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?

Question

Leslie Kaz · Accepted Answer

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.

Answered by Leslie Kaz on April 28, 2025

Agent Licensed in CA, AL, AZ & 7 other states

Answered by Leslie Kaz Medicare Insurance Agent

Tasha Riggs · Answer

Yes. As long as your providers contract with Medicare. It is up to the provider to be contracted by Medicare to take their payments

Mark Bilgere · Answer

Beginning in January of 2025, Medicare did approve some Digital Therapeutics when order by a provider. The approved therapeutics are:
SleepioRx for Insomnia
Somryst for Chronic insomnia
DaylightRx for Generalized anxiety disorder
Rejoyn for Major depressive disorder	
reSET for Substance use disorder
reSET‑O	for Opioid use disorder

Alicia Hoilman · Answer

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.

Answered by Alicia Hoilman on June 11, 2025

Broker Licensed in VA, DE, FL & MD

Answered by Alicia Hoilman Medicare Insurance Agent

Justin Doherty · Answer

For now, there are only 7 apps that are eligible under Medicare. However, coverage generally requires a prescription and an unusual billing process that involves the providers instead of pharmacies. Sadly, these hurdles will likely cause more roadblocks to getting help paying for digital therapeutics.

That being said, the 7 apps currently eligible are:
1) SleepioRx for insomnia 2)Daylight for anxiety 3) Rejoyn for depression 4) reSET for substance use disorder 5) reSET-O for opioid use disorder 6) Somryst for chronic insomnia 7) MamaLift Plus for maternal mental health

Diana Garner · Answer

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.

Ron Cronwell · Answer

Digital Therapeutics may be covered under original Medicare, but on a case by case basis. Medicare Advantage Plans also on a case by case basis.

According to "HealthCare Brew" A history of challenges
This latest development is a long time coming.

The FDA cleared the first DMHT for market, Pear Therapeutics’s reSET, in 2017. But in April 2023, Pear declared bankruptcy and reSET, plus its opioid use disorder program reSET-O, were sold to digital treatment provider PursueCare. In a LinkedIn post, Pear’s former CEO partly blamed its collapse on payer denials.

In September 2023, Akili Interactive—a digital medicine company that created an FDA-authorized prescription video game to treat ADHD—abandoned the prescription model after hitting roadblocks from payers, and offered its video game-based treatment over the counter.

These new codes may get more payers on board, Andy Molnar, SVP of industry affairs at trade group American Telemedicine Association (ATA) and head of digital health at advocacy arm ATA Action, told Healthcare Brew.

“We’re in such a better place now in 2025 than we have ever been before,” he said, explaining that now it’s possible to “actually start to show real-world evidence and cost data” to convince Congress to further expand coverage.

The Medicare test
So far, seven apps qualify for CMS’s HCPCS codes, according to the DTA:

Big Health’s SleepioRx for insomnia and Daylight for anxiety
Otsuka Precision Health and Click Therapeutics’s Rejoyn for depression
PursueCare’s reSET for substance use disorder and reSET-O for opioid use disorder
Nox Health’s Somryst for chronic insomnia
Curio’s MamaLift Plus for maternal mental health
But even with Medicare coverage, challenges remain.

Check with your professional and the insurance provider.

Walt Smith · Answer

I am aware that Medicare covers digital health tools when it comes to mental health conditions I am not aware of and the other general applications.

Marcie Barnes · Answer

Your question requires more details to give the best answer.  I suggest you call licensed expert to further assist you.

Tony Hardwick · Answer

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.

Answered by Tony Hardwick on April 28, 2025

Agent Licensed in GA, AZ, CA & 15 other states

Answered by Tony Hardwick Medicare Insurance Agent

Chuck Winslow · Answer

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.

Robert Baez · Answer

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.

Answered by Robert Baez on April 11, 2025

Agent Licensed in IL

Answered by Robert Baez Medicare Insurance Agent

Rick Balistreri · Answer

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.

Answered by Rick Balistreri on May 19, 2025

Agent Licensed in MO, AZ, FL & 7 other states

Answered by Rick Balistreri Medicare Insurance Agent

Bob Nunn · Answer

I would advise go to Medicare.gov/coverage  or call 1-800-633-4227 if it’s not on previous website list .

Lenora Sikkenga · Answer

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.

Answered by Lenora Sikkenga on April 10, 2025

Broker Licensed in NV

Answered by Lenora Sikkenga Medicare Insurance Agent

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?

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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?

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