I use several prescription apps and digital therapeutics for my chronic conditions. Does Medicare provide any coverage for digital health tools in cases like mine?
Answered by 12 licensed agents
Medicare’s coverage for prescription apps and digital therapeutics (DTx) is limited but evolving, particularly for chronic conditions. Original Medicare (Parts A and B) typically does not cover DTx, as these tools often fall outside defined benefit categories. However, recent developments show some progress; so the answer would depend on what your currently using.
Medicare just recently approved coverage for certain digital therapeutics for mental health treatment beginning January 1, 2025. Although it may still be limited, there are now digital mental health treatment devices that a physical can prescribe and Medicare will cover. This includes apps and software for treating anxiety, depression and insomnia.
Yes, as of January 1, 2025. Medicare will now pay for certain digital therapeutics used for mental health treatment, which are FDA-approved digital health apps.
As of January 2025, Medicare has begun covering certain digital therapeutics (DTx) specifically for mental health conditions, such as depression, insomnia, and substance use disorders. These are FDA-cleared, prescription-based software tools designed to deliver clinical interventions, and they are now reimbursable under the Medicare Physician Fee Schedule.
However, for chronic physical conditions like diabetes or kidney disease, Medicare's coverage of digital health tools remains limited. While Medicare does provide reimbursement for remote patient monitoring (RPM) services—such as tracking blood glucose or blood pressure—this coverage is typically indirect, billed through your healthcare provider as part of their care management services.
It's important to note that Medicare Advantage plans may offer additional digital health benefits, including wellness apps or chronic care management tools, but these offerings vary by plan. If you rely on specific digital therapeutics for managing your chronic conditions, it's advisable to consult with your healthcare provider or Medicare plan administrator to determine if these tools are covered under your current plan.
Medicare has expanded coverage for digital health tools. To be eligible for coverage digital tools must be FDA cleared, used as part of a broader treatment plan, and the provider must incur costs of the tool.
Medicare's coverage for digital health tools is evolving. Some digital therapeutics, particularly those related to mental health, are now reimbursable, although coverage for other chronic conditions may still be limited. Coverage for digital therapeutics targeting various chronic conditions is still under consideration in 2025.
The Medicare statute does not directly address coverage of digital health technologies, nor does the statute specifically limit or prohibit coverage of digital health technologies within the program’s benefit categories. Please check with your insurance carrier for more details.
As of January 2025, Medicare does have coverage for digital therapeutics and apps but for mental health only. As far as I have researched mental health conditions are the only ones covered. I would have to do more research.