The Medicare Telehealth 2025 Changes Insurance Agents Need to Know

We’re officially over the Medicare telehealth policy cliff. On September 30, 2025, expanded Medicare coverage of telehealth services expired.

Your clients may have questions about Medicare telehealth services ending and the telehealth services Medicare will cover in 2026.

Let’s explore the 2025 Medicare telehealth changes and what they mean for you and your clients.

Is Medicare Going to Stop Paying for Telehealth?

The Medicare telehealth policy cliff occurred because of Congress failing to pass legislation to extend expiring enhancements.

In response to the Congressional failure, the Centers for Medicare and Medicare Services (CMS) issued a Medicare Learning Network (MLN) Matters notice to all Medicare Administrative Contractors (MAC). The notice instructed MACs to put out a standard, temporary claims hold.

During the hold, providers can continue to submit claims, but payments will not be released until the hold is lifted.

Without legislation that extends the flexibilities granted during the PHE, Medicare will cover fewer telehealth services as of October 1, 2025.

What Is Telehealth?

Telehealth, also known as “telemedicine” and “telecare,” enables consumers to use technology to digitally connect with health care physicians for certain health care services.

Both the policyholder and health care professionals must have real-time communication, with both audio and video capabilities, for telehealth services.

There are pros and cons of telehealth, but advancements in the effort of value-based care are possible due to flexibility telehealth provides.

Advancements in the effort of value-based care are possible due to the flexibility telehealth provides.

Telehealth service coverage can vary based on the product type (e.g., ACA insurance vs. Medicare) and carrier to carrier (e.g., Medicare Advantage plans). You may have clients who prefer in-person appointments to telehealth or vice versa. It’s important to consider their telehealth preferences and needs when determining which coverage may suit them best.

The COVID-19 pandemic caused a spike in telehealth use in 2020, when many Americans practiced social distancing and telehealth became more accessible. Since regulation changes and vaccine availability, the usage of this service has declined, but is still higher than it was pre-pandemic. A survey conducted at the beginning of 2025 reported 76 percent of US hospitals offer telehealth services.

Medicare Telehealth Changes for 2025

Prior to the pandemic, only Medicare beneficiaries in rural areas could utilize telehealth services in health facilities under certain circumstances. CMS temporarily expanded Medicare telehealth coverage in March 2020 so beneficiaries could obtain certain telehealth services in urban areas and at home while staying safe and preventing the spread of COVID-19. Congress has since passed a series of extensions for the expanded policy; however, the last extension expired September 30, 2025.

Now, millions of Medicare beneficiaries will not have the right to use telehealth services from their home. This may require your clients to travel to a facility for care that could have been handled through telehealth care.

Now, millions of Medicare beneficiaries will not have the right to use telehealth services from their home.

Providers may also deny claims based on the new coverage restrictions after CMS and MACs lift the temporary claims hold.

Who Do These Changes Affect?

The expiration of these provisions mainly affects Medicare beneficiaries and various telehealth providers. Specifically, the kinds of beneficiaries that are most affected by this are:

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. 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

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.

What Are Some Differences Your Clients Can Expect?

Now that we’re on the other side of the cliff, there are quite a few distinctions that you’ll want to discuss with your clients.

• Telehealth services restricted — Most clients can no longer receive telehealth visits from their own homes.
• Required “originating site” — Clients must now go to an approved site for their appointment, such as a doctor’s office, hospital, or skilled nursing facility.
• Rural limitations — The “originating sites” must also be in a rural professional health shortage area, which severely limits access to clients in metropolitan areas.
• Reduced audio-only calls — This is typically only covered if a patient can’t or won’t use video technology and the broad flexibility for these calls has ended for most non-behavioral health services.
• Initial visit required — For new patients, an in-person visit is required within six months of their first telehealth service.
• Annual follow-up — An annual in-person follow-up is required to continue to use telehealth services.
  • Exceptions to this rule — Patients with substance use disorders or those in a qualifying rural location
• Fewer eligible providers — Those who were able to offer these services during the pandemic are no longer able to for Medicare patients.
• “Hospital At Home” lapsed — Patients enrolled in this program will face many disruptions, such as Medicare no longer covering these services, leading to discharges or transfers to an inpatient hospital.

What Can Your Clients Do?

Your clients may be unnerved by these recent changes and ask you what to do. You can advise them to:

• Check their coverage — Make sure your clients check their telehealth appointments to see if they’re still covered under the new rules.
• Reschedule appointments — If your clients don’t have covered telehealth services, suggest they rebook for in-person appointments.
• Review bills and notices — Have your client be on the lookout for changes to billing, like receiving an Advance Beneficiary Notice of Non-coverage (ABN), which makes your client financially responsible.

Will Medicare Telehealth Services Be Expanded for 2026?

Currently, due to the government shutdown, it’s very uncertain whether Medicare telehealth services will be extended again. The best way to keep track of what will become of telehealth services is to stay in the know with the most recent news about Congressional legislation.

Politicians from different parties have recognized the importance of telehealth. Multiple bills have been introduced, such as H.R. 4206 and H.R. 5081. H.R. 4206 amends the Social Security Act to expand access to telehealth services. H.R. 5081 also amends the same bill to extend certain telehealth flexibilities under the Medicare program.

In addition, on September 19, 2025, the U.S. Senate passed S. Res. 417, which names the week of September 14, 2025, to September 20, 2025, as Telehealth Awareness Week. This recognizes how helpful telehealth has become for Americans, as well as urging steps to be taken to continue to promote access to telehealth for everyone.

While falling down the Medicare telehealth policy cliff can be scary for your clients, use this knowledge to help them make the best decisions for their specific situations. You can answer their questions and provide guidance during this turbulent and confusing time!

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