Medicare covers telehealth services under Original Medicare Part B, but rules are changing after January 30, 2026. Beneficiaries should be aware of potential limitations and cost implications as coverage reverts to pre-pandemic standards with specific exceptions.
Understanding Medicare’s coverage of telehealth visits is crucial for beneficiaries seeking convenient healthcare options. With the landscape shifting after January 30, 2026, many may find that the rules are stricter than they expect, making it essential to stay informed about coverage limits and potential costs as they navigate their healthcare needs.
Key Takeaways
- Original Medicare Part B covers various telehealth services, including consultations and follow-ups.
- Beneficiaries pay 20% of the Medicare-approved amount after the Part B deductible.
- Medicare Advantage plans must cover Original Medicare telehealth benefits and may offer expanded options.
- Post-January 30, 2026, most telehealth services will require beneficiaries to be at a qualifying originating site.
- Certain services like mental health and ESRD visits will remain covered at home after January 2026.
- Flexibilities for telehealth services are extended until January 30, 2026, with potential bipartisan support for further extensions.
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Understanding Medicare’s Coverage of Telehealth Services
Comprehensive Telehealth Services Under Original Medicare
Original Medicare Part B provides coverage for a variety of telehealth services, including consultations, follow-ups, and management of chronic conditions. Until January 30, 2026, beneficiaries can access these services from anywhere in the U.S., including their homes, without geographic restrictions, which significantly enhances access to care.
Medicare Advantage Plans and Telehealth Benefits
Medicare Advantage plans are required to cover the telehealth benefits provided by Original Medicare. However, many plans may offer expanded telehealth options that vary by region, allowing beneficiaries to take advantage of additional services that suit their needs.
Financial Implications of Telehealth Services
Understanding Costs Associated with Telehealth
Beneficiaries are responsible for paying 20% of the Medicare-approved amount for telehealth services after meeting the Part B deductible, which is set at $257 for 2025. During the expansion period, providers in non-facility settings receive higher payments, but this will revert to lower facility rates for most services starting January 2025.
Potential Cost Increases After Policy Changes
As telehealth coverage rolls back after January 30, 2026, beneficiaries may face increased out-of-pocket costs and potential delays in care, especially for those living in urban areas without access to rural sites. This shift could significantly impact those who have relied on telehealth for convenient access to healthcare.
Key Exceptions to Telehealth Coverage Rules
Services Covered Beyond January 2026
Certain telehealth services will continue to be covered at home after January 2026, including monthly visits for end-stage renal disease (ESRD) and mental health services. For established patients, behavioral health services will not require in-person visits, ensuring continued access to essential care.
Audio-Only Services and Specialized Care
During the pandemic, audio-only services were limited to specific treatments, but these will continue if a patient cannot use video technology. Additionally, specialized services such as acute stroke evaluations will have fewer restrictions, allowing for more flexible access to critical care.
Eligibility Criteria for Telehealth Providers
Who Can Provide Telehealth Services
To offer telehealth services, providers must accept Medicare assignment. After January 31, 2026, the list of eligible providers will be limited to specific healthcare professionals, including physicians, physician assistants, and certain behavioral health providers.
Pandemic Flexibilities and Provider Eligibility
During the pandemic, any Medicare-billable professional could provide telehealth services, including physical and occupational therapists. However, post-pandemic rules will exclude some therapy providers from eligibility, narrowing the options available to beneficiaries.
Recent Updates Impacting Telehealth Services
Current Telehealth Flexibilities and Future Changes
The current flexibilities for telehealth services have been extended until January 30, 2026, allowing beneficiaries continued access to care. Bipartisan bills are also proposing to extend these provisions further, potentially until December 2026, reflecting ongoing support for telehealth.
Important Updates from CMS
The Centers for Medicare & Medicaid Services (CMS) has updated its telehealth FAQs to clarify the rules that will take effect after January 31, 2026. Beneficiaries should be aware that temporary provisions for telehealth will expire after January 30, 2026, impacting their access to services.
Practical Tips for Beneficiaries Considering Telehealth
Maximizing Telehealth Benefits
To make the most of telehealth visits, beneficiaries should utilize interactive audio-video technology for effective communication with their healthcare providers. It’s also advisable to discuss telehealth options with physicians to determine the best approach for their individual health needs.
Preparing for Future Telehealth Access
Beneficiaries should review their Medicare Advantage plans to explore potential telehealth options available to them. Additionally, advocating for permanent extensions of telehealth services with legislators can help ensure continued access to these vital healthcare resources.
Navigating the Future of Telehealth in Medicare
Understanding the implications of coverage changes is essential for beneficiaries relying on telehealth services to maintain access to care. As the landscape evolves, it is crucial for seniors to prepare for potential changes in coverage and costs, ensuring they remain informed and proactive in managing their healthcare.