Medical alert systems: cost, features, and how to choose one

A button. Press it and a person at a monitoring center answers, talks to you, and sends help if you need it. That is the whole product. Everything else is a variation on where the button works and what happens if you cannot press it.

More than one in four adults over 65 falls each year. The injury is only part of the danger. The other part is the time spent on the floor waiting for someone to notice. A medical alert system is a way to make that wait short.

In home systems

A base station plugs into the wall. You wear a pendant or wristband that talks to it. Press the button anywhere within range and the base station calls the monitoring center over a landline or a built in cellular connection.

Range is the number to check. NCOA measured 200 to 1,000 feet across the systems it tested, and up to 1,400 feet on the longest. That covers most houses and a good part of the yard. It does not cover the grocery store.

Mobile systems

One device, worn or carried, with its own cellular connection and GPS. It works anywhere there is a phone signal. The monitoring center can see where you are. It costs more per month and it has to be charged.

Battery life across the mobile devices NCOA tested ran from two days to ten. A device that dies on the nightstand protects nobody. If the person is not going to remember to charge it, the in home system with its plugged in base is the safer choice, even though it does less.

Automatic fall detection uses sensors in the pendant to notice a fall and call for help without the button being pressed. It exists for the situation where the person is unconscious, or cannot reach the button, or is too confused to use it.

It is not perfect. NCOA is direct about this: no fall detection is 100% accurate, and every company says so in its terms. In one study NCOA cites, 83 of 84 alarms over four months were false. Devices can also miss falls, especially slow ones where the person slides down rather than drops.

So why pay the extra $10 a month? Because a false alarm costs a phone call and a missed fall is rare. The failure that matters is the one where nobody is called at all. Fall detection makes that less likely. It does not replace the button.

1. 1Will it be worn? The best system in the world does nothing in a drawer. Pendant or wristband, waterproof or not, big button or small. Ask the person who will wear it. Then believe the answer.
2. 2Is it waterproof? The bathroom is where the device is needed most and where it is most often taken off. It has to survive the shower.
3. 3Response time. How long between pressing the button and a human voice. NCOA times this for every system it reviews. Compare the numbers, and ask the company for its own figure.
4. 4Fall detection. See above. Worth the $10 for anyone who lives alone.
5. 5Range or GPS. Range for an in home system. GPS for a mobile one. Match it to how the person actually spends the day.
6. 6Battery. For mobile devices only. Longer is better, and a charging routine has to exist.
7. 7Caregiver app. Useful if family wants to see alerts. Not essential, and it should not cost more than a few dollars.

Original Medicare does not cover medical alert systems. That is the plain answer and it has not changed.

Some Medicare Advantage plans do cover them, in full or in part, as a supplemental benefit. Coverage varies by plan, and the plan usually decides which vendor. Call the number on the card and ask about a personal emergency response system, which is the term plans use. Most Medicaid programs do not cover them. It is still worth asking.

For most people this is an out of pocket expense of $20 to $60 a month. Set against the cost of one long lie on a bathroom floor, it is one of the cheaper things on this site.

• Is there an equipment fee, an activation fee, or a shipping fee? Get all three.
• Is the plan month to month? What does cancelling cost?
• Is the price locked, or does it rise after a promotional period?
• Is fall detection included in the quoted price or extra?
• Is the pendant waterproof, and can it be worn in the shower?
• Does the in home system need a landline, or does it have its own cellular link?
• Who answers the call, and where are they? Ask for the average response time.
• Can a family member be called first, before emergency services?

A medical alert system shortens the time between a fall and help. It does nothing to prevent the fall. That job belongs to the house: the lighting on the route to the bathroom, the grab bars, the handrails, the step at the back door.

The two go together. The cheap end of home changes is covered in our guide to lighting. The bathroom, where the device matters most, is covered in the bathroom modification guide. If the person has already fallen more than once, our guide to the signs it is time for a home safety assessment is worth ten minutes.