UnitedHealthcare (UHC) has instituted a massive change to its coverage policies for Medicare Advantage (MA) members, significantly curtailing access to Remote Patient Monitoring (RPM) services starting January 1, 2026.
This policy shift runs contrary to the momentum of remote monitoring uptake and recent regulatory expansion of RPM under Health Secretary Robert F. Kennedy Jr.’s Department of Health and Human Services (HHS).
UHC’s new policy limits RPM to only two conditions deemed “medically necessary”, namely chronic heart failure (CHF) and hypertension during pregnancy. The insurer explicitly excludes RPM coverage for Type 2 diabetes and hypertension outside of gestation, despite these being among the most popular uses of the technology.
UHC defended the policy by claiming that remote physiologic monitoring is “unproven and not medically necessary due to insufficient evidence of efficacy” for a broad range of conditions.
This restrictive action has faced sharp criticism from legal and health experts. Medicare has covered RPM services since 2019.
A letter by the Remote Monitoring Leadership Council to CMS Director Mehmet Oz, M.D, in April defended the use of remote devices and argued they actually brought overall savings.
“One of our members recently completed a cost and utilization analysis, which included 5,872 patients enrolled in an RPM program compared against 11,449 patients in propensity-score matched control group, demonstrating annual total savings of $1,308 per patient across three chronic disease programs (heart failure, hypertension, and type 2 diabetes). Cost savings were primarily driven by a 27% reduction in hospital admissions – specifically, reductions in hospitalizations for heart failure and stroke,” concluded the letter.
TJ Ferrante, partner at law firm Foley & Lardner said that losing access to remote monitoring could be harmful to many Americans.
“These patients are getting remote monitoring because the doctors deem it appropriate,” Ferrante told Fierce Healthcare. “That’s why the doctors are ordering it. So, yeah, it would be very harmful to, I think, tens of thousands of patients, probably.”
CMS could attempt to bring an enforcement action on UnitedHealth Group and hand out fines.