Why Oz’s Medicare Plan Could Harm Rural Seniors

The Centers for Medicare and Medicaid Services is proposing steep limits on traditional Medicare enrollees’ use of remote health monitoring tools.

Under Mehmet Oz’s leadership, the Centers for Medicare & Medicaid Services, or CMS, is moving to sharply restrict how traditional Medicare beneficiaries use remote monitoring devices for health conditions. A proposed rule would end coverage unless the service is delivered from a physician’s office. That would hit people who struggle to make in-person visits especially hard, including many rural seniors, and would also run counter to a Republican effort to soften the effects of last year’s “big, beautiful bill.”

Remote monitoring lets patients track their own health data, including blood pressure, oxygen levels, or blood sugar, and send that information to clinicians for review. These programs are not merely convenient; they help doctors manage chronic illness sooner and may prevent emergencies. They also reduce the need to depend on a single reading at a scheduled appointment or wait until a condition gets worse.

As a result, use of remote monitoring has grown in recent years. Nearly 1 million Medicare enrollees used it in 2024 alone. It has been especially helpful for people with chronic conditions who face barriers to office visits. Rural residents and people in areas with too few health professionals often avoid long trips for frequent appointments, while transportation, vision problems, and limited mobility can make in-person care difficult.

CMS says the new limits are based on a report from the Department of Health and Human Services inspector general. The report flagged possible billing abuses and cases in which patients did not receive treatment. But it recommended a careful response: tighter billing oversight while keeping access to the program intact. CMS would go much further. Because most medical practices do not have the staff to create and run remote monitoring programs on their own, requiring the service to come from someone in a physician’s office would effectively wipe out the benefit. Put differently, where the inspector general recommended a scalpel, CMS is reaching for a hammer.

A bipartisan group of House members has already urged Oz to rethink the proposal, but the rule also reflects a wider pattern in the Trump administration’s quiet effort to reduce Medicare’s reach.

Attention around H.R. 1 — the “big, beautiful bill,” as Trump called it — centered on its severe Medicaid cuts, but the law also set in motion an automatic $500 billion reduction in Medicare from 2026 through 2034. It also pushed back until late 2034 the implementation of finalized rules designed to help very low-income Medicare enrollees pay premiums and cost-sharing.

Since then, CMS has allowed a subsidy program for Medicare Part D drug costs to lapse. It has also launched a pilot in six states that uses artificial intelligence to assess the medical necessity of care that doctors prescribe. That process, known as prior authorization, had rarely been used in traditional Medicare and has already caused major delays in treatment.

The latest CMS proposal is especially striking given the way the “big, beautiful bill” was structured. To help offset the harm rural communities are expected to suffer from the law’s cuts, Republicans created a $50 billion rural healthcare fund. A central feature of that effort, known as the Rural Health Transformation Program, was technological innovation.

Restricting remote monitoring does nothing to encourage innovation. Its impact will also become more pronounced over time. The RHTP is small compared with the Medicaid cuts in H.R. 1 and will do little to stop rural hospital closures or preserve essential services. When a rural hospital shuts down, the average drive to the next hospital grows by 20 to 40 miles, regardless of whether a patient relies on Medicaid or Medicare — making at-home health monitoring even more important.

Remote monitoring is not perfect and does require oversight, but it helps deliver care in places that are often underserved. It can also improve outcomes by catching problems earlier, which usually makes treatment less expensive. In that sense, remote monitoring benefits both patients and the broader healthcare system.

Along with Social Security, Medicare is often described as the “third rail” of American politics. The program is popular, seniors make up about 90% of enrollees and vote at high rates, and younger voters also tend to want to preserve it for their own future use. The political risks of cutting Medicare may end up being less obvious than the real-world effects of reducing health programs. Lawmakers understand the cost of direct Medicare cuts, yet under Oz’s leadership CMS is showing how the program can be weakened through administrative changes that keep coverage on paper while reducing access in practice. Medicare’s biggest threat may not be open cuts, but the quiet erosion of the benefits seniors have come to rely on.

Miranda Yaver

Miranda Yaver is an assistant professor of health policy and management at the University of Pittsburgh and the author of "Coverage Denied: How Health Insurers Drive Inequality in the United States."