Implications of Trump Halting Medicare Telehealth Reimbursements.
During the COVID-19 pandemic, Medicare expanded coverage for telehealth services to ensure increased access care remotely. This expansion was enabled by emergency waivers under the Trump administration, leading to a 63-fold surge in telehealth usage in 2020 compared to 2019 . Virtual visits quickly became a critical lifeline for elderly patients, rural communities, and those unable to travel, providing safe and convenient access to medical care. Recently, however, the Trump administration moved to end Medicare reimbursements for many telehealth visits, effectively rolling back these pandemic-era flexibilities.
This report analyzes the implications of that decision. It will examine the historical context of Medicare’s telehealth coverage (and its COVID-19 expansion), outline the specific policy changes and services no longer covered, and discuss impacts on underserved populations. It will also explore the consequences for addiction treatment and mental health services, present expert opinions and reactions, consider economic and cost effects (such as potential increases in emergency visits or delayed care), and suggest policy alternatives to mitigate negative outcomes while addressing Medicare’s budget concerns.
Telehealth visits had to use real-time two-way video, and only certain types of providers (physicians, nurse practitioners, psychologists, etc.) and services were eligible. These rules meant that telemedicine utilization was extremely low – only about 15,000 Medicare fee-for-service beneficiaries per week used telehealth before 2020. In effect, Medicare’s telehealth benefit was narrowly confined and underused. In the years leading up to the pandemic, there were modest steps to broaden telehealth in Medicare. Legislation in 2018 and 2019 created limited exceptions to the rural requirement – for example, allowing telestroke care nationwide and permitting in-home telehealth for patients with end-stage renal disease or substance use disorders. Medicare also began paying for brief “virtual check-ins” and remote evaluations in 2019, which were baby steps toward virtual care. These changes were incremental, however, and most seniors still had no telehealth access under traditional Medicare before 2020.
The COVID-19 public health emergency (PHE) upended this status quo. Starting in March 2020, the Department of Health and Human Services (HHS) used emergency authority (granted by Congress through COVID relief laws) to waive many of Medicare’s telehealth restrictions. Suddenly, Medicare telehealth coverage exploded: geography and originating site requirements were suspended so that any beneficiary (rural or urban) could receive telehealth from home, and dozens of services (from standard office visits to emergency department consults, therapy, and more) were added to the covered telehealth list. Providers of all types, including physical therapists, occupational therapists, and Federally Qualified Health Centers, were allowed to deliver telehealth visits – a big change from prior rules limiting which providers could bill for virtual care.
Medicare even covered audio-only telephone consultations for the first time (for certain evaluation & management, behavioral health, and check-in services) so that seniors without internet or video devices could still get remote care. These flexibilities were intended to be temporary, but they led to a massive uptake: from mid-March to mid-October 2020, over 24.5 million Medicare beneficiaries (out of ~63 million) received a telemedicine service a sharp increase in access. Telehealth proved invaluable in maintaining continuity of care during lockdowns. For example, by mid-2020 nearly 46.7% of Medicare beneficiaries had used telehealth at least once, and telehealth accounted for a third of all behavioral health visits that year, helping offset reductions in in-person mental health care. Both patients and providers grew accustomed to the convenience and safety of virtual visits. These emergency policies were tied to the PHE and set to expire when it ended. Absent further action, Medicare would revert to its pre-pandemic telehealth rules once the emergency declaration lifted. During 2020, the Trump administration’s CMS (Centers for Medicare & Medicaid Services) did use its regulatory levers to make some telehealth services permanent within the limits of the law.
In a December 2020 rule, CMS added more than 60 telehealth services to the Medicare covered list beyond the PHE (including certain emergency visits, therapy services, and critical care). However, due to statutory restrictions, those services would still only be reimbursable for patients in rural areas and when not at home. CMS officials acknowledged they lacked authority to continue broad telehealth access for urban and home-bound beneficiaries without Congress changing the law. In essence, the administration signaled that most telehealth flexibilities would end along with the PHE unless new legislation intervened. This created a “telehealth cliff” scenario: a return to the highly limited coverage that existed pre-2020. Despite bipartisan support in Congress for extending telehealth (and numerous temporary extensions that were eventually passed through 2024), the Trump administration’s decision meant that Medicare’s expansive telehealth reimbursement would be halted as planned, shrinking coverage back to its previous scope. This context sets the stage for understanding the impact of stopping Medicare telehealth reimbursements after such a period of unprecedented expansion.
The waiver of geographic/site requirements has ended. Medicare beneficiaries in urban and suburban areas will no longer be eligible for most telehealth services under traditional Medicare. Coverage again applies only to those in designated rural areas, and even they generally must travel to an approved originating site (such as a clinic, hospital, or doctor’s office) to connect with a remote provider kff.org. In other words, the convenience of receiving telehealth at home is largely gone. Prior to COVID, a patient’s home was not an eligible site (with very few exceptions), and that restriction is now back in force for non-behavioral services. (mental health telehealth was made an exception – a 2021 law permanently allowed tele-mental healthvisits from home, but it requires the patient to have an in-person visit with the provider at least once every 12 months. That in-person requirement, which had been waived during the pandemic, is now slated to take effect, potentially limiting some usage.)
Medicare has dropped many telehealth services that were temporarily added during the pandemic. The expanded list of telehealth services (over 100 new services ranging from emergency department consults to physical, occupational, and speech therapy, home visits, and more) is shrinking back to the pre-pandemic list. Before COVID, Medicare’s telehealth coverage was mostly limited to routine office visits, mental health therapy, preventive health screenings, and a few others. Now, services like physical and occupational therapy via telehealth, initial nursing facility visits, audio-only evaluation & management calls, and emergency department tele-triage are no longer covered. For example, physical therapists and speech therapists had briefly been able to conduct virtual sessions with Medicare patients; under the rollback, those are not reimbursed, meaning patients must return to in-person rehab visits or pay out-of-pocket if they want virtual sessions.
Telephone-only consultations are no longer reimbursed in most cases. During the pandemic, Medicare recognized audio-only phone calls as valid telehealth for certain services (particularly in behavioral health and check-ins) to accommodate seniors without video capability kff.org. With the waiver gone, Medicare has reverted to requiring a two-way audio-video connection for telehealth. This means patients who only have a regular phone (no smartphone or computer) cannot have a covered telehealth visit. The only partial exception is for mental health: if a patient is unable or unwilling to use video technology, a phone session for mental health services can be covered kff.org– but even this requires that the patient could use video if available (an acknowledgment of tech barriers).
The broad availability of “telehealth by phone” that existed in 2020-2023 is effectively ending, which disproportionately affects those without internet or devices. Under the COVID flexibilities, any healthcare professional who could bill for an in-person service (doctors, nurse practitioners, physician assistants, therapists, clinical social workers, etc.) could provide telehealth, and even Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) were allowed to serve as distant-site telehealth providers. Now we are returning to previous rules where only certain providers qualify – mainly physicians, NPs, PAs, clinical psychologists, licensed social workers, and a few others – and FQHCs/RHCs are not authorized to bill as telehealth distant sites (they can only act as an originating site) kff.org. This change removes some important safety-net providers from the telehealth ecosystem for Medicare patients. It also means patients may not be able to do telehealth visits with specialists or therapists who were temporarily available to them. Additional pandemic allowances have ended as well. New patients via telehealth – during the emergency, providers could see new Medicare patients virtually with no prior relationship. Traditionally, some telehealth services required an established relationship (e.g. the patient had been seen in person in the last three years).
That requirement is technically back (for services where it applies), potentially limiting access for beneficiaries seeking to start care with a new provider virtually. Medicare also had allowed hospice recertification via telehealth during the pandemic; that convenience is now gone – hospice patients must have recertification encounters in person again. Similarly, temporary flexibility that allowed telehealth supervision of certain medical services (and relaxed rules around cross-state licensing under federal waiver) are ending, although state-level and other federal rules play a role in those aspects. So, the policy reversion “stops the clock” on Medicare telehealth to essentially pre-2020 settings in most respects. Beneficiaries in non-rural areas will lose access to virtual visits, except for a limited subset of mental health services. The broad menu of telehealth options is curtailed to a short list. Phone-based care is largely eliminated. And many providers who integrated telehealth into their practice can no longer offer it to Medicare patients, unless those patients are in the narrow circumstances still allowed. These changes represent a significant contraction of benefits that millions of seniors had become accustomed to over the past few years.
The end of Medicare telehealth reimbursement is expected to have outsized negative impacts on underserved groups – notably the elderly and chronically ill (who make up Medicare’s core population), people in rural areas, and those who face challenges traveling to a doctor’s office. These populations benefitted greatly from telehealth flexibility, and losing that option may widen healthcare disparities.
Elderly Individuals & Those with Mobility Issues: Medicare primarily serves adults age 65+, many of whom have mobility limitations, do not drive, or rely on caregivers for transportation. For these seniors, telehealth was a game-changer. During the pandemic they could attend routine check-ups, follow-up visits, and specialist consultations from the safety of home, avoiding arduous trips. According to AARP, allowing older adults to use telehealth not only offers convenience, but also helps them stick to treatment regimens and manage chronic diseases by making it easier to attend appointments. Family caregivers could more readily join virtual visits as well, to help communicate or coordinate care. Taking away telehealth means many frail or homebound seniors might skip care that they find too difficult to get to in person. For example, an elderly patient with heart failure who used telehealth for frequent monitoring may now forego those check-ins, risking complications. The loss of phone visit coverage is particularly harmful for the oldest and most vulnerable seniors – a significant number of Medicare beneficiaries in their 70s, 80s, and 90s are not tech-savvy or lack internet access. For them, a simple telephone call with their doctor was a lifeline during COVID.
With phone calls no longer covered, these patients may end up with no contact at all between infrequent in-person visits. Research underscores that about 26% of Medicare beneficiaries lack telehealth-ready technology or skills (no computer or smartphone or internet), meaning they only could use audio-only telehealth. This group is disproportionately older, minority, and lower-income. Removing coverage for audio telehealth essentially excludes a quarter of seniors from any remote care option, likely reducing their access to needed services.Rural Communities: Rural Medicare beneficiaries have faced longstanding healthcare access challenges – including provider shortages, long distances to specialty care, and transportation barriers. Ironically, Medicare’s original telehealth rules were intended to help rural residents by allowing telehealth from local clinics. But in practice, the requirement to travel to a clinic for telehealth and limited service types meant uptake was low. During the pandemic, when Medicare allowed in-home telehealth for rural patients, usage climbed significantly and rural patients were able to consult with far-away specialists or receive routine care without traveling miles.
Now that in-home telehealth is no longer broadly covered, rural patients are back to square one: they may have to drive long distances or go without care. For instance, a rural diabetic patient who met with an endocrinologist via video now might have to drive hours to see that specialist, or see a less-specialized local provider instead. Additionally, rural areas often have limited broadband infrastructure, and many rural seniors don’t have high-speed internet or even cellular data service for video visits. The pandemic workaround for this was phone visits. The return of the video-only rule will hit rural communities hard: if audio-only calls are not covered, patients who lack reliable internet effectively lose telehealth entirely. As one analysis noted, beneficiaries in rural or underserved areas often “lack the infrastructure to support reliable video telehealth visits or the means to afford internet access,” so eliminating audio-only coverage “may further impede access” for them. This digital divide means the telehealth rollback could worsen rural health disparities, leaving those in remote areas with even fewer options for care than before. It’s a step backwards just as many rural patients and providers had begun integrating telehealth into regular care (rural telehealth visits rose from 0.4% of outpatient visits pre-COVID to 9.4% during COVID).
Underserved urban populations – including low-income seniors and racial/ethnic minorities – also benefitted from telehealth flexibilities. During 2020, telehealth use was actually higher among Black and Hispanic Medicare beneficiaries than White beneficiaries cms.gov, once access was expanded, suggesting it filled an unmet need. These communities often face transportation hurdles, higher burden of chronic illness, and caregiver responsibilities that make scheduling in-person care difficult. Telehealth provided a convenient option to get care without missing work or arranging childcare. Now, the removal of telehealth coverage could contribute to lower care engagement. For example, a Spanish-speaking patient in an urban area who was able to have video visits with a linguistically appropriate provider from another region might lose that access if only local in-person visits are covered. While Medicare Advantage plans (chosen by about half of Medicare beneficiaries) often offer extra telehealth benefits, the other half in traditional Medicare will feel this cutback most acutely. Many low-income seniors are in traditional Medicare and cannot easily switch plans or afford supplemental benefits. Thus the policy change risks widening inequities between those who can afford alternatives and those who rely solely on Medicare’s standard benefits.
A subset of Medicare beneficiaries are under 65 and qualify due to disabilities. This group (which includes people with serious physical disabilities, ALS, end-stage renal disease, etc.) found telehealth to be an invaluable tool during the pandemic. It removed barriers like arranging special transportation (e.g., wheelchair-accessible vans) or caretakers for clinic visits. With telehealth, patients with limited mobility or compromised immune systems could see their doctors regularly from home. Now, those benefits are curtailed. Someone who is homebound or immunocompromised may have no choice but to risk in-person visits or delay care. This is particularly detrimental for continuous management of complex conditions.
Without coverage, issues may go unnoticed until a crisis occurs. Chronic disease management overall may suffer for Medicare patients: telehealth was used for monitoring hypertension, diabetes education, medication management and more. According to AARP’s commentary to Congress, making telehealth permanent would help older adults manage chronic diseases more effectively by keeping them engaged with care. Losing it could lead to poorer control of chronic conditions like blood pressure or blood sugar, especially for those who had difficulty attending frequent in-person appointments in the past. The policy to stop Medicare telehealth reimbursement threatens to reverse the gains in healthcare access for populations that need care the most but have the hardest time obtaining it. Elderly and disabled patients will lose a convenient option that improved their ability to follow through with medical advice. Rural patients will again face geographic isolation from many services. Underserved minority and low-income communities may experience a drop-off in care usage. The overall effect is likely a reduction in preventive care and early intervention, which could exacerbate health disparities and outcomes for these vulnerable groups.
One of the clearest success stories of telehealth during the pandemic was in the realm of behavioral health – including mental health counseling, psychiatric care, and treatment for substance use disorders (SUD). Telehealth became a critical lifeline for patients struggling with anxiety, depression, addiction, and other behavioral health issues. As Medicare telehealth coverage is pulled back, experts fear serious consequences for these services and the patients who rely on them:
Telemental health surged under the emergency policies, and with good reason. Many seniors and disabled individuals face mental health challenges (about 1 in 4 Medicare beneficiaries has some mental illness diagnosis), yet they encounter barriers to accessing care such as stigma, transportation, or shortage of local mental health professionals. Telehealth virtually eliminated some of these barriers by allowing therapy and psychiatry visits from home. In 2020, telehealth constituted roughly 33% of all Medicare mental health visits (behavioral health specialist appointments), a huge jump from virtually zero pre-pandemic. Patients who might have skipped in-person therapy due to mobility issues or fear of COVID were able to continue treatment. Importantly, data suggest telehealth helped prevent a collapse in mental health care: overall Medicare visits to mental health specialists stayed much steadier compared to other services, likely because virtual visits offset what would have been lost in-person care.
If these tele-mental health options go away (or become more limited with new in-person requirements), many patients may discontinue therapy or psychiatric follow-ups. For example, an elderly patient with depression who had been talking to a therapist weekly by video might find it too burdensome to start traveling to a clinic, leading them to drop out of care. Gaps in mental health care can quickly lead to worsening symptoms, isolation, and in severe cases, crises like suicidal ideation or hospitalization. Consistent access is key for managing chronic mental illnesses, and telehealth was providing that consistency. The phone call option was also particularly useful in mental health – some seniors feel more comfortable speaking by phone or don’t have webcam setups; Medicare covering phone therapy meant even those patients could get counseling.
Now, with Medicare insisting on video/in-person for coverage, some of those individuals could be left with no support. The end result could be higher relapse rates for conditions like depression or anxiety, and potentially more psychiatric emergencies. On the provider side, many mental health clinicians had shifted to virtual practice (some operating 100% remotely). They will now have to either revert to in-person (which could reduce their capacity or reach) or stop seeing Medicare patients who are not local. This shrinkage in provider availability might hit rural mental health care especially hard – during the pandemic a patient in a rural town could see an urban psychiatrist via telehealth; with coverage ending, that patient might have essentially no specialist nearby.
The opioid epidemic raging in the U.S. made addiction treatment access a top priority, and telehealth proved to be a remarkably effective tool for this. Medicare covers many under-65 individuals with disabilities who have substance use disorders, as well as seniors with alcohol or prescription drug addictions. During COVID, regulators waived rules (like the Ryan Haight Act provisions) to allow medication for opioid use disorder (MOUD) – such as buprenorphine prescriptions – to be initiated via telehealth without an initial in-person visit. Clinicians could perform intake and follow-up appointments for addiction treatment entirely remotely. This led to more people entering treatment and staying in treatment. A major study published in 2022 (using national Medicare data) found that the expansion of telehealth for OUD during the pandemic was associated with patients staying in treatment longer and a reduced risk of overdose. In fact, Medicare beneficiaries with opioid use disorder who received telehealth services had a 33% lower risk of fatal overdose compared to those who didn’t.
These outcomes highlight that telehealth literally saved lives by connecting patients with addiction treatment that they otherwise might not have accessed. Behavioral health experts cheered these improvements: “the results of this study add to the growing research documenting the benefits of expanding telehealth services for people with OUD,” said CDC researcher Dr. Christopher Jones cms.gov. If Medicare stops reimbursing telehealth visits, including those for SUD treatment, it could reverse these gains. Many addiction treatment programs had set up virtual counseling, tele-MAT (medication-assisted treatment) inductions, and group therapy sessions online. Patients with opioid addiction often face many barriers to in-person care (lack of transportation, fear of stigma at clinics, etc.). Telehealth lowered those barriers. Now, requiring in-person visits for treatment or for prescription renewals may cause some patients to drop out – e.g., a patient doing well on buprenorphine through telehealth might relapse if they can’t travel to see a provider for a refill. This is especially concerning for rural areas where addiction specialists are scarce; telehealth was bridging that gap. Additionally, mental health and SUD providers worry that without telehealth, relapse rates and ER visits for detox or overdose will climb, which is not only tragic for patients but costly for the healthcare system.
Beyond formal therapy, telehealth also enabled primary care doctors to routinely check on patients’ mental health or substance use as part of regular care. A quick telehealth check-in could flag a patient’s rising anxiety or opioid misuse and prompt early intervention. With fewer telehealth touchpoints, some of those early warning opportunities will be missed.
Many behavioral health interventions (like psychotherapy or substance use counseling) require frequent, consistent sessions to be effective. Telehealth made weekly counseling feasible for patients who couldn’t come in that often. The termination of coverage risks interrupting continuity of care – missed sessions, longer gaps, and ultimately patients losing therapeutic momentum. Also, telehealth was used for group therapy sessions or support groups for seniors (for example, group psychotherapy or caregiver support groups) which some patients found less intimidating to join remotely. Losing Medicare reimbursement might cause those groups to disband or charge fees that seniors cannot pay.
The telehealth rollback is poised to hit mental health and addiction services particularly hard, even though these were arguably some of the most successful uses of telemedicine. The likely consequences include reduced access to care for vulnerable patients, higher rates of untreated mental illness and addiction, and a backslide in the progress made during COVID in normalizing and expanding behavioral health treatment. Experts in addiction medicine and psychiatry have expressed alarm at pulling back telehealth now. They note that telehealth dramatically improved engagement in treatment for conditions that are traditionally under-treated in Medicare populations (for example, very few seniors with depression ever see a therapist in person, but many tried teletherapy during the pandemic). With America facing mental health and substance abuse crises, cutting off a proven method of reaching patients could be detrimental. As one mental health advocate succinctly put it, “Telehealth became integral to our ability to care for patients – taking it away will leave many people with nowhere to turn.”
Providers saw firsthand during the pandemic how telehealth kept patients engaged; they fear an abrupt policy change will cause confusion and care gaps. The National Law Review noted that “healthcare providers continue to call for action to bridge the gap… in order to avoid a telehealth cliff that could impact the continuity of care to Medicare patients.” Clinicians are concerned they will have to tell patients that services they’ve been receiving virtually will no longer be available, which could particularly harm those in the middle of treatment plans. The American Medical Association (AMA) and other medical organizations have been strong advocates for extending telehealth. The AMA strongly backed congressional efforts to continue Medicare telehealth coverage through at least 2026, arguing that patients and doctors have come to rely on these services.
In an August 2024 statement, the AMA praised a bipartisan bill that cleared a House committee to prolong telehealth flexibilities, emphasizing that both patients and physicians need certainty that these virtual care options won’t vanish. Specialist groups – like the American Psychiatric Association and addiction medicine societies – have similarly lobbied for preserving telehealth for behavioral health given its success. Many clinicians also point out the high patient satisfaction with telehealth. Medicare surveys found beneficiaries were generally satisfied with telehealth visits and many want them to continue. From a provider perspective, removing telehealth feels like a step backward. Some have expressed frustration that after investing time and money to stand up telehealth capabilities, Medicare is pulling support. Not all provider feedback is purely positive, however – a subset have raised concerns about telehealth’s potential for fraud or the loss of physical exam elements. But by and large, the healthcare community’s reaction has been to urge continuation in some form. For example, the American College of Physicians issued a statement that cutting telehealth now would “jeopardize access to care for our most vulnerable seniors” and called on policy makers to find a permanent path forward (as reported in medical news outlets).
AARP (American Association of Retired Persons), which represents millions of older Americans, has publicly opposed reinstating pre-pandemic telehealth restrictions. In a June 2023 letter to Congress, AARP argued that telehealth had become “a safe, convenient and popular way for older adults to get needed health care” and that letting the expansion lapse would be detrimental . AARP endorsed legislation (the CONNECT for Health Act) to permanently allow telehealth for all Medicare beneficiaries, stating that Medicare needs to be “brought in line” with how care is delivered today. Their position is that outdated rules should not force seniors to travel unnecessarily when technology makes remote care possible. They also highlight how telehealth helps those without transportation and allows caregiver involvement.
Rural advocates underscore that telehealth can alleviate specialist shortages and that removing coverage will hurt rural seniors disproportionately. Disability rights groups note that telehealth is a reasonable accommodation for people with disabilities, and taking it away undermines accessibility. Many of these organizations have shared compelling stories: for instance, a rural cancer patient who could consult with an oncologist at a distant center via telehealth rather than endure a 3-hour drive; or a diabetic senior who managed to avoid hospitalizations because weekly tele-nurse check-ins kept her on track. These anecdotes have been used to urge policymakers to not abandon telehealth.
Within the Trump administration itself, there were initially strong proponents of telehealth. HHS Secretary Alex Azar in mid-2020 called the telehealth expansion a “historic” transformation and said they were working to make many changes permanent. CMS Administrator Seema Verma likewise praised telehealth’s success, stating “it’s clear that the healthcare system has adapted seamlessly to a historic telehealth expansion” and that it “inaugurates a new era in healthcare delivery”. These statements indicate that even the administration implementing the rollback recognized telehealth’s value. The decision to end reimbursements seems driven less by a belief that telehealth is ineffective, and more by legal constraints and cost concerns (which we’ll discuss later). In the legislative arena, there has been bipartisan support for extending telehealth, yet political maneuvering has complicated matters. For example, at the end of 2024, a larger healthcare package that included a 2-year telehealth extension was dropped in favor of a slimmed-down spending bill, reportedly at the behest of then-incoming President Trump.
That slimmed bill removed the telehealth extension and only provided a very short 3-month continuance, which frustrated many lawmakers who wanted a longer-term solution . Ultimately, because consensus couldn’t be reached in late 2024, telehealth coverage was only extended briefly into early 2025, setting up the current situation. Policymakers like Senator Brian Schatz (D-HI) and Senator Roger Wicker (R-MS), who co-authored the CONNECT for Health Act, have been outspoken that telehealth should be permanent in Medicare. They and others cite telehealth as a clear example of a pandemic lesson that should be cemented into policy . On the other side, some fiscal conservatives and oversight bodies (like the Medicare Payment Advisory Commission, MedPAC) urge caution. They express concern about increased spending and fraud. For instance, MedPAC has recommended rolling back payment rates for telehealth and requiring more data collection to ensure telehealth isn’t being overutilized or abused. These voices aren’t against telehealth entirely, but they support a more measured continuation rather than an open-ended expansion. The Office of Inspector General (OIG) at HHS has also warned about telehealth-related fraud schemes during the pandemic (like fraudulent durable medical equipment orders happening via sham telehealth visits). So, in the policy debate, there is a tension: most stakeholders acknowledge telehealth’s benefits, but some want stronger safeguards before making it permanent.
The telehealth industry (platform providers, telemedicine companies) and health technology experts obviously favor continued reimbursement – it directly affects their viability. But beyond self-interest, many have provided data-driven analyses. For example, experts at the Bipartisan Policy Center (BPC) conducted studies using a Medicare telehealth spending simulator and concluded that permanent telehealth expansion could be done in a cost-effective way if paired with certain payment adjustments. Academic experts in health policy (Harvard, etc.) have published opinion pieces noting that telemedicine “can change care for the better — with the right rules”, advocating that pandemic-era rules be made permanent to preserve quality gains.
They often highlight that telehealth improves access and in many cases outcomes, so the focus should be on developing the right regulatory framework (for example, requiring some in-person assessments for high-risk situations, or investing in fraud prevention) rather than eliminating telehealth. These expert opinions generally frame telehealth not as a temporary stopgap, but as an integral part of modern healthcare that Medicare must incorporate going forward. So, the reaction from experts and organizations to ending Medicare telehealth payments has been largely negative, with calls to reconsider. Physicians worry about their patients losing access. Senior and rural advocates worry about convenience and equity. Policymakers from both parties have signaled they’d prefer to keep telehealth (though they differ on how). Even within the Trump administration, there were acknowledgements of telehealth’s transformative potential, making the decision to curtail it somewhat contradictory. The relatively few voices urging restraint do so on grounds of cost control and program integrity, not because they doubt telehealth’s clinical value. This broad consensus around the benefits of telehealth is why many experts are pressing for policy alternatives that can save money or prevent fraud without stripping away telehealth access entirely. We will explore some of those solutions after examining economic implications.
One motivation behind ending or limiting telehealth reimbursements is likely containing Medicare costs. Virtual visits, when added on top of existing care, could increase utilization and thus spending. However, the economic implications of cutting telehealth are complex: while it may reduce certain direct costs (fewer claims for telehealth services), it could also lead to indirect cost increases if patients forego early care and end up with more serious health issues. Let’s break down the cost considerations:
Expanded telehealth undoubtedly led to more Medicare spending on Part B services in 2020-2023, simply because so many more visits were happening virtually. Analyses predict that expanding telehealth generally increases utilization and thus total spending to some degree. The Congressional Budget Office (CBO) estimated that extending pandemic telehealth flexibilities for a full year (through 2024) would cost Medicare about $2.4 billion. This is on top of ~$660 million for prior short-term extensions. These figures indicate that Congress views telehealth as a real (but relatively modest) new cost to the program. The rationale for cost increases is two-fold: some telehealth visits replace in-person visits (which could be cost-neutral or even cost-saving if they prevent something worse), but other telehealth visits may be new utilization – people seeking care they might have skipped before because it’s easier to do so virtually.
For example, a beneficiary who otherwise wouldn’t bother to drive to a dermatologist might do a quick video consult for a minor rash; that’s a new cost that Medicare didn’t previously incur. Prior research cited by KFF found only modest spending increases per person in areas with high telehealth use, but it was an increase nonetheless. The fear among cost watchdogs is that if telehealth remained as convenient as it was in 2020, Medicare patients might start doing many extra visits – “one for each ache and pain” – driving up volume. By cutting telehealth coverage, Medicare will likely see an immediate drop in the number of billed services, which translates to cost savings on paper. However, how large those savings are vs. the value of services lost is debatable. Notably, the $2.4B cost for a year of telehealth flexibilities is a tiny fraction of Medicare’s total spending (which is in the hundreds of billions). Some experts argue that this is a worthwhile investment for better access, while budget hawks view it as low-hanging fruit for cuts.
One major issue with eliminating telehealth is that delayed or forgone care could result in higher downstream costs. Telehealth often addresses issues early – a patient can hop on a video call at first sign of a problem. Without that option, some will wait until the issue becomes serious enough to absolutely require attention. This can lead to emergency room visits, hospital admissions, or other intensive treatments that could have been avoided. There is some evidence supporting this: a Health Affairs study suggested that Medicare beneficiaries with more accessible telehealth had fewer emergency department visits. The reasoning is that conditions were managed before they got to an emergency stage. Similarly, telehealth has been linked to improved medication adherence (for instance, regular telehealth check-ins helped patients stick to blood pressure meds or insulin regimens). If adherence slips without those nudges, complications can rise.
While it’s hard to precisely quantify, even a small increase in hospitalizations can wipe out the savings from cutting a lot of office visits. For example, one prevented hospitalization (which can cost ~$10,000-$20,000) might pay for dozens of telehealth visits. Emergency room visits are expensive, and if, say, heart failure patients who had telehealth monitoring now end up in ER more often, the Medicare costs could increase. The Kaiser Permanente analysis provides a hopeful note: they found telehealth did not generally lead to a flood of extra in-person visits afterward, and ER follow-ups after tele visits were rare (around 2%). This implies telehealth was effective at resolving issues. Without telehealth, those unresolved issues might directly become ER cases. In essence, cutting telehealth risks a penny-wise, pound-foolish scenario – saving a bit on outpatient services but then spending more on emergencies and hospital care. Many experts have called for detailed monitoring of this trade-off. If data later show that the telehealth rollback caused higher acute care spending, it would undermine the cost-containment rationale.
Telehealth brings system efficiencies that have economic value. For instance, a video visit takes slightly less provider time or office resources than an in-person one (no room setup needed, etc.), potentially allowing doctors to see the same number or even more patients comfortably. If providers can’t do telehealth, some might reduce their patient panel or have more no-shows (patients who can’t make it in). That could paradoxically lead to less revenue for providers and less care delivered – not exactly what Medicare wants either. Medicare pays for volume to some extent; telehealth may have allowed more volume but with preventative tilt. Removing it might reduce volume but if that volume was beneficial, it’s a loss. There’s also the factor of telehealth infrastructure investments: providers and health systems spent money on telehealth technology during the pandemic. If Medicare won’t reimburse telehealth, those investments yield no return from half the insurance market (Medicare), making it a sunk cost. Some practices might abandon telehealth platforms, meaning all patients (not just Medicare) lose that option – a broader economic loss in terms of wasted tech and innovation.
Economic implications aren’t just about legitimate care – they also involve preventing waste and fraud. One argument for rolling back telehealth has been to curb opportunities for fraudulent billing. Telehealth can indeed be misused – e.g., scammers offering “free telehealth consults” to bill Medicare or order unnecessary DME (durable medical equipment). The HHS OIG found upticks in certain suspicious billing patterns with telehealth, although the vast majority of providers followed rules. By cutting telehealth access, Medicare potentially prevents some fraud simply by removing the medium that fraudsters exploited. But this is a blunt instrument approach. Ideally, better fraud monitoring could address this without denying services to everyone else. Nevertheless, from a cost perspective, fraud and abuse do cost Medicare money, so any increase in that due to telehealth would erode the net benefit. Program integrity experts suggest putting systems in place (like requiring telehealth providers to use specific billing codes, or flags for excessive telehealth billing) rather than broad denial of coverage. If the administration feared it couldn’t adequately police telehealth at scale, halting it might seem a safer bet economically. However, it’s worth noting that fraudulent actors often shift tactics; removing telehealth might just move them to other schemes, while legitimate patients lose out.
There’s an ongoing debate about the long-term economic impact of telehealth. In theory, better access to primary and preventive care should improve health outcomes and reduce expensive interventions over the long haul (years). Telehealth could enable more proactive management of chronic diseases, which drive a huge share of Medicare costs. For example, if telehealth helps diabetics avoid complications, Medicare saves on dialysis, amputations, etc. But those savings accrue later, while the costs of telehealth visits are immediate. Policymakers often have short budget windows (1-2 years) in mind, where telehealth looks like “extra cost.” Some studies and expert panels have posited that increased access via telehealth may reduce some long-run costs like preventable hospitalizations. It’s just hard to conclusively prove without several years of data. Medicare’s experiment in 2020-2023 wasn’t long enough to see chronic disease outcome changes in full. By ending telehealth coverage early, we might lose the chance to achieve those long-term cost savings. It also cuts off the flow of data that could inform whether telehealth truly bends the cost curve. Economically, one could view telehealth as an investment in patient health that might pay off later. Removing it might preserve cash now but miss out on potential future dividends in the form of healthier, less expensive patients.
Some seniors will pay out-of-pocket for telehealth or seek alternative coverage. For example, some might choose to enroll in Medicare Advantage plans that tout extra telehealth benefits, or pay cash for a telehealth service if they really need it. This transfers cost from Medicare to patients or private plans. While that saves federal dollars, it could strain seniors financially, particularly those on fixed incomes. If a patient chooses not to get care at all because Medicare won’t cover telehealth and they can’t afford private pay, the human and economic cost of untreated illness (pain, suffering, perhaps later high-cost emergency care) is hard to capture in Medicare’s balance sheet but is very real. Health equity issues arise here: wealthier or more tech-savvy seniors might find a workaround (like concierge telehealth services), while poorer seniors simply go without.
The economic calculus of stopping telehealth reimbursements includes some clear immediate savings for Medicare, but also significant risks of higher costs elsewhere. The decision appears to prioritize short-term budget impact over potential long-term savings and qualitative benefits. It is true that telehealth can lead to more service utilization (and thus higher expenditures) – the CBO and MedPAC are wary of an unfettered expansion. However, even they acknowledge potential offsets like fewer ER visits and better medication adherencekff.org. The key is whether those offsets can eventually outweigh the additional costs. As one analysis put it, the goal is to determine “whether any increases in Medicare spending as a result of expanded telehealth coverage are offset by improvements in quality of care or decreases in other costs, such as preventable hospital admissions”. That question remains somewhat unanswered due to limited data. By pulling back now, the Trump administration is essentially betting that the cost of telehealth outweighs the savings. Many health economists and clinicians are not convinced; they argue for refining telehealth policy rather than ending it, to strike a balance between cost control and accessible care.
The challenge facing policymakers is how to preserve the benefits of telehealth for Medicare beneficiaries while managing legitimate concerns about costs and quality. Instead of a binary choice (cover telehealth for everyone vs. cover no one), numerous policy alternatives could offer a middle path. These recommendations aim to mitigate the negative effects of the reimbursement cutoff:
One approach is to continue telehealth coverage for specific high-value services or populations. For instance, Congress could authorize Medicare to permanently cover telehealth for mental health and addiction treatment services (areas where evidence of benefit is strongest and access gaps are severe). In fact, steps in this direction have already been taken – Medicare will permanently allow telehealth for behavioral health (mental health disorders) regardless of location, thanks to the Consolidated Appropriations Act of 2021 kff.org. Ensuring this is implemented smoothly (with minimal burdens like the in-person requirement) will protect mental health access. Similarly, telehealth for opioid use disorder treatment was effectively allowed by prior law (Support Act of 2018) and could be emphasized so that patients can continue remote MAT. Another group could be rural patients: even if urban telehealth reverts, perhaps allow all rural beneficiaries to receive telehealth at home, not just at clinics. Targeting could also be by service type – e.g., allow telehealth for routine primary care visits and chronic care management (which keep patients healthy) but maybe not for more complex new patient visits where an in-person exam is important. By carving out these exceptions, Medicare retains telehealth where it’s most needed (underserved areas, behavioral health, chronic disease check-ins) while limiting usage in areas thought to be more discretionary.
A fundamental fix is to change the outdated Medicare statutethat imposed rural and originating site restrictions. Bipartisan bills like the CONNECT for Health Act propose permanently removing the geographic and facility requirements, letting Medicare beneficiaries in all areas and in their homes use telehealth. This would align Medicare with how private insurance works (most private plans have no such telehealth location limits). Advocacy from groups like AARP strongly supports this legislative change. If cost is a worry, the law could start with a multi-year pilot or limited scope and require monitoring. But modernizing the law is key; otherwise every extension is a temporary patch. Congressional action here would override the Trump administration’s rollback by giving CMS the permanent authority to cover telehealth broadly. There appears to be significant bipartisan will to do this eventually, given the popularity of telehealth with constituents. Pursuing legislation sooner rather than later could prevent the lapse in coverage from dragging on.
One compromise to address cost is to adjust how much Medicare pays for telehealth services rather than cutting eligibility entirely. Currently, Medicare often paid the same for a telehealth visit as an in-person visit (payment parity) during the pandemic to encourage adoption. MedPAC has recommended that Medicare pay less for telehealth after the PHE – essentially, pay the “facility rate” (which is lower, assuming the doctor’s practice has lower overhead for a tele visit) . This could reduce the per-visit cost to Medicare and thus the overall spending impact, without denying the service. For example, if a typical office visit is $100, maybe a telehealth visit could be reimbursed at $85. Providers might accept slightly lower reimbursement in exchange for the flexibility and efficiency telehealth offers. Payment differentiation could also discourage overuse: if providers only get a full in-person rate when something is truly needed in person, they won’t do everything virtually just for convenience. However, policymakers must balance this so as not to disincentivize telehealth too much. Another idea is to limit the number of telehealth visits that will be paid for certain patients (though this gets complicated and could harm those who actually need many visits). A more holistic approach is shifting toward value-based care models: in an Accountable Care Organization (ACO) or Medicare Advantage, providers are capitated or rewarded for outcomes, so they can use telehealth freely as a tool without worrying about fee-for-service limits. Encouraging these models would inherently manage telehealth’s cost impact, since providers have a budget to stick to and will only use telehealth when it helps overall care. In fact, even under previous law, ACOs were allowed to waive telehealth geographic restrictions, pointing to integrating telehealth in broader payment reform.
To address the digital divide, a strong recommendation from many advocates is that Medicare should continue covering audio-only phone visits for certain services or patient groups. As discussed, a sizable share of seniors rely on phone calls. The current policy ending phone coverage could be modified: for instance, Medicare could pay for audio-only telehealth for beneficiaries who attest that they lack video access or have difficulty using it. This was effectively allowed during the pandemic and could be means-tested or limited to specific services (like mental health counseling or chronic care management by phone). The 2021 law already allows audio-only for mental health if needed; expanding this to primary care check-ins or other counseling (nutrition, advance care planning, etc.) would help underserved populations. The equity impact of audio-only is huge – continuing it would prevent a large swath of vulnerable patients from being cut off. Additionally, phone calls are relatively low-cost, so the spending impact is minimal. Policymakers could set lower fees for phone visits to align with the shorter time they often take. This is a practical compromise to ensure no beneficiary is left completely behind due to technology issues.
To alleviate the program integrity concerns, Medicare can implement stricter oversight measures in lieu of a blanket rollback. This could include: requiring telehealth providers to use a unique modifier or code for each tele visit so they can track utilization patterns; performing audits of telehealth services to ensure medical necessity; using analytics to flag providers with unusually high telehealth volumes for review; and educating beneficiaries on guarding Medicare numbers to prevent scams. The HHS OIG has already issued fraud alerts for telehealth schemes – building on this, CMS could collaborate with law enforcement to aggressively go after telehealth fraud rings. By making it clear that fraudulent use will be caught and punished, they can deter bad actors. Some have suggested requiring a one-time in-person verification for new patients before allowing unlimited telehealth – but this can be counterproductive in areas with no providers. At minimum, identity verification steps can be taken (to ensure the patient on the telehealth call is the actual beneficiary, etc.). The goal is to give confidence that telehealth can be offered widely without turning into a “wild west” of fraud. With these safeguards, the justification for completely cutting access weakens.
As a complementary policy, the government could invest in broadband expansion and digital literacy for seniors. This addresses the root barrier that made telehealth challenging for some. For example, expanding programs that provide low-cost internet or devices to low-income seniors (similar to the FCC’s Lifeline program or the Emergency Broadband Benefit) would increase the share of Medicare population that can fully utilize telehealth. Training programs through community centers or libraries on using telehealth apps could also help reluctant users. While this isn’t a Medicare reimbursement policy per se, it goes hand-in-hand with it. If more seniors are comfortable with telehealth technology, you get more effective use and potentially better health outcomes – making telehealth a more powerful cost-saving tool in the long run. Policymakers have noted that telehealth’s benefits won’t be realized if large groups can’t access it , so addressing those gaps is crucial and politically appealing (expanding rural broadband has bipartisan support, for instance).
Rather than an abrupt stop, another alternative is a phased approach. For instance, extend telehealth coverage for another year or two (as was being considered) but include directives for data collection and an automatic review. During that time, study utilization patterns closely: Who is using telehealth? How often? Is it replacing other care or adding to it? Are outcomes better, worse, or the same? Also monitor spending and fraud. Then in a year or two, adjust the policy accordingly – e.g., keep what’s working and trim what’s not. This evidence-based policy making would ensure Medicare doesn’t permanently adopt telehealth in a way that’s unsustainable, but also doesn’t kill it off without full information. In essence, treat 2020-2024 as a trial run (which it was), and refine the model. Many health policy experts have advocated for using this wealth of pandemic experience to inform permanent rules, rather than defaulting to pre-2020 rules that were set in a very different context . A formal demonstration project could even be done in Medicare to test various telehealth coverage scenarios and compare outcomes and costs.
While fixing traditional Medicare, also encourage Medicare Advantage (MA) plans (which cover ~50% of beneficiaries) to continue robust telehealth offerings. MA plans have flexibility to include telehealth as a supplemental benefit, and many did so even pre-pandemic. Ensuring that MA plans don’t now roll back telehealth is important, as it provides at least half of seniors an ongoing option. For those in traditional Medicare, perhaps creating a telehealth-specific supplemental plan or benefit could be an idea – where beneficiaries who value telehealth could buy an affordable rider that covers telehealth services. This is not ideal as it could stratify access by ability to pay, but it’s a creative interim solution if Congress deadlocks on fully funding it. Ultimately, though, integrating telehealth into standard Medicare benefits (as opposed to side programs) is preferable for equity. There are many strategies to mitigate the negative effects of ending telehealth reimbursements while still minding Medicare’s budget.
The overarching recommendation from experts is not to throw the baby out with the bathwater. Telehealth proved its worth in many areas; the focus should be on adapting Medicare to include telehealth in a prudent, data-driven way. That means keeping the services that clearly improve access and outcomes (like mental health, SUD treatment, routine chronic care check-ins), making needed statutory changes to eliminate arbitrary barriers, adjusting payment levels or frequency if needed to curb excess cost, and doubling down on oversight to prevent misuse. Such an approach could maintain access for underserved populations – ensuring seniors, rural patients, and others continue to get the care they need – without letting costs spiral. Indeed, many experts see telehealth as part of the solution to healthcare access and possibly cost management (through prevention), rather than the problem.
As Kaiser Permanente’s analysis showed, telehealth can substitute for in-person care effectively without generating a wave of extra utilization. And AARP points out that it helps seniors manage conditions which, if uncontrolled, are very expensive. Thus, smart policy tweaks can harness telehealth’s advantages (improved access, patient engagement, convenience) in a sustainable way. The recommendations above, if implemented, could largely avoid the worst outcomes (like increased ER visits or underserved populations losing care) even as Medicare addresses cost and integrity issues.
The historical context shows that Medicare telehealth went from a niche, restrictive benefit to a mainstream mode of care during COVID-19, dramatically improving access for seniors nationwide. By rolling back coverage, Medicare is poised to revert to a far more limited model that may not meet the needs of today’s aging population. The implications are far-reaching: underserved groups – including homebound elderly, rural residents, and disadvantaged communities – stand to lose convenient access to care, potentially widening health disparities. Mental health and addiction services, which saw unprecedented engagement via telehealth, could suffer setbacks in outcomes as patients lose a flexible treatment option. While the policy shift might produce some short-term Medicare savings, it risks higher costs later in the form of emergency visits and complications fromuntreated conditions, not to mention the human cost of poorer health. Experts from across the spectrum – physicians, patient advocates, and bipartisan policymakers – largely oppose an abrupt end to telehealth coverage. They emphasize that telehealth has become an integral part of healthcare delivery and that patients are now expecting and relying on it. The near-consensus is that telehealth should continue in some capacity, with sensible guardrails, rather than vanish. Indeed, the experience of the pandemic has been a proving ground for telemedicine, and it would be a profound regression to eliminate those gains without exploring compromises.
Policy alternatives exist that can balance cost control with access. By selectively covering high-value telehealth services, adjusting payment rates, ensuring audio-only options for those who need them, and strengthening oversight, Medicare can maintain much of telehealth’s benefit while addressing fiscal concerns. Legislative action to modernize Medicare’s telehealth rules is likely the ultimate solution – a permanent authorization that reflects 21st-century technology and care practices. Until then, interim measures (extensions, pilots, etc.) are critical to prevent a collapse in telehealth availability. In conclusion, the decision to stop broad telehealth reimbursements has significant negative implications for patient access and health equity. It may be premature and overly broad, given the largely positive results seen during the pandemic. The hope among healthcare leaders is that this rollback will be short-lived – prompting a sense of urgency for policymakers to craft a more nuanced, sustainable telehealth policy for Medicare. As one healthcare executive noted, “Telehealth should be here to stay”, and the focus now must be on making it work for the long haul, rather than turning back the clock. By learning from the pandemic and implementing thoughtful reforms, Medicare can avoid the worst outcomes of this decision and ensure that beneficiaries continue to receive the right care, at the right time, wherever they may be.
Sources
- Kaiser Family Foundation – Medicare and Telehealth: Coverage and Use During the COVID-19 Pandemic and Options for the Future (May 19, 2021)
kff.org
kff.org - CMS Press Release – Trump Administration Finalizes Permanent Expansion of Medicare Telehealth Services (Dec 1, 2020)
cms.gov
cms.gov - CMS Data Highlight – New HHS Study Shows 63-Fold Increase in Medicare Telehealth Utilization During the Pandemic (HHS ASPE Report, 2021)
cms.gov
cms.gov - NatLawReview – Update: Telehealth “Cliff” Looming at End of 2024 (Dec 17, 2024)
natlawreview.com - KFF Health News – House Rejects Trump-Favored Spending Deal That Stripped Out Health Measures (Morning Briefing, Dec 20, 2024)
kffhealthnews.org
kffhealthnews.org - Kaiser Permanente – Medicare Telehealth Flexibilities Should Be Here to Stay (Keavney Klein, Government Relations, 2024)
about.kaiserpermanente.org
about.kaiserpermanente.org - AARP Blog – AARP to Congress: Expand Medicare Telehealth Coverage (Natalie Missakian, June 20, 2023)
blog.aarp.org
blog.aarp.org - CMS Press Release – Increased Use of Telehealth for Opioid Use Disorder Services…Associated with Reduced Risk of Overdose (JAMA Psychiatry study, Aug 31, 2022)
cms.gov - CDC/NIDA Study – Telehealth for OUD and Overdose Outcomes (Referenced in CMS Press Release above)
cms.gov - KFF Issue Brief – What is the expected impact of telehealth on Medicare spending?
kff.org
kff.org - MedPAC commentary via KFF – MedPAC recommendation on telehealth payment
kff.org - KFF Issue Brief – Medicare telehealth trends and disparities
kff.org - Additional references from CMS and HHS on telehealth usage and policy changes
cms.gov
kff.org