Choosing a Medicare Advantage Plan? Look for the Medical Alert Benefit
Medicare Open Enrollment runs October 15 to December 7. Every year around this time, people work through the same short list: premium, drug coverage, which doctors are in network. Here is one more box worth checking before you sign anything. Does the plan include a personal emergency response benefit.
It is easy to miss. It usually is not the headline of a plan's marketing. It shows up further down, listed alongside things like a dental allowance or a gym membership. If you are already comparing plans this fall, it takes only a few extra minutes to ask about it.
Plenty of people go through this same review every fall. If a personal emergency response benefit is part of the plan you choose, it can lower what you would otherwise pay for a system out of pocket.
If it is not part of your plan, that is useful to know too. It means you are free to choose whichever system actually fits you, instead of being steered toward one supplier.
What the Benefit Usually Is
Original Medicare generally does not cover personal emergency response systems. That has not changed. Medicare Advantage works differently. Because these plans can offer extra supplemental benefits beyond what Original Medicare covers, some of them choose to include a personal emergency response benefit as one of those extras.
When a plan does include it, the shape of the benefit varies. Some cover a device outright. Some offer a monthly allowance toward one. Some point you toward a specific supplier the plan has an arrangement with, rather than letting you pick your own.
The exact terms live in the plan's Summary of Benefits, not in the ad that brought you to the website in the first place.
Benefits also change from year to year. A plan that included this last year is not guaranteed to include it again next year, and a plan that did not offer it before might add it now. The only way to know for sure is to ask about the current year's plan, not last year's brochure.
If you are already enrolled in a plan and are not sure whether it includes this benefit, you do not have to guess. Your plan's member services line can tell you over the phone, and the plan's Evidence of Coverage document spells out the details in writing, including any allowance amount and any supplier requirement.
Questions to Ask a Plan
A plan representative should be able to answer these directly on the phone. If they cannot, that is worth noting too.
- Is there a personal emergency response benefit included?
- Which devices or vendors does it cover?
- Is there a monthly allowance, or does it require a specific supplier?
- What happens to the device if I change plans next year?
That last question is easy to skip and probably the most important one. A device tied to a specific plan is often tied to that plan only. If you switch plans during a future enrollment period, for any reason, the coverage and sometimes the device itself may not follow you.
The Honest Tradeoff
If your plan already includes this benefit at no extra cost, it is worth using. A plan-provided device can be a genuine saving, and there is no reason to pay twice for something you already have covered.
The tradeoff is choice and portability. A plan's supplier usually offers one type of device, and that device may not be the one that actually fits how you live day to day, whether that is a home-only system or one built for someone who leaves the house often.
Coverage tied to a plan is also coverage you could lose over a decision that has nothing to do with the device itself, like switching plans next year for a better drug formulary.
There is no single right answer here. A plan-provided benefit can work well for someone who is comfortable with whatever device the plan happens to offer, and who does not expect to change plans again soon.
A private system tends to work better for someone who wants a specific device, or who would rather their emergency device not be tied to an insurance choice at all.
Help Now Medical Alert is a private company. We do not bill insurance, and we are not a benefit included in any Medicare Advantage plan.
We wrote this because people who are in the middle of comparing plans ask us where a private system fits into that decision. The honest answer is that it depends entirely on what your specific plan offers this year.
Whichever system you end up with, plan-provided or private, the same limits apply. A medical alert does not prevent falls. No fall detection catches every fall, so press the button when you can. Any system needs working power and a phone line or cellular connection to work.
Know the Cost Either Way
Whatever plan you choose, and whether or not it ends up including this benefit, it helps to know what a medical alert system typically costs out of pocket. That gives you a real number to measure a plan's offer against, so you can tell whether it is a genuine saving or close to a wash.
See what a system typically costs before you decide. And if a private system turns out to be the better fit for you, whether that is right now or after this year's enrollment period settles, you can see the options any time. No plan membership required.