Although new health tech gadgets are developed regularly, receiving coverage for these devices can be tricky. Digital health technologies range from wearables to phone apps and everything in between.
Despite constant tech innovation, plan language for Medicare still doesn't address digital health technology.
Medicare part B discusses medical device coverage qualifications for medically proven equipment.
Multiple regulatory government bodies play a role in the regulation of health device coverage by Medicare.
Discounts on health tech are most likely to be bundled with Medicare Advantage (part C) plans.
When health tech is seen as a luxury rather than life-saving, Medicare members are locked out of the preventative health benefits that this technology offers.
What is a health tech gadget?
A “gadget” is a small device with a specific purpose. Gadgets also have the connotation of being a novelty, meaning they’re a new or unusual item. In contrast, insurance plans typically don’t provide coverage unless an object or service is proven to be the standard of care and medically necessary.
Here are some examples of health technology applicable for individual use:
- “Smart” (wi-fi connected) hearing aids.
- Blood glucose monitors and associated phone applications.
- Health watches and associated phone applications.
- Medical alert systems.
- Wearable cardiac patches.
- Innovative lab testing (allergy panels, genetic panels, ancestry panels).
Some health technology is covered through insurance under specific circumstances. Although not all gadgets are covered by insurance, many of them are still obtainable through other measures. In the future, these novel technologies may become the proven norm and be included in insurance plans.
Devices Medicare considers medically necessary
There is no specific mention in the Medicare plan language of “gadgets” or “technology”. However, there is a group of health technology called “durable medical devices” (DMEs) that include both technological and non-digital health equipment.
Durable medical devices range from:
- Diabetes equipment.
- Mobility equipment (canes, walkers, scooters, wheelchairs).
- Oxygen supplies.
- CPAP supplies.
- Infusion (IV) supplies.
Durable medical devices must meet the following qualifications to meet for Medicare coverage:
- Able to withstand repeated use.
- Useful for a medical reason (not for enjoyment or curiosity).
- Not useful to an individual without the above medical reason.
- Used in the home setting.
- Generally able to last 3 years or greater.
Medicare part B is the coverage that addresses DME needs. Some of the DME languages are specifically in contrast with up-and-coming tech. For example, DMEs must be used for medical reasons and they must also not be useful for individuals without a medical reason. Many new health tech items are designed for healthy individuals to gather data about their health, which would not be covered under Medicare part B.
The role of government bodies
Several government agencies influence what type of technology may be covered by Medicare.
The U.S. food and drug administration (FDA)
The FDA has a branch called the Center for Devices and Radiological Health (CDRH). This branch regulates the approval and ongoing guidelines for medical devices in the United States. FDA approval for a medical device is one of the most standard requirements for insurance coverage to prove its efficacy and medical necessity. Expedited FDA clearance would allow a greater volume of technologies to be approved and covered by insurance.
The centers for medicare and medicaid services (CMS)
CMS is the primary body that oversees Medicare and Medicaid coverage. Currently, there is no benefit category for health technology in Medicare, despite the recent decades of tech innovation. If CMS had a category for health technology and was able to increase its reviews of new technologies, more services could be approved for coverage.
The U.S. department of health and human services (HHS)
The role of the HHS is to improve the overall health of the United States population and to oversee CMS. Working with CMS, the HHS often helps with initiatives to expand health coverage and improve population health. More collaboration with the HHS is needed to examine new health technology that would be appropriate for Medicare coverage.
These 3 regulatory bodies work together to create and collaborate with Medicare health plans. Without each body restructuring slightly for the digital age, medical device coverage will continue to stall.
Getting coverage for health technology
Getting coverage for health technology may vary. For coverage of wearable health devices, a Medicare Advantage plan (Medicare part C) is likely the best bet. These plans often have partnerships with tech brands that may allow you to get deals on fitness watches or similar health tech.
Other devices, like continuous blood glucose monitors (CGMs) and wearable cardiac patches, may be requested by your medical provider. These devices have a distinct medical purpose and insurance might approve them if you have a qualifying condition and have met the requirements.
Medical alert systems
A highly sought-after item not covered by traditional Medicare is a personal emergency alert system (PERS). Alert systems have been shown to help individuals contact emergency services after a fall. These may be discounted under other ancillary programs, but are not considered medically necessary by Medicare itself.
For some health gadgets, it will be necessary to pay out-of-pocket. Especially for tech that is for curiosity or data collection, or if the technology is new. If you see a medical device you’re interested in, consult your medical provider to see if it would be beneficial to you. If you don’t have insurance coverage or a discount through another program, you can try to contact the product manufacturer directly and may be able to get a discount through them.
Moving forward with healthcare tech
The medical device technology is a rapidly growing industry. New technology being released has the potential to decrease the pain and anxiety related to aging and chronic disease. Innovation by influential government bodies is necessary for health tech gadgets to be approved at the rate they’re needed by individuals today.
Become familiar with your Medicare part B and C plan language on medical equipment, and speak with your medical provider about what types of health tech would benefit you with your health conditions.
- AdvaMed Centers for Digital Health. Modernizing Medicare Coverage of Digital Health Technologies.
- Centers for Medicare & Medicaid Services. Medicare Coverage of Innovative Technology (CMS-3372-F) Fact Sheet.
- U.S, Food & Drug Administration. An Introduction to FDA’s Regulation of Medical Devices.
- Medicare.gov. Durable medical equipment (DME) coverage.
- U.S. Department of Health and Human Services. Medicare Benefit Policy Manual Chapter 14 - Medical Devices.