On March 15, 2025, the U.S. government finalized an extension allowing beneficiaries to maintain access to COVID-era Medicare telehealth flexibilities through September 30, 2025.
Many enrollees heavily relied on expanded Medicare telehealth benefits during the COVID-19 pandemic. Continue reading to learn what exactly is changing later this year and how your clients may be impacted.
What’s Changing with Medicare Telehealth Benefits in 2025?
Certain Medicare telehealth benefits were set to expire March 31, 2025; however, the recent extension delays the “telehealth cliff” six more months.
Generally, as of September 30, 2025, Medicare beneficiaries will no longer have the right to utilize audio or video health appointments from anywhere in the U.S., including their home. As a result, your clients may need to explore other options for access to medical and behavioral health services.
Note: Medicare Advantage plans and some providers with Accountable Care Organizations in Original Medicare may offer more telehealth benefits than the basic coverage in Original Medicare.
As of September 30, 2025, Medicare beneficiaries will no longer have the right to utilize audio or video health appointments from anywhere in the U.S..
Beneficiaries who live in a qualifying rural area and travel to a qualifying office or medical facility in that area will still be able to utilize telehealth services when the flexibilities end. Additionally, all beneficiaries should retain access to certain Medicare telehealth services like:
- Monthly End-Stage Renal Disease (ESRD) visits for home dialysis
- Services for diagnosis, evaluation, or treatment of symptoms of an acute stroke wherever you are, including in a mobile stroke unit
- Services for the diagnosis, evaluation, or treatment of a mental and/or behavioral health disorder (including a substance use disorder) in your home
Why Will Medicare Telehealth Services End?
Prior to the pandemic, only beneficiaries in rural areas could utilize telehealth services in health facilities under certain circumstances. CMS temporarily expanded Medicare telehealth coverage in March 2020, through the Coronavirus Aid, Relief, and Economic Security (CARES) Act and other legislation, so that beneficiaries could obtain certain telehealth services in urban areas and in home while staying safe and preventing the spread of COVID-19. While Congress passed a series of extensions through the American Relief Act and spending bills, the last of these is set to expire September 30.
CMS cites that they regularly review available evidence to support legislation and that services can be removed if a service is “not safe, effective, or medically beneficial.”
How Can Rural Medicare Beneficiaries Access Health Services?
The Centers for Medicare and Medicaid Services (CMS) defines rural areas by using a variety of factors including the number of plan options, census data, and the number of health care providers in an area. Generally speaking, starting October 1, your clients living in these areas will have to visit a qualifying doctor’s office or medical facility to receive approved telehealth services or in-person care for physical and behavioral health services.
Starting October 1, your clients living in these areas will have to visit a qualifying doctor’s office or medical facility to receive approved telehealth services or in-person care for physical and behavioral health services.
Ensure that your clients are aware of this change in coverage. Before October arrives, communicate to them that they will have to make appointments in person to be able to use their Medicare benefits. Explain that there are alternatives if this change causes a disruption.
Some Medicare Advantage plans or carriers may include telehealth services as a benefit, regardless of your clients’ location. Also, some Medicare Advantage plans offer ride coverage to and from appointments. This could be a solution for homebound individuals or clients that live significant distances away from care facilities. Check with your client’s carrier to see if telehealth benefits are available.
Will Metropolitan Medicare Beneficiaries Be Affected?
Individuals who reside in metropolitan or suburban areas may be affected by these changes as well. Your clients will likely not be able to access remote routine doctor visits anymore but will be able to receive select telehealth benefits.
The health insurance industry is constantly revolving, and telehealth accessibility is no exception. Pass this newfound knowledge to your clients and present valuable alternatives that may enhance their quality of life!
To learn more about this update, visit HHS.gov.
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Not affiliated with or endorsed by Medicare or any government agency.
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