Most Medicare Coverage for Telehealth is Halted Because of Congressional Inaction

But Medicare is encouraging providers to keep performing telehealth services and to wait to file a claim for reimbursement until after the shutdown ends. AARP is urging beneficiaries to check with their providers to see how they’re handling the situation.

What’s unknown is whether that could prompt private insurers and state Medicaid programs to limit their telehealth coverage because Medicare often sets the standard for other insurers. Medicaid is a federal and state program that covers health and long-term care costs for people with limited income and assets.

Organizations, including the alliance and the American Telemedicine Association (ATA) with nearly 500 industry members total, are pushing to continue the expanded telehealth options. AARP is a supporter of the public education campaign Telehealth Access for America along with the American Medical Association, American Hospital Association and nearly 50 other groups. 

“We are in a race against time,” says Kyle Zebley, ATA senior vice president for public policy. Failure to extend the current telehealth provisions “potentially leave[s] millions without the ability to access a health care provider remotely and set[s] back the clock on technological progress in care delivery.”

Bills could solve telehealth expiration long term

Several bipartisan bills have been introduced this year that would continue the COVID-19 Medicare telehealth provisions or make them permanent. They include:

• A lasting solution. The Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act of 2025, HR 4206 and S 1261, would erase the end date for the expanded telehealth provisions. Sen. Brian Schatz (D-Hawaii) reintroduced S. 1261 in April while Reps. Mike Thompson (D-Calif.) and David Schweikert (R-Ariz.) filed HR 4206 in June. AARP has endorsed these companion bills and earlier said, “Congress should act to make telehealth access permanent.”

• A two-year extension. The Telehealth Modernization Act, HR 5081, was introduced in September by Reps. Buddy Carter (R-Ga.) and Debbie Dingell (D-Mich.). Sens. Tim Scott (R-S.C.) and Brian Schatz (D-Hawaii) also filed the Senate version, S 2709, the same month. These bills would extend the Medicare telehealth flexibilities through Sept 30, 2027.

All have been referred to committees without additional action being taken.

A bill that President Trump signed in March to fund the federal government had continued the telehealth coverage for six months and delayed a partial government shutdown until Oct. 1. 

Pandemic changed perceptions of telemedicine

In the early part of the pandemic, nearly half of Medicare beneficiaries had at least one virtual medical visit between April and June 2020. And participation continued to be much higher than pre-pandemic levels, according to data from the Centers for Medicare and Medicaid Services (CMS).

The original waiver was temporary, ending when the public health emergency was declared over on May 11, 2023. Congress subsequently folded extensions into various spending bills.

“Telehealth is important because it breaks down geographic barriers to care,” Zebley says. “It’s important to virtually every American.”

Nearly three-quarters of adults 50 and older said they used telehealth services at least once in the past 12 months, according to a January 2024 AARP poll. Nine in 10 said they were somewhat or very satisfied with their experience; about half of those surveyed were on Medicare, the federal insurance program that helps pay health care costs for adults age 65 and older and some younger than 65 with disabling conditions.

Telehealth is most popular among people 65 and older with long-term disabilities, as well as those who qualify for both Medicare and Medicaid, according to KFF, a Washington-based nonpartisan nonprofit formerly known as the Kaiser Family Foundation that studies health care trends.

“People with Medicare are accustomed to checking in with their health care providers from the comfort of their own home,” says Andrew Scholnick, government affairs director at AARP. “Some people are using technology to assist with managing chronic conditions or see specialists that work far away.”

Medical appointments at home help those with disabilities

If the Medicare coverage for telehealth in place for the past five years isn’t extended, patients will have to travel to an office or medical facility for most telemedicine services. Those not in a rural setting could still have certain Medicare telehealth services covered, including monthly consultations about home dialysis for kidney failure; diagnosis and treatment of sudden stroke symptoms; and some mental health care.

In the first quarter of 2020 before the pandemic, fewer than 7 percent of Medicare patients used telehealth services, according to CMS data. That shot up to nearly 47 percent the next quarter.

By the end of 2023, the percentage had dropped substantially, to about 13 percent of people using original Medicare, but that’s still twice the rate of those using telehealth before the pandemic, says Alex Cottrill, senior policy analyst for KFF’s Medicare policy program.

“Telehealth can be a lifeline for people with disabilities, especially for disabilities that impact their mobility,” Cottrill says. People whose incomes are low also may have a tougher time physically getting to a doctor’s office or may not be able to miss work for an in-person visit.

Benefits include better management of chronic conditions

How much telehealth costs Medicare is difficult to assess, he says. The practice often uses fewer resources and takes up less clinician time. The extra convenience may mean that more people will use medical services, but in the long run, that may also mean lower costs if regular care prevents more serious illnesses later.

Medicare had been paying providers the same rates for telemedicine and in-person appointments. 

Zebley says he’s optimistic Medicare telehealth coverage will continue, even if it is in a series of extensions retroactively.

“It’s just that Congress, the federal government, has difficulty doing basic things. It’s a fraught moment in time,” he says. “They’ll make us sweat it. It might be last minute, but I think we’re going to get it done.”