offering precisely the same options. Here are some of the specifics to look out for when shopping for a PERS.

Valuable as it may be, it is key to remember that a fall detection option does not correctly report all falls.
Some alarm systems require a landline. If the senior does not currently have one, a chat with a phone company representative would determine if it would be cost-effective to have one laid on. If not, choose a different medical alarm system.
Thanks to the competitive atmosphere, fewer companies are insisting on long-term contracts. Even so, read over the contract carefully before signing anything.
As regards voice-activated devices, one does have to be close enough to it to trigger it and, of course, one must be able to speak. While this can be useful in augmenting a medical alert system, it shouldn’t be the sole component.
The follow-up sales calls can be annoying. Not all companies, though, are as competitive. To halt this behavior, it may be necessary to either email or snail-mail the company to stop phoning; just telling the representative during the call may not be enough.

Tips to save money on a medical alert system

Here are some things to think about when budgeting for a medical alert device:

  1. Do your research and take the time to shop around. Take time to ask for support and advice from family, friends, and healthcare professionals. Reading online reviews can also tell you a lot. Lacking this data, you (and your loved one) may be the victims of the sales representative who most effectively plays on your fears. (Not that all sales reps are like that, but, depending on company policy, they can be.) Learning what a medical alert can offer, and figuring out what the senior and caregivers need, will help the decision-maker feel more confident and in control during this tense time.
  2. An AARP membership discount may apply. Some medical alert companies extend discounts or other special offers (a free month or a lockbox, for instance.) based on the type of commitment the subscriber makes. Committing for, say, three months at a time (or even longer) would be acceptable if this fit into the budget and one knew that a prorated refund based on the unused time would be forthcoming if the senior moves into assisted living, e.g.
  3. Many if not most companies offer discounts, whether on a regular or periodic basis. Even if the ads don’t mention one, always ask the representative about possible discounts. Representatives may be authorized to offer one but only if asked.
  4. Call the local Office for Area Aging (the name of the office varies from state to state). Ask if there are any resources available to help with costs.
  5. Read the contract carefully before signing. Among the things to note: are there any hidden costs? What is their refund policy? Do they prorate for unused time? What is their policy about repairing or replacing equipment? How accessible is customer support? How much notice do you have to give before terminating the contract?
  6. Avoid long term contracts. If the company fails to perform satisfactorily, you want to be able to terminate the contract and not have to pay for a full term when you didn’t use it. If possible, the best way to go is month-to-month.

Should a company fail to deliver services as agreed upon (for whatever reason), and refuse to reimburse the client, the client can email or write to the State Attorney General of the state in which the company is headquartered. Include as fully detailed and documented a report as possible. There is no guarantee of success here, but at the very least, your complaint will be registered.

Bottom Line

The cost of medical alert systems is decreasing as the number of companies offering such equipment grows. When factored into a budget, the sum may still be considerably less than the monthly rental fee for senior housing.

It is also important to realize that, while the caregivers may agree that a medical alert system would make life safer and better for both the senior as well as for themselves, it would be a mistake to just surprise the loved one with an alert system.

Involving a loved one by talking about the possible features and benefits will serve several purposes. One, it is an expression of respect and proves their opinion is valued. Two, the ensuing discussion can help overcome possible reservations. And three, it all goes toward building up the sense of camaraderie and teamwork necessary to make the caregiver-senior relationship function at its best.

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