UnitedHealthcare Limits RPM Coverage While Medicare RPM Expands in 2026

UnitedHealthcare (UHC), the largest private health insurer in the U.S., is set to significantly limit its remote patient monitoring (RPM) coverage beginning January 2026. The insurer will restrict RPM benefits primarily to chronic heart failure and hypertensive disorders during pregnancy across Medicare Advantage, commercial, and Medicaid plans. This policy represents a narrowing of RPM coverage for conditions such as general hypertension and type 2 diabetes. Meanwhile, a U.S. Department of Health and Human Services Office of Inspector General (OIG) report highlights expanding Medicare RPM use, projecting payments exceeding $500 million in 2024 and noting potential for further growth under enhanced CMS oversight. Industry experts note the contrasting approaches between UHC's conservative RPM policy and the broader Medicare expansion, emphasizing that effective RPM programs are components of comprehensive virtual chronic disease management rather than isolated device use. The OIG advocates for targeted oversight, provider education, and vigilance against fraudulent billing to ensure RPM's clinical value. The regulatory landscape remains uncertain, with ongoing discussions about Medicare Advantage plan authority to restrict RPM coverage based on specific diagnoses. Looking ahead to 2026, RPM's evolution is expected to prioritize high-value applications, particularly for high-risk cardiac patients and pregnancy-related hypertensive conditions, where evidence and cost reductions are strongest. RPM for general hypertension and diabetes will likely persist within value-based care models such as ACOs, capitated arrangements, and risk-bearing provider groups rather than broad fee-for-service reimbursement. Success for RPM providers will depend on adherence to guideline-based protocols, detailed documentation of care management activities, and compliance with OIG fraud prevention guidelines. UHC's policy is being viewed as a potential legal case to delineate the extent to which Medicare Advantage plans can limit coverage, possibly prompting regulatory clarification and enforcement to align plan decisions with statutory and clinical evidence standards. Concurrently, federal initiatives like the Rural Health Transformation Program aim to leverage virtual care to address access and workforce challenges in rural America by supporting hospital stability and extending specialty and behavioral health services virtually. Furthermore, tightening federal Medicaid funding is driving safety net and rural providers to adopt virtual care as a cost-effective strategy to manage patient volumes, reduce avoidable emergency and inpatient use, and maintain care access amid coverage fluctuations. Virtual care, including RPM, is increasingly seen not solely as an innovation but as an operational necessity to enhance care delivery efficiency in changing policy and financial environments.