Telehealth has been an efficient way to provide certain kinds of health care services for many people on Medicare (and their providers) – providing easier access to healthcare for patients and better use of time for providers ever since the pandemic.
That’s about to largely end as restrictions on telehealth reimbursement and geographic restrictions are set to take effect after April 1, 2025. impacting how and where (and sometimes whether) Medicaid members get their care.
Medicare telehealth set to expire
The expansion of telehealth during the pandemic showed remarkable improvements in access to care. As documented in a Kaiser Family Foundation report, before the pandemic, Medicare’s telehealth coverage was limited. Only patients in rural areas or specific settings had access, and visits had to be conducted via real-time audiovisual technology.
The public health emergency lifted these barriers, enabling all Medicare beneficiaries to use telehealth for a broad range of services, including behavioral health, chronic disease management, and primary care visits.
A study published in Health Affairs highlighted how these changes improved care access for members who had struggled to see their doctors regularly. Older adults, those living in rural & underserved areas, and patients managing multiple chronic conditions benefitted the most.
Geographic Restrictions & Behavioral Health Services
Medicare beneficiaries can still access telehealth services from virtually anywhere, but they won’t be able to in a couple weeks. Starting April 1, 2025, geographic restrictions will return.
This means that telehealth services will be limited to rural areas unless members receive specific services, like monthly visits for home dialysis or certain mental health treatments.
If you’re in an urban area and require telehealth for general care or mental health services, you’ll likely need to visit a healthcare facility in person after 4/1.
Behavioral health services have seen significant benefits from telehealth, allowing patients to access care from home. After April 1, most of those services will require in-person visits, especially if they’re part of an ongoing treatment plan.
Medicare Advantage Plans May Offer More Flexibility
Medicare Advantage plans sometimes offer more flexibility when it comes to telehealth. These private plans often have broader coverage options and may not be as restricted by geographic limitations. If you’re enrolled in a Medicare Advantage plan, check with your plan provider to understand the specific telehealth benefits and flexibility available after April 1, 2025.
What Could Have Been
It didn’t have to be this way. The bipartisan CONNECT for Health Act offered a comprehensive and efficient solution. This bill proposed permanent expansions of telehealth in Medicare (including the removal of geographic site requirements that restrict telehealth to rural areas) and drops in-person visit rules for behavioral health.
Importantly, it also included measures to reduce potential fraud and abuse, something sorely needed to prevent fraud and make telehealth services sustainable over time. Those measures include setting stricter guidelines for billing and ensuring better auditing of services.
The CONNECT Act also addresses concerns about overuse of telehealth by focusing on finding high-value services that are proper for virtual care.
Sadly, it appears that Congress will wait until they hear from mad constituents before they take up the CONNECT Act.
