Medicare coverage to change for millions under new proposal

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Suzanne Blake

By Suzanne Blake

Reporter

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Millions of Americans could see their Medicare options change as the government-run health insurance considers covering digital therapy services for the first time.

Previously, seniors on Medicare did not see their health insurance cover online therapy tools. However, that might change as the Centers for Medicare and Medicaid Services (CMS) announced a proposal last week on its website that would see doctors reimbursed for the subscription and app fees for digital mental health services.

If the policy is enacted, digital therapy programs would be covered if they are "in conjunction with ongoing behavioral health care treatment," beginning in 2025.

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"Simply put, it's time," Alex Beene, a financial literacy instructor at the University of Tennessee at Martin, told Newsweek. "We know many seniors are more tech savvy than past generations in their age group and being able to access digital mental health services can be a real difference maker depending on their situations. This would allow for more flexibility in how and when they can access these crucial services."

CMS also included three proposed new payment codes to reimburse providers for using the digital therapy tools. Depending on the range of services, providers could be reimbursed anywhere from $10 to $110 per patient per month.

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Granted, not every online mental health tool would be covered under Medicare if the proposal is implemented. It would only apply to products already approved by the Food and Drug Administration (FDA), and CMS said it would keep track of the digital programs and potentially change the coverage over time.

"It's also important to note that as proposed this is not going to open up Medicare payments to a bunch of bad actors in the digital space," Beene added. "The scope of the expansion at this time is narrow and will have to meet very stringent standards. Not only will this increase health care availability, but it will hopefully equate to the cream-of-the-crop providers being able to provide their services more readily."

Many mental health tech platforms have come under scrutiny lately as data breaches continue to put patients in jeopardy.

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One of the most well known platforms, BetterHelp, agreed in May to pay $7.8 million to the Federal Trade Commission (FTC) after allegedly sharing health data, with recent reports also finding that telehealth companies routinely sent their patients' health information to tech giants Meta and Google.

Newsweek has reached out to Google via email for comment.

"We've been clear in our policies that advertisers should not send sensitive information about people through our Business Tools," a Meta spokesperson told Newsweek. "Doing so is against our policies, and we educate advertisers on properly setting up Business Tools to prevent this from occurring. Our system is designed to filter out potentially sensitive data it is able to detect."

However, if boosted by Medicare coverage, many of these platforms could expand their use. Private insurers could also follow Medicare's move and allow coverage for their patients as well.

"Mental health has historically been a challenge to get treatment under Medicare especially for non-medication treatments," Chris Fong, a Medicare specialist and the CEO of Smile Insurance Group, told Newsweek. "This will help Medicare beneficiaries get better access and more options for their mental health treatments."