Without action from Congress, Medicare’s telehealth coverage will see a sharp decline soon.
— From CNET — By Thomas Kika —
Medicare members could potentially lose their telehealth benefits next month, with temporary COVID-19 era expansions set to expire without action from Congress.
If you’re on Medicare, you might have heard a thing or two about cuts coming to what sort of telehealth services your plan covers. Maybe you’ve heard some of the noise that Representative Ro Khanna, a California Democrat in Congress, has been making about the issue.
“Breaking news, the Trump administration just announced that Medicare will stop covering telehealth starting April 1,” Khanna said in a video shared to his official TikTok account. “This is going to be devastating for so many seniors who are homebound or don’t live close to a doctor’s office.”
Unfortunately, the congressman is largely correct: Without congressional intervention, most of the telehealth coverage offered by Medicare might be ending soon, and a lot of people could be affected. The popularity of telehealth spiked during the pandemic, and though it’s dipped since then, it’s still used by more people now than it was prior to COVID. According to research from the Kaiser Family Foundation, around 12.6% of the 65 million Medicare beneficiaries used telehealth services in the last quarter of 2023.
What is telehealth?
The term “telehealth” refers to situations in which medical services, like primary care visits or specialist consultations, are conducted remotely rather than in person. This can mean phone calls or texts, but it is more popularly associated with video calls. Think getting on a Zoom call to ask your physician if that rash looks worrisome.
It can also refer to the use of “remote patient monitoring” devices, which are wearables that can transmit health data collected from a patient directly to a professional.
These sorts of services have become especially popular and useful for patients in rural areas without close access to medical care or certain specialists, and patients who, for one reason or another, might be stuck at home.
Does Medicare currently cover telehealth?
Yes, and you can thank COVID-19 for that.
During the pandemic, Medicare coverage was expanded to allow greater access to telehealth services. This included things like lifting restrictions on which locations patients could receive these services from and allowing controlled substance prescriptions to be done via telehealth, but the expansion was designed to be temporary.
When is Medicare losing telehealth coverage?
Initially, this expansion of Medicare telehealth coverage was supposed to end on Dec. 31, 2024. As that deadline approached, Congress passed the American Relief Act, which was signed into law by President Joe Biden. In addition to keeping the government funded through mid-March, it kept Medicare’s telehealth coverage in effect through March 31, 2025.
Without another extension by Congress, after that date Medicare’s coverage of telehealth will be scaled back. Most of those services will only be covered if a patient goes to a medical facility in a rural area, according to Medicare’s website.
Only a few exceptions will remain in place for patients who aren’t getting care in that sort of setting: monthly home dialysis visit for end-stage renal disease patients, as well as “services for diagnosis, evaluation or treatment of symptoms” for patients who have suffered an acute stroke or who are receiving treatment for mental or behavioral health disorders. Telehealth services in a patient’s home or anywhere in a non-rural area won’t be covered anymore.