How much does a medical alert system cost?

The four things you pay for

Monthly monitoring: what you are actually buying

The monitoring fee pays for a staffed center that answers at any hour, speaks to the person through the base unit or pendant, and decides whether to call a neighbor, a family member or an ambulance. That decision-making is the product. The hardware is almost incidental.

Prices scale with how the device connects. A landline plan is the cheapest, because it uses a phone line you already pay for. A cellular plan costs more because the provider is paying for a mobile connection. A mobile GPS plan, which works away from home, costs more again.

Be clear about which of those three you need. A great many households pay for a mobile GPS plan for someone who has not left the house unaccompanied in two years.

The add-ons, ranked by whether they earn their keep

• Automatic fall detection - worth it if the person has fallen before, has fainting episodes, or lives alone. It is the one add-on that regularly justifies itself, and our guide to automatic fall detection explains how it works and when it misses.
• A second pendant or wall button - usually worth it. A button in the bathroom costs little and covers the room where falls are most likely.
• A lockbox for a door key - almost always worth it. Without one, a responder may have to force a door, and that bill will exceed years of lockbox fees.
• Caregiver app access - worth it if a family member will actually use it. Dead weight if nobody opens it.
• Medication reminders - rarely worth the add-on price. A separate automatic pill dispenser does the job better for a one-off cost.
• Activity monitoring - think carefully. It can feel intrusive, and the person wearing it has a vote.

Questions to ask before you sign

1. Is there an activation fee, and will you waive it? This is frequently negotiable.
2. Is the equipment bought, rented, or included? If rented, what happens to the fee if it breaks?
3. Is there a contract, or is it month to month? Month to month is standard now, and a long contract is a reason to look elsewhere.
4. What is the cancellation policy, including after a death or a move into care? Ask for it in writing.
5. Is there a discount for paying annually, and does it come with a longer commitment?
6. Is the monitoring center in the country, and is it staffed around the clock by people rather than an automated system?
7. What is the battery life of the pendant, and who is told when it runs low?
8. Does the pendant work in the shower and the garden, and what is the actual range from the base unit?

Ask every one of these on the phone before giving a card number. Providers answer them straightforwardly; the ones that do not are telling you something.

The no-monthly-fee route

A no-monthly-fee device replaces the monitoring center with a programmed list of phone numbers, or with a direct call to emergency services. You pay once for the hardware and nothing afterwards. Over five years that is a substantial saving.

The trade is real and worth stating plainly. A monitoring center answers within seconds, every time, and knows the person's address and medical notes. A family list depends on somebody picking up - and the people on that list are often at work, driving, or asleep.

It suits a household where several family members live nearby and at least one is reliably reachable. It suits a person living alone in a quiet area much less well. Our no-monthly-fee roundup covers the devices in detail.

Help with the cost

• Original Medicare does not generally cover medical alert systems, but some Medicare Advantage plans include them as a supplemental benefit - check your specific plan.
• Some state Medicaid waiver programs cover personal emergency response systems for people receiving home and community-based services.
• Your local Area Agency on Aging may know of subsidized or loaned equipment programs.
• Veterans may be eligible for equipment through VA programs - ask the VA directly rather than a sales line.
• Some providers discount for AARP members, veterans or annual payment. It is always worth asking.

Coverage rules change and vary by state and plan. Confirm with the plan or agency directly rather than relying on a provider's marketing page.

Landline, cellular or mobile - pick the cheapest one that fits

The single largest factor in the monthly price is which connection the system uses, and it is the one most often chosen wrongly. A landline system plugs into an existing phone line and is the cheapest to run, because the provider is not paying for a connection on your behalf. It only works inside the house, and it stops working if the phone line fails or a handset is left off the hook.

A cellular in-home system uses a mobile connection built into the base unit, so no phone line is needed. It costs more each month, it keeps working when the landline does not, and it is the right default for a household that gave up its landline years ago - which is now most of them.

A mobile GPS system works anywhere with cell coverage and reports a location. It is the most expensive tier, and it is the one most commonly sold to someone who does not leave the house alone. Before paying for it, ask honestly how often the person is out without a companion. If the answer is rarely, an in-home system plus a phone in the pocket covers it for less.

Range is worth checking whichever tier you choose. Providers quote a distance from the base unit, and that figure is measured in open air rather than through two brick walls. Ask specifically whether the pendant reaches the end of the yard, the garage and the bathroom, because those are the three places it will actually be needed.