UnitedHealth Group, CVS Health, and Kaiser Permanente have written to Medicare opposing its plan to stop paying for remote patient monitoring performed by outside contractors, STAT reported. Humana and the Blue Cross Blue Shield Association support the proposal, according to the report, which was also published by The Boston Globe.
The split matters for older adults who track blood pressure, weight, or blood sugar at home with connected devices. Many of them get coverage through private Medicare Advantage plans run by these companies, and Medicare open enrollment begins October 15.
The divide also shows how business structure shapes policy positions. UnitedHealth, CVS, and Kaiser each operate both insurers and large care organizations, so a ban on contracted monitoring staff would affect their own clinics.
Insurers Split Over a Fix for Billing Abuse
In its proposed 2027 physician fee schedule, released July 14, the Centers for Medicare & Medicaid Services (CMS) would pay for remote physiologic and therapeutic monitoring only when the clinical staff doing the work are employed directly by the billing practice, not by a contracted company, Becker’s explained. Staff would not need to work on-site. The proposal would also require an initiating visit before monitoring begins and cut some payment values. If finalized, most changes would take effect January 1, 2027.
CVS, which owns Aetna, argued that Medicare should set standards for vendors rather than ban them. Kaiser Permanente wrote that the proposal would «disproportionately impact integrated delivery systems,» where staff employed by one business unit care for patients of another.
UnitedHealth’s position stands out because of its own coverage history. Its insurance arm, UnitedHealthcare, announced in 2025 that it would cover remote monitoring only for heart failure and high blood pressure during pregnancy, calling other uses unproven, before postponing that policy after pushback from providers.
Medicare Advantage Members in the Middle
More than 230 health groups have warned that the vendor limits could disrupt care, MedicalDaily previously reported. That coalition’s estimate of more than 1 million affected beneficiaries comes from the coalition, not from CMS.
What is new is the division among insurers that cover Medicare Advantage members. Plans without large employed care networks or vendor partnerships can support a ban with less disruption to their own business, an industry analyst told STAT. That means the rule’s effect on a patient may depend partly on who owns the doctor’s office.
Medicare Advantage plans generally must cover what traditional Medicare covers, but they set their own networks and some coverage criteria within federal limits. A member whose monitoring program relies on contracted staff could see changes if the rule is finalized as written.
The Evidence Behind the Crackdown
CMS cited a 2024 report from the HHS Office of Inspector General, which found that about 43% of Medicare enrollees who received remote monitoring did not receive all three components of the service: device setup and education, the device itself, and treatment management by a clinician.
Use has grown quickly. A 2025 follow-up found Medicare payments for these services rose 31%, from $408 million in 2023 to $536 million in 2024, with nearly 1 million enrollees receiving them in 2024, according to Becker’s.
The findings point to billing gaps, not necessarily fraud in each case. Some physician groups argue that missing components may reflect how services were billed rather than whether care was delivered. Research supports monitoring for certain conditions, especially heart failure, but no study has compared patient outcomes under employed staff versus contractors.
Checking Your Coverage Before Open Enrollment
Nothing changes for patients today. If you or a parent uses a home monitoring device, keep using it as directed and keep sending readings. The rule is a proposal, and CMS typically publishes its final physician payment rule in early November.
During open enrollment, ask your plan or doctor’s office whether monitoring is handled by the practice’s own staff or by an outside company, and whether they expect changes in 2027. Compare plans on Medicare.gov or by calling 1-800-MEDICARE, and ask how each plan covers remote monitoring for your condition.
Watch for scams. Review Medicare statements for unfamiliar monitoring charges, and do not share your Medicare number with unsolicited callers.
Do not wait for a monitoring team to call about dangerous readings. A very high blood pressure reading with chest pain, severe headache, confusion, or weakness on one side needs emergency care, and sudden weight gain or worsening breathlessness in someone with heart failure calls for prompt contact with a clinician.
Key Questions Answered
What is Medicare proposing? Starting January 1, 2027, Medicare would pay for remote monitoring only when clinical staff employed by the billing practice do the work, not outside contractors.
Which insurers oppose the plan? UnitedHealth Group, CVS Health, and Kaiser Permanente wrote to CMS opposing it. Humana and the Blue Cross Blue Shield Association support it.
Why do insurers disagree? Companies that own large care organizations say the rule would disrupt their clinics. CVS proposed standards for vendors instead of a ban.
Why did CMS propose the change? CMS cited a federal watchdog report that found about 43% of enrollees did not receive all parts of the service, along with rapid spending growth.
Will my home monitoring stop? Not now. The rule is a proposal, and any changes would begin in 2027 if finalized.
What should Medicare Advantage members do? Ask your plan and the doctor who runs your monitoring program, compare coverage during open enrollment starting October 15, and check statements for unfamiliar charges.
Published by Medicaldaily.com
