UnitedHealthcare Limits Remote Monitoring Coverage to Heart Failure and Pregnancy-Related Hypertension

UnitedHealthcare has issued a major revision to its remote patient monitoring (RPM) policy that could impact thousands of Medicare beneficiaries. The insurer now considers RPM medically necessary only for two conditions: chronic heart failure and hypertensive disorders during pregnancy. Coverage for other uses, including Type 2 diabetes and hypertension outside pregnancy, will end under the new guidelines.

The policy, published in September, states that “remote physiologic monitoring is unproven and not medically necessary due to insufficient evidence of efficacy” for several conditions, including diabetes mellitus, gestational diabetes, chronic obstructive pulmonary disease, hypertension outside of pregnancy, and mental health disorders.

 Beginning January 1, 2026, UnitedHealthcare plans to cover RPM solely for heart failure and pregnancy-related hypertension, according to a company spokesperson. “Starting Jan. 1, 2026, we will cover remote physiologic monitoring only for members diagnosed with heart failure or hypertensive disorders during pregnancy, based on the latest clinical evidence,” the spokesperson said.

UnitedHealthcare has cited select studies and recommendations to justify the change, claiming insufficient proof of benefit for many conditions. However, experts have challenged the insurer’s interpretation of clinical guidelines. The company referenced the American College of Cardiology (ACC) and American Heart Association’s 2025 Joint Guideline, saying it did not recommend remote monitoring for hypertension. 

In contrast, the guideline explicitly supports home blood pressure monitoring “combined with frequent interactions with multidisciplinary team members” as an important tool for improving blood pressure control.

Legal and healthcare policy experts have questioned both the scientific basis and legality of the new policy. Emily Cook, a lawyer at McDermott, Will & Emery who helped draft Medicare Advantage regulations, said, “This is a far more restrictive policy than the type of limitations we’ve seen in the past.” Cook and other lawyers called UnitedHealthcare’s approach an “aggressive interpretation” of its authority as an administrator of Medicare Advantage plans.

Attorneys argue that Medicare Advantage plans must cover all services available through traditional Medicare, which has covered RPM since 2019. Cook noted that the statute “very, very clearly says that Medicare Advantage plans are required to cover all of the benefits that are available through traditional Medicare.” She added that while plans can assess medical necessity at the individual level, UnitedHealthcare’s decision appears to rule out entire categories of coverage without such a case-by-case review.

TJ Ferrante, a partner at Foley & Lardner, said the move departs from how Medicare has approached remote monitoring coverage. He noted that the Centers for Medicare & Medicaid Services (CMS) has consistently supported broader RPM coverage since 2019. Ferrante also warned that the policy could harm many patients and remote monitoring providers. “These patients are getting remote monitoring because the doctors deem it appropriate,” he said, adding that removing coverage could affect “tens of thousands of patients.”

Remote monitoring advocates have presented data to support RPM’s cost and care benefits. A study cited by the Remote Monitoring Leadership Council showed an annual savings of $1,308 per patient and a 27% reduction in hospital admissions among participants in RPM programs for heart failure, hypertension, and Type 2 diabetes.

The new policy may also test legal boundaries around Medicare Advantage coverage determinations. Experts suggest it could set a precedent allowing insurers to restrict other services not explicitly defined in national or local coverage determinations. Cook said this approach indicates UnitedHealthcare “may be contemplating” similar measures for additional service categories.

CMS did not respond to a request for comment by the time of publication. For now, the change is scheduled to take effect on January 1, 2026.

UnitedHealthcare’s New Remote Monitoring Coverage Policy

The health insurer UnitedHealthcare announced a significant shift in its remote monitoring coverage: starting January 1, 2026, UnitedHealthcare will restrict its remote physiologic monitoring (RPM) reimbursement to only two specific patient populations—those diagnosed with chronic heart failure and those experiencing hypertensive disorders during pregnancy. Becker’s Payer Issues | Payer News+3fiercehealthcare.com+3BenefitsPro+3

According to UnitedHealthcare’s updated policy, for other commonly monitored chronic conditions—such as type 2 diabetes, standard hypertension (outside of pregnancy), chronic obstructive pulmonary disease (COPD), sleep apnea, and various behavioral health conditions—RPM will no longer be deemed “medically necessary” or “proved” according to the insurer’s assessment of the evidence. fiercehealthcare.com+2americanhealthlaw.org+2

Why UnitedHealthcare Made This Decision

UnitedHealthcare states that its decision is grounded in a review of the clinical evidence and cost-effectiveness of RPM. The policy document notes that RPM is “only proven and medically necessary” for chronic heart failure and hypertensive pregnancy disorders, and that for other conditions the evidence of efficacy was deemed insufficient. STAT+2Becker’s Payer Issues | Payer News+2

Even though broader health-care policy trends (such as those from Centers for Medicare & Medicaid Services) are expanding remote monitoring, UnitedHealthcare’s move diverges from this trajectory—raising concerns about both patient access and the future of RPM as a standard of care. Prevounce Blog+1

Implications for Patients and Providers

For patients covered under UnitedHealthcare’s commercial, Medicare Advantage and Medicaid plans, the narrowing of RPM coverage means that those with diabetes, non-pregnancy hypertension, COPD or other chronic conditions may lose eligibility for remote physiologic monitoring services as of early 2026. Providers who rely on RPM as part of chronic-care workflows will need to reassess care models for UnitedHealthcare patients or find alternative management strategies. Prevounce Blog+1

Providers may need to shift eligible patients into other care models (for example, chronic care management or advanced primary care) where reimbursement for devices and monitoring may not be as comprehensive. The practical impact could include fewer devices prescribed, fewer remote check-ins, and potentially greater risk of unmonitored progression of chronic disease. Prevounce Blog

What This Means for the Remote Monitoring Industry

UnitedHealthcare’s policy change sends a strong signal to the digital health and remote monitoring industry: even as technology adoption grows, payer coverage remains deeply tied to payer assessment of evidence and cost-effectiveness. The restriction may curtail the business models of remote monitoring vendors who target populations now excluded by UnitedHealthcare’s criteria. insidehealthpolicy.com+1

Meanwhile, some legal experts question whether UnitedHealthcare’s move is compliant with Medicare Advantage regulations, which require that Medicare Advantage plans provide at least the same level of benefits as traditional Medicare — and remote monitoring remains available under Medicare in broader contexts than UnitedHealthcare allows. fiercehealth