Educational disclaimer. This is not medical advice, not a product recommendation, and not a government site. I am not a clinician, a licensed insurance agent, or a Medicare counselor. Savvy Senior Central is not affiliated with, endorsed by, or paid by any medical alert company, and it is not affiliated with CMS, SSA, or HHS. We do not rank brands on this page. For Medicare coverage questions, use Medicare.gov or 1-800-MEDICARE (1-800-633-4227; TTY 1-877-486-2048). For free local help, call the ACL Eldercare Locator at 1-800-677-1116.
A medical alert system is a way to reach a person who can send help when you cannot get to a phone. You press a button on a pendant, wristband, or watch, or a sensor decides you fell, and the device opens a call. Someone answers. That someone might be a trained operator at a monitoring center, or it might be your daughter’s cell phone. That one detail matters more than the brand name on the box.
Original Medicare generally does not pay for these systems. CMS lists “telephone alert systems” as a denied item on its durable medical equipment reference list because they are emergency communication devices, not diagnostic or treatment equipment. Some Medicare Advantage plans and some state Medicaid programs do offer help. Most families pay out of pocket.
I have spent 18 years in consumer marketing and lead generation aimed at older adults and their families. That is operator experience, not a clinical credential. Medical alert offers are sold fear first, fine print later. This page is the fine print.
Why families start looking
The usual trigger is a fall, or a near miss. The numbers explain why. According to the CDC, falls are the leading cause of injury for adults 65 and older. More than 14 million older adults, about 1 in 4, report falling each year. About 37% of people who fall report an injury that needed medical treatment or limited their activity for at least a day. CDC also reports that falling once doubles the chance of falling again, and that the age-adjusted fall death rate for older adults rose about 21% between 2018 and 2024.
A medical alert device does not prevent any of that. It addresses the time after a fall, when a person is on the floor, hurt or unable to get up, and no one knows. Clinicians sometimes call that a “long lie.” Shortening it is the whole job of the device, and it only works when the person is wearing it, it has power and signal, and someone reliable answers.
How a medical alert system actually works
Every system, whatever the marketing calls it, is a chain with four links:
- The trigger. A button press, a voice command, or an automatic fall-detection sensor.
- The connection. A home base station on a landline or cellular signal, or a mobile device with its own cellular service.
- Who answers. A professional monitoring center that is staffed around the clock, or a list of family and friends the device calls in order.
- What happens next. The responder talks through the device’s speaker, decides whether to call family, a neighbor, or 911, and passes along location and medical notes if the system stores them.
When a salesperson describes a feature, ask which link it improves. A longer battery, a louder speaker, or a faster answer at 3 a.m. matters. Most other features do not.
Device types compared: PERS, mobile, fall detection, and smartwatches
The industry term for the classic setup is PERS, short for personal emergency response system. The newer categories are variations on the same chain.
Swipe sideways to see every column.
| Type | Where it works | How it connects | Who usually answers | Main weakness |
|---|---|---|---|---|
| In-home PERS (base plus pendant or wristband) | Inside the home and sometimes the yard, within range of the base | Landline or cellular base station | Monitoring center | No help once the person leaves the property |
| Mobile PERS (GPS pendant or clip-on) | Anywhere the cellular network reaches | Built-in cellular and GPS | Monitoring center | Must be charged, often every few days |
| Automatic fall detection | A feature added to a pendant, mobile unit, or watch | Same as the device it is built into | Depends on the device | Misses some falls and triggers on some non-falls |
| Smartwatch with emergency calling | Near a paired phone, or anywhere with a cellular watch plan | Phone, Wi-Fi, or watch cellular service | Often 911 or a contact list directly, not a monitoring center | Daily charging, small buttons, setup complexity |
In-home PERS fits someone who is home most of the time and does not want to charge anything. Range varies, so test it from the far bedroom, the basement stairs, and the mailbox.
Mobile PERS fits someone who still drives, walks, shops, or travels. GPS lets the responder see roughly where the person is. The tradeoff is charging. A mobile unit that sits dead on the nightstand is worth nothing.
Smartwatches are consumer electronics with safety features added. They work well for people who already wear and charge a watch every day. They tend to work poorly for people with arthritis, vision loss, or no interest in a new gadget.
Fall detection: what it can and cannot do
Automatic fall detection uses motion sensors, usually an accelerometer and sometimes a pressure sensor, to guess that a fall happened. If the wearer does not cancel within a short window, the device opens a call.
It is a useful backup, especially for someone who could be knocked unconscious or confused after a fall. It is not a guarantee. Slow slides out of a chair, falls onto a soft surface, and falls while the device is on a nightstand can go undetected. Sitting down hard, dropping the pendant, or a vigorous hug can set it off.
Set expectations accordingly:
- Keep the habit of pressing the button. Fall detection is a second layer, not the first.
- Ask how false alarms are handled. Will the operator call back? Will they send an ambulance if no one answers? Who pays if they do?
- Ask whether fall detection costs extra each month. It often does.
- Ask whether sensitivity can be adjusted, and who adjusts it.
Monitored vs self-monitored: who picks up at 3 a.m.
Professionally monitored systems route calls to a staffed center that is open 24 hours a day. You pay a monthly fee for that staffing. The operator can stay on the line, call your contacts, and request emergency services.
Self-monitored systems, often sold as “no monthly fee,” dial a list of phone numbers you choose. There is no operator. If your contacts are asleep or driving, the call rolls to the next name or to voicemail. Some devices can dial 911 directly, but then the person must be able to speak and explain where they are.
Self-monitored can work for a couple who live together, or someone with a neighbor who is home all day and has agreed to be first call. It is a weaker fit for someone who lives alone with family hours away. Test it at an inconvenient hour before you rely on it.
What these systems cost, line by line
There is no federal price benchmark for medical alert service the way CMS publishes Medicare premiums. Prices change often and vary by feature. For a dated reference point, an FTC complaint filed in 2015 against a robocall operation described monthly monitoring fees of $29.95 to $39.95. Treat that as history, not a quote.
What you can control is how you compare offers. Ask every company for a written 12-month total that includes:
- Equipment: purchased outright, leased, or “free” with a contract
- Activation or setup fees
- Monthly monitoring fee, and whether it is locked for the contract term
- Fall detection add-on, if priced separately
- Second wearable or spouse coverage
- Lockbox for a house key so responders can get in without breaking a door
- Shipping, return, and restocking fees
- Cancellation terms: notice required, prorated refunds, and fees for lost or unreturned equipment
A lower monthly fee with a long contract and a steep return fee can cost more than a higher fee you can cancel any month.
Who pays: Medicare, Medicare Advantage, Medicaid, and local help
Original Medicare (Parts A and B). Generally no. CMS’s National Coverage Determination for durable medical equipment (NCD 280.1) lists telephone alert systems as “Deny” because they “are emergency communications systems and do not serve a diagnostic or therapeutic purpose.” A doctor’s note does not change that category. Medigap policies follow Original Medicare’s coverage, so they do not add it either.
What Medicare does cover can still help with the underlying risk. Part B’s yearly Wellness visit includes a review of functional ability and safety, and Medicare covers physical therapy when it is medically necessary. Ask the doctor about fall risk directly. The CDC’s STEADI program exists to help clinicians screen for it.
Medicare Advantage (Part C). Some plans offer a personal emergency response benefit as an extra. It is plan by plan, can change each year, and may limit you to one vendor. Check the plan’s Evidence of Coverage, not the television ad, and ask whether the benefit includes fall detection.
Medicaid. Many states cover personal emergency response systems through Medicaid home and community-based services programs for people who qualify. Rules, waitlists, and approved vendors are state specific. Ask your state Medicaid agency.
Local aging services. Area Agencies on Aging sometimes know of local programs that loan or subsidize devices. Start with the Eldercare Locator at 1-800-677-1116.
Signal, power, and the network question
A medical alert device is a phone. It has the same weak points as a phone.
- Cellular coverage. Ask which carrier network the device uses, then check coverage at the home, the basement, and the places the person goes. A company can usually tell you how to run a signal test.
- Network retirements. When carriers shut down 3G networks in 2022, the FCC warned that certain medical devices and home security systems relying on 3G could lose service. Ask what network a device uses and what the company does when that network retires.
- Power outages. Ask how long the home base station runs on its backup battery. The FCC notes that internet-based phone service may not work during a power outage without a backup power supply.
- Monthly tests. Most monitoring centers welcome test calls. Put a recurring reminder on the calendar.
Questions to ask before you sign
Use these with every company. Write the answers down.
- Is the monitoring center staffed 24 hours a day, every day? Who operates it?
- How do you measure answer time, and what was it last month?
- Can operators speak my parent’s preferred language?
- Does the device call your center, a contact list, or 911 directly?
- Is fall detection included or extra? How are false alarms handled?
- How long does the battery last, and how is low battery reported to us?
- Is it rated to be worn in the shower and bath, so it never has to come off to wash?
- Which cellular network does it use, and what happens when that network is retired?
- What medical and contact information do you store, who can see it, and how do we change it?
- What is the contract length, and what are the cancellation and equipment return terms in writing?
- Is the monthly price locked, and for how long?
- Is there a trial period with a full refund, including shipping?
Red flags: the “free medical alert” call
The FTC and state attorneys general have sued operations that used robocalls to pitch “free” medical alert devices to older adults. Callers claimed a relative had already bought the device, promised no billing until activation, then charged card or bank accounts right away.
- A recorded sales call is almost always illegal. Hang up. Do not press a number to “opt out.”
- Nobody legitimate needs a card or bank number to ship a “gift.”
- Real companies will mail written terms before you pay.
- Report the call at ReportFraud.ftc.gov and add the number to the National Do Not Call Registry.
The first 30 days: setup checklist
Most medical alert failures are habit failures, not hardware failures. A good first month looks like this:
- Wear it for a full week, including in bed and in the shower if it is rated for water.
- Place a test call and confirm the center sees the right address and contacts.
- Test range from the far corners of the house and yard.
- Tie charging to something daily, like the morning coffee.
- Install a key lockbox if the service supports it, and confirm the code is on file.
- Review the first bill line by line against the written quote.
- After 30 days, ask the wearer honestly: is it comfortable, and do you actually wear it?
FAQ
Does Medicare pay for a medical alert system?
Original Medicare generally does not. CMS classifies telephone alert systems as emergency communication devices, not durable medical equipment. Some Medicare Advantage plans include a benefit as an extra, and some state Medicaid programs cover them for people who qualify.
What is the difference between PERS and fall detection?
PERS is the whole system: a wearable button, a connection, and someone who answers. Fall detection is a feature some PERS devices and watches add. It tries to recognize a fall and call for help automatically if the wearer cannot press the button.
Is a smartwatch a good substitute for a medical alert system?
It can be for someone who already wears and charges a watch daily and is comfortable with the settings. Many watches call 911 or contacts directly instead of a monitoring center. For someone who will not charge a device every day, a traditional pendant is usually the more reliable choice.
Are “no monthly fee” medical alert systems worth it?
They save money but replace a trained operator with your contact list. They fit best when someone reliable is nearby and always reachable.
How accurate is automatic fall detection?
No sensor catches every fall, and some ordinary movements set it off. Treat it as a backup to pressing the button. Ask the company how false alarms are handled and whether sensitivity can be adjusted.
What should I do if someone calls saying a relative bought me a free medical alert?
Hang up. The FTC has sued operations that used that exact pitch to collect payment information and start monthly charges. Report the call at ReportFraud.ftc.gov.
Will a medical alert system work during a power outage?
Mobile units run on their own batteries. Home base stations usually have a backup battery that lasts a limited time. If the base connects through an internet-based home phone line, that line may need its own backup power. Ask the company for specifics.
Sources
Coverage statements trace to CMS and Medicare.gov. Fall statistics trace to CDC. Scam and telecom points trace to the FTC and FCC. No medical alert company marketing is used as proof. Last verified September 23, 2026 (ET).
- CMS: National Coverage Determination 280.1, Durable Medical Equipment Reference List (telephone alert systems listed as "Deny")
- Medicare.gov: Durable medical equipment (DME) coverage
- Medicare.gov: Yearly "Wellness" visits
- CDC: Older Adult Falls Data
- CDC: Facts About Falls
- CDC: STEADI: Stopping Elderly Accidents, Deaths and Injuries
- FTC: FTC, Florida Attorney General Sue to Stop Deceptive Robocalls from Operation That Pitched Seniors "Free" Medical Alert Systems (July 2015)
- FTC: Robocalls
- FCC: Plan Ahead for Phase Out of 3G Cellular Networks and Service (archived 2022 guidance)
- FCC: VoIP and 911 Service
- Medicaid.gov: Home and Community-Based Services
- ACL: Eldercare Locator (1-800-677-1116)