Most Medicare telehealth coverage ended on October 1, affecting millions of aging and disabled people. Tom Williams/CQ Roll Call/Getty
In 2001, Congress implemented partial Medicare coverage for telehealth, allowing remote visits with doctors and other forms of long-distance care—a response to the increasing need, in particular, for people in rural areas to reach specialists, and an essential service especially after the start of the Covid-19 pandemic, when lawmakers expanded that coverage to a broad range of services now used by a quarter of the country’s 68 million Medicare users.
But Wednesday’s federal budget impasse has halted that funding—and unlike other, temporary service cuts brought on by the shutdown, telehealth won’t be restored for long just by bringing the government back online.
As a consequence of the temporary way it was funded, Congress has had to renew Medicare telehealth coverage roughly annually since 2021.
This latest termination is linked to the government shutdown that began Wednesday: Medicare telehealth funds were tied to the failed continuing resolution for the federal budget, which would have funded government operations for just seven more weeks. But the repeated expirations of a program with bipartisan support, which Congress has repeatedly agreed to continue, look increasingly ridiculous to health care advocates and federal government observers.
Multiple bills across multiple recent sessions of Congress would have extended that coverage either for a two-year period or more permanently. The president of the American Medical Association has also argued in support of making telehealth coverage permanent for people on Medicare.
“Commercial payers generally follow Medicare guidance, and…this could eliminate coverage for telemedicine across the board for all Americans.”
Gin Jones, an author who lives in Massachusetts, is one of the millions of people affected. Jones has a rare genetic disorder, X-linked hypophosphatemia, which requires specialized treatment from an endocrinologist who lives four hours away. Her next visit, on Tuesday, may be in-person rather than remote; Jones doesn’t know what she is going to do about it. The long trip would be exhausting and painful and an “extraordinary waste of my time.”
“The big question is whether I go ahead and endure the four-hour round trip,” Jones said, “or switch to a closer endocrinologist who isn’t really qualified to treat me.”
Some smaller clinics are rescheduling their Medicare patients in person and suspending their telehealth appointments for Medicare patients, said Lydia Homovich, a policy analyst with the Center for Telehealth and eHealth Law.
Other patients are insulated, said Homovich, as some larger institutions are “going to continue providing these telehealth services as normal, even if they don’t get back payment for that if the waivers are reauthorized.”
Dr. Kanwar Kelley, the CEO and co-founder of Side Health, which focuses on virtual chronic disease management, said that his practice will be greatly impacted: most of his patients are on government insurance. “Unfortunately, given the uncertainty around whether we will be reimbursed, we are planning a dramatic reduction in workforce with furloughs,” Kelley said.
Homovich notes that some members of Congress may view a longer-term expansion of telehealth as too expensive—but ultimately, she says, it may actually be a cost-saver.
“Telehealth allows for the earlier detection and treatment of conditions that otherwise would be escalated to much more costly levels of care, like being admitted to a hospital or an emergency room,” Homovich said.
Kelley also cautioned that the expiration of Medicare telehealth waivers could have a knock-on impact for people on private health insurance.
“While this may not immediately affect patients with commercial insurance, commercial payers generally follow Medicare guidance,” Kelley said,” and depending on when or if the waivers are reinstated, this could eliminate coverage for telemedicine across the board for all Americans.”
