Medicare's telehealth coverage underwent dramatic expansion during the COVID-19 pandemic, temporarily allowing beneficiaries to receive care virtually from their homes using phones, tablets, and computers. Many of these expansions have been made permanent or extended through 2025 and beyond, fundamentally transforming how Medicare beneficiaries can access healthcare. Understanding what telehealth services Medicare covers, how to access them, and what rules apply empowers you to take advantage of convenient virtual care while ensuring you receive covered services that won't generate unexpected bills.
Medicare Telehealth Before and After COVID-19
Before the COVID-19 pandemic, Medicare's telehealth coverage was extremely limited. Original Medicare only covered telehealth for beneficiaries in rural areas, required patients to travel to designated originating sites like hospitals or clinics rather than receiving care at home, covered only specific types of services via telehealth, and required two-way, real-time video communication—phone calls didn't qualify.
These restrictions meant most Medicare beneficiaries never used telehealth services. The infrastructure existed, but regulatory barriers prevented widespread adoption. When COVID-19 forced social distancing and made in-person healthcare visits risky, Congress and the Centers for Medicare & Medicaid Services (CMS) temporarily waived these restrictions, dramatically expanding telehealth access.
During the COVID-19 public health emergency, Medicare temporarily covered telehealth services for all beneficiaries regardless of location, allowed patients to receive care at home rather than traveling to specific facilities, greatly expanded the types of services covered via telehealth, permitted audio-only telephone visits for some services when patients lacked video technology, allowed new types of providers to deliver telehealth services, and relaxed certain provider licensing requirements to increase access.
These temporary expansions proved immensely popular and beneficial. Millions of Medicare beneficiaries used telehealth for the first time, continuing routine care during the pandemic, reducing COVID-19 exposure risks, eliminating transportation barriers, and accessing specialists unavailable locally. The expansions demonstrated that telehealth could be delivered safely, effectively, and efficiently for many conditions.
When the COVID-19 public health emergency ended in May 2023, questions arose about which telehealth flexibilities would continue. Congress acted in December 2024 by passing legislation that made many telehealth expansions permanent while extending others through December 31, 2025, providing clarity about ongoing telehealth access for Medicare beneficiaries.
Permanent Telehealth Expansions for 2025 and Beyond
Several major telehealth expansions have been made permanent, meaning they continue indefinitely regardless of the COVID-19 public health emergency status. Medicare now permanently covers telehealth services for beneficiaries in any location, including their homes, eliminating the previous rural-only restriction. This change is revolutionary—urban, suburban, and rural beneficiaries all have equal access to telehealth services from the comfort of their homes.
Federally qualified health centers (FQHCs) and rural health clinics (RHCs) can permanently serve as distant site providers, delivering telehealth services to Medicare beneficiaries. This expansion increases access to primary care and mental health services through community health centers that serve many low-income and rural populations.
The list of covered telehealth services has been permanently expanded to include many services previously unavailable via telehealth. Medicare permanently covers more than 200 services via telehealth, including evaluation and management visits with primary care doctors and specialists, mental health counseling and psychotherapy, preventive services and health risk assessments, chronic care management and other care coordination services, and many diagnostic and treatment services across various specialties.
Medicare Advantage plans have permanent authority to provide additional telehealth benefits beyond what Original Medicare covers. Medicare Advantage plans can offer telehealth for any medically necessary service they choose to cover, providing even broader virtual care access. Many Medicare Advantage plans offer 24/7 telehealth services for urgent care, direct-to-consumer telehealth platforms, and comprehensive virtual care programs as extra benefits.
Audio-only telehealth visits have been extended through December 31, 2025, for mental health services, allowing Medicare beneficiaries to receive counseling and therapy via telephone when video isn't available or practical. This accommodation recognizes that some beneficiaries lack smartphones, computers, or reliable internet but can access mental health services via regular telephone, ensuring equity in access to behavioral health care.
Mental Health Telehealth Services
Mental health and behavioral health services received some of the most significant telehealth expansions. Through December 31, 2025, Medicare covers mental health services via telehealth without geographic restrictions and from the patient's home. Covered mental health telehealth services include individual psychotherapy, group psychotherapy, family psychotherapy, psychiatric diagnostic evaluations, medication management for mental health conditions, and psychological and neuropsychological testing with some limitations.
Critically, mental health telehealth services can be delivered via audio-only telephone through 2025 for patients who don't have access to video technology or prefer telephone visits for behavioral health care. This audio-only flexibility recognizes barriers to video technology and the particular value of telephone access for mental health services, where the therapeutic relationship may be maintained effectively through voice alone.
The mental health telehealth expansions eliminate a previous requirement that patients have at least one in-person visit with their provider within six months before receiving telehealth services. Now, Medicare beneficiaries can establish new patient relationships via telehealth for mental health services, greatly expanding access to psychiatrists, psychologists, and mental health counselors, particularly in areas with provider shortages.
Medicare covers telehealth for substance use disorder treatment, including individual and group counseling, medication-assisted treatment services, and opioid use disorder treatment via telehealth. These services can be accessed from home and, for audio-only qualified services, via telephone through 2025. Given the ongoing opioid crisis and challenges accessing substance use disorder treatment, these telehealth expansions provide critical access improvements.
Rural health clinics and federally qualified health centers can provide mental health telehealth services, with Medicare paying a facility fee even when the patient is at home. This payment structure ensures community health centers can sustain telehealth mental health programs, maintaining access for vulnerable populations who depend on these facilities.
Telehealth Services Through December 31, 2025
Several telehealth flexibilities have been extended through December 31, 2025, meaning they're currently available but could expire after that date unless Congress acts to extend them further or make them permanent. Audio-only telehealth for mental health services continues through 2025 as described above. Whether audio-only mental health telehealth continues beyond 2025 depends on future Congressional action, but advocates are working to make this flexibility permanent given its importance for access.
Many evaluation and management services and other non-mental health services can be provided via telehealth from patients' homes through 2025. While some services have been permanently expanded, others have temporary extensions. The specific services list is detailed in CMS guidance, with codes identifying which services fall under permanent versus extended coverage.
Direct supervision requirements for certain services have been modified through 2025, allowing supervision to occur via real-time audio-video technology rather than requiring in-person presence. This flexibility helps teaching hospitals, clinics, and practices deliver care with appropriate supervision while maximizing efficiency and trainee learning opportunities through virtual supervision.
Certain teaching physician requirements have been relaxed through 2025, allowing teaching physicians in teaching hospitals to supervise residents providing services via telehealth without needing to be physically present. These flexibilities help academic medical centers continue graduate medical education while providing expanded telehealth services.
The telehealth extensions through 2025 create some uncertainty—patients and providers don't know whether these services will continue beyond December 31, 2025. Congress is considering legislation to make more telehealth flexibilities permanent. Advocates encourage beneficiaries to contact their Congressional representatives supporting permanent telehealth expansions to ensure continued access beyond 2025.
How Telehealth Works Under Original Medicare
Under Original Medicare, telehealth services generally have the same cost-sharing as in-person services. For services covered under Part B, you pay the Part B deductible ($257 in 2025) if you haven't met it, then typically 20% coinsurance for covered telehealth services. Medicare pays the remaining 80% of the Medicare-approved amount.
To receive telehealth services, you need access to technology for two-way, real-time communication. For most services, this means a smartphone, tablet, or computer with video capability and internet access. For certain mental health services through 2025, a regular telephone suffices for audio-only visits. Your provider's office can tell you what technology is required for your specific appointment.
Scheduling telehealth appointments works similarly to in-person visits. Call your doctor's office and ask whether telehealth is available for your appointment type. Verify that the provider accepts Medicare assignment for telehealth services to avoid unexpected costs. Before your appointment, confirm what platform will be used—many providers use HIPAA-compliant video platforms, though during the pandemic some consumer platforms were temporarily permitted.
At your scheduled appointment time, connect to the video platform per your provider's instructions. Have your Medicare card and any other health insurance information available. Have a list of current medications, symptoms you're experiencing, and questions for your provider. Ensure you're in a quiet, private location with good lighting and stable internet connection.
After your telehealth visit, you'll receive a Medicare Summary Notice showing what services were provided, what Medicare paid, and what you owe. Billing works the same as for in-person visits—if your provider accepts assignment, you pay the standard 20% coinsurance. If you have Medigap supplemental insurance, it typically covers the telehealth cost-sharing just as it would for in-person care.
Telehealth in Medicare Advantage Plans
Medicare Advantage plans have more flexibility than Original Medicare to offer telehealth services. All Medicare Advantage plans must cover at minimum the same telehealth services that Original Medicare covers. However, plans can—and most do—offer additional telehealth benefits beyond Original Medicare's coverage.
Many Medicare Advantage plans offer direct-to-consumer telehealth services, allowing you to access urgent care, primary care, or specialist visits 24/7 through contracted telehealth companies. These services often have low copays—sometimes $0—and provide immediate access to care without scheduling delays. Common uses include treating minor illnesses, getting prescriptions, addressing urgent concerns outside office hours, and receiving medical advice.
Some Medicare Advantage plans partner with telehealth platforms like Teladoc, MDLive, or Doctor on Demand, providing members with access credentials and instructions for using these services. Other plans develop their own telehealth platforms or integrate telehealth into their existing provider networks. Check your Medicare Advantage plan's Evidence of Coverage or call member services to understand exactly what telehealth services are available and how to access them.
Medicare Advantage plans set their own cost-sharing for telehealth services. Some plans waive copays entirely for telehealth, making virtual visits free to members. Others charge the same copays as in-person visits, while some charge reduced copays for telehealth. Review your plan's Summary of Benefits to understand your specific telehealth costs.
Network rules apply to Medicare Advantage telehealth just as they do to in-person care. Unless it's an emergency, you typically need to use in-network providers or approved telehealth platforms to receive covered services. Using out-of-network telehealth services may result in higher costs or no coverage, depending on your plan type (HMO vs. PPO) and specific benefits.
Types of Services Commonly Provided via Telehealth
Many medical services can be effectively delivered via telehealth. Primary care visits for follow-up appointments, medication management, reviewing test results, managing chronic conditions like diabetes or hypertension, and addressing minor acute illnesses work well via telehealth. Specialty consultations including dermatology (with photo sharing), psychiatry, cardiology follow-ups, endocrinology, and many other specialties can often be conducted virtually.
Mental health and behavioral health services are particularly well-suited to telehealth. Individual therapy, couples counseling, group therapy, psychiatric medication management, and substance use disorder counseling can all be delivered effectively via video or, for some services through 2025, audio-only telephone.
Chronic disease management including diabetes care, heart disease management, chronic obstructive pulmonary disease monitoring, and other ongoing condition management can incorporate telehealth for regular check-ins, education, and care coordination between in-person visits. Remote patient monitoring, where devices track your vital signs or symptoms and transmit data to your care team, often combines with telehealth visits for comprehensive chronic disease management.
Post-operative follow-up visits can often be conducted via telehealth, allowing surgeons to check healing progress, address concerns, and adjust care plans without requiring patients to travel to clinics shortly after surgery. Preventive care including health risk assessments, some counseling services, and certain preventive visits may be delivered via telehealth.
Some services cannot be provided via telehealth. Physical examinations requiring hands-on assessment, procedures requiring in-person presence, diagnostic tests like laboratory work or imaging that require physical specimens or equipment, and emergencies requiring immediate in-person intervention cannot be done virtually. Your provider will advise whether your specific healthcare need can be appropriately addressed via telehealth or requires an in-person visit.
Benefits and Limitations of Medicare Telehealth
Telehealth offers numerous benefits for Medicare beneficiaries. Convenience ranks highly—no travel time, no waiting rooms, no parking hassles. You receive care from home in comfortable surroundings. For people with mobility limitations, transportation challenges, or living in areas with provider shortages, telehealth dramatically improves access to care. Telehealth can reduce disease exposure, particularly important for immunocompromised patients or during infectious disease outbreaks.
Telehealth increases access to specialists who may not practice locally. A beneficiary in rural Montana can consult with a specialist at a major medical center hundreds of miles away without traveling. Telehealth supports care coordination, allowing your primary care doctor and specialists to confer about your care more easily than coordinating in-person meetings.
For mental health services, telehealth can reduce stigma and increase comfort. Some patients feel more at ease discussing mental health concerns from home rather than visiting a mental health clinic. The flexibility of telephone visits for mental health (through 2025) ensures that lack of technology doesn't prevent access to critical behavioral health services.
However, telehealth has limitations. Not all medical situations can be appropriately evaluated virtually. Physical examinations, hands-on assessments, and certain diagnostic procedures require in-person visits. Technology barriers affect some beneficiaries—those without smartphones, computers, or reliable internet may struggle to access video telehealth. Digital literacy varies, with some older adults finding technology challenging to navigate.
Some patients and providers feel that telehealth lacks the personal connection of in-person care. Non-verbal cues may be harder to detect via video. Technical problems—poor video quality, audio lag, connection drops—can frustrate patients and providers, disrupting care. Privacy concerns arise for patients who lack private spaces at home for confidential medical discussions.
Looking Ahead: The Future of Medicare Telehealth
Medicare telehealth is at a crossroads. Many expansions are permanent, but others expire December 31, 2025. Congress is considering legislation to make additional telehealth flexibilities permanent, including audio-only mental health services, expanded services delivered from patients' homes, and continued flexibilities for teaching physicians and supervision requirements.
Stakeholders including patient advocates, healthcare providers, and telemedicine organizations are urging Congress to make these expansions permanent, citing improved access, patient satisfaction, and comparable health outcomes to in-person care for appropriate services. The data from widespread telehealth use during the pandemic demonstrates that virtual care can be delivered safely, effectively, and efficiently when properly implemented.
Uncertainty remains, however. Some policymakers express concerns about costs, potential fraud or abuse, and ensuring quality of care via telehealth. The debate balances expanded access and convenience against fiscal responsibility and quality assurance. Medicare beneficiaries should stay informed about legislative developments affecting telehealth coverage and advocate for policies supporting continued access to virtual care.
Regardless of legislative outcomes, telehealth has permanently changed healthcare delivery. The combination of permanent expansions and technology advances means Medicare beneficiaries will continue having significant telehealth access. As technology improves, broadband expands, and providers gain telehealth experience, virtual care will increasingly complement in-person services, providing beneficiaries with more flexible, accessible healthcare options.
Medicare's telehealth coverage represents one of the most significant positive developments in the program's recent history. By understanding what services are covered, how to access telehealth, and what rules apply, you can take advantage of convenient, high-quality virtual care that reduces barriers and improves access to the healthcare services you need.