Medicare telehealth coverage is again under threat. Here’s how it affects elderly patients

Medicare may no longer cover telehealth services after Jan. 30, the deadline for the most recent extension of congressional appropriations.

The loss of coverage could mean over 1.3 million Wisconsinites will no longer be able to use telehealth services for primary or specialty care — although behavioral health services will not be affected.

Medicare telehealth coverage has routinely been on the brink. It relies on short-term extensions through general congressional appropriations rather than its own legislation — an arrangement that hospital workers say threatens access to health care and makes their jobs harder.

"What (legislators) don't fully understand is how much work it is on the back end," said Jessica Easterday, director of virtual care at Emplify Health by Gundersen. "When it's this constant 'Is it not going to happen?' 'Is it going to happen?' It … makes health care inefficient."

Medicare, a federal health insurance program, mostly covers people 65 and older, and Easterday said the patients most affected by a loss in telehealth coverage would be elderly patients in rural communities.

Before the COVID-19 pandemic, Medicare only covered telehealth in rural communities — but even then, rural patients often lacked the internet service or technology to make virtual visits possible.

During the pandemic, the federal government expanded Medicare telehealth coverage and invested billions to develop broadband in rural areas.

For the past several years, telehealth services have been a key solution to the challenges of rural medicine, making it easier for rural patients to receive care wherever they live.

"It's hard to recruit in-person physicians in the rural climates," said Heather Schimmers, president of Emplify Health by Gundersen.

Schimmers, Heather.jpgSchimmers

In 2025, 23% of Gundersen's telehealth visits were with patients covered by Medicare. Many also are covered by Medicaid, a joint state-federal insurance program that does cover telehealth in Wisconsin. According to Easterday and Schimmers, many of those patients appreciate the flexibility that telehealth offers.

Rather than setting aside a full day for an appointment, patients might spend 20 minutes attending a virtual checkup. Similarly, children of elderly parents can attend a doctor visit they wouldn't have before.

"We need to make it as easy as possible for people to be seen," Schimmers said.

Despite their best efforts, telehealth coverage is under threat yet again.

Impact of coverage loss

The last time Medicare dropped coverage for telehealth services was late last year, when the government shutdown paused congressional appropriations altogether.

Before the shutdown, Gundersen saw over 700 Medicare patients per month through video visits. After Medicare coverage for this service dried up, that number dropped to 321 — a 56% decrease.

"We lose … our ability to take care of patients the way they want to be taken care of," Easterday said.

Schimmers heard from dozens of Gundersen patients who were forced to cancel their virtual visits. One patient traveled 120 miles round trip to attend a 20-minute checkup — a visit mandated by Medicare.

"They had to see their provider. They had to," Schimmers said. "We could have done that with telehealth … and avoided hours of burden on that patient."

Telehealth is also a useful tool for preventive or upstream care. Consistent, accessible checkups make it more likely that more serious problems are identified earlier.

"If we don't do it this way, guess what door they come in? The emergency room," Schimmers said. "(Telehealth) is the ideal patient path."

Schimmers and Easterday are "cautiously optimistic" that coverage won't shut off — but the uncertainty itself is damaging, they said.

'Incredibly disruptive'

Since the pandemic, Medicare telehealth coverage has been wrapped in short-term congressional appropriations.

It's been extended several times in recent years, and each time, providers have been uncertain about its future.

"It's incredibly disruptive to the health care system," Schimmers said. "Because we have to continually be reprioritizing and refocusing and trying to figure out, 'Are the patients scheduled a video visit?' 'Are they scheduled an in-person visit?' "

Medicare-specific legislation, independent of appropriations, would give providers some much-needed room to breathe.

In 2025, Congress introduced two bills that might address this problem.

The Connect for Health Act, introduced in the Senate last April, would permanently expand Medicare to telehealth services. The Telehealth Modernization Act, introduced in the House, would extend current waivers for two years.

"People are begging for health care systems to restructure, reformulate, figure out a different way to get this done, make this easier for people, make it easier for the provider, make it easier for the patient."

Although both bills enjoy bipartisan support, neither has passed in either chamber.