Before the COVID-19 pandemic, Medicare beneficiaries who wanted to use virtual health care were few and far between — quite literally. Medicare policy stipulated that to be reimbursed for virtual care, also known as telehealth, a beneficiary had to live in a rural area. Only about 2 percent of Medicare enrollees met this criterion. Not only did the beneficiary have to live in a rural area, but they also had to travel to an approved site, such as a physician’s office or a hospital, to use a virtual service.
When COVID-19 forced most of us to stay in our homes, Congress allowed Medicare to ease telehealth restrictions. This allowed many more Medicare beneficiaries to take advantage of the convenience and time-saving benefits of virtual health care.
Since the end of the COVID-19 public health emergency, Congress has extended the relaxed restrictions twice. However, the original restrictions on telehealth are set to renew on January 1, 2025, unless Congress acts soon to extend the more inclusive access to which many Americans have become accustomed. The restrictions would put more burden on older adults and individuals with disabilities, as they are more likely to be affected by mobility issues.
Expanded Coverage of Telehealth Services
The increased use of telehealth has benefited patients and providers. Meeting with health care providers via phone or internet has streamlined the health care process and saved patients money and time since they no longer have to travel for every medical appointment. Some ways Medicare has expanded its coverage of telehealth services include:
- Expanded Service Types. Medicare has allowed telehealth appointments for a wider range of conditions, including chronic disease management, mental health, and routine follow-up visits. Previously, telehealth was mostly limited to specific services, such as consultations, psychotherapy, and substance use disorder treatment.
- Broader Access. Beneficiaries have been able to receive telehealth services in their homes, removing the requirement to visit a doctor’s office or other medical facility. This change has allowed more flexibility, especially for those who have mobility issues or live in areas with limited access to health care providers.
- Additional Providers. More health care professionals, such as physical therapists, occupational therapists, and speech-language pathologists, have been permitted to deliver virtual-visit services under Medicare. This expansion has been especially helpful for those in need of rehabilitative services.
- Audio-Only Visits. Recognizing that not all beneficiaries have access to video technology, Medicare has allowed audio-only telehealth visits for certain services, making it easier for older adults to consult with their health care providers.
These expansions helped maintain continuity of care during the pandemic, ensuring that vulnerable individuals could access essential health services without risking exposure to the COVID-19 virus.
The Future of Medicare’s Coverage of Telehealth
The future of Medicare-reimbursed telehealth services will largely be shaped by ongoing legislative efforts. Congress has introduced several bills aimed at extending many of the temporary telehealth expansions or making them permanent. For example, the Telehealth Extension and Evaluation Act proposes to extend key telehealth flexibilities for Medicare beneficiaries until May 2025, providing more time to evaluate which services should be permanently covered. If passed, this would represent a significant step in solidifying telehealth medical care as a standard part of the Medicare program.
We may have to wait till December 31 to see whether Congress will extend Medicare’s pandemic-era coverage of the telehealth services many patients and health care providers have come to rely on.
