The Medicare telehealth flexibilities will continue through January 30. Under the CMS enrollment requirements, distant-site practitioners can deliver telehealth services from their home and often do not need to report their home address on their Medicare enrollment application.
“Under the CR, certain telehealth services have been retroactively restored through January 30th. This means individuals who paid out-of-pocket during the lapse in coverage may now be eligible for refunds,” Kevin Thompson, the CEO of 9i Capital Group and the host of the 9innings podcast, told Newsweek.
“In these cases, practitioners must refund any overpayments to beneficiaries and resubmit claims directly to Medicare. Any claims that were previously returned during the lapse period are now eligible for payment and should be submitted during this extension window.”
More than 66 million Americans rely on Medicare for health coverage each year. That includes many rural patients who depend on telehealth, which became increasingly popular during the coronavirus pandemic.
Robert Hoyer, a Colorado-based doctor specializing in cancer, started a petition among others to stop Medicare from limiting home telehealth coverage earlier this year.
“For patients living with a cancer diagnosis or chronic conditions, telehealth provides an important link to their care team. Telehealth also helps alleviate costly travel to medical appointments, time off work, and child care expenses,” Hoyer wrote in his Change.org petition.
What People Are Saying
Kevin Thompson, the CEO of 9i Capital Group and the host of the 9innings podcast, told Newsweek: “Telehealth has been a lifeline since the pandemic, giving providers the ability to reach patients, especially in rural or underserved areas who lack easy access to in-person care. If these provisions are not extended further, rural residents and individuals with limited mobility could face serious challenges, including long travel times and reduced access to care that telehealth once helped eliminate.”
Alex Beene, a financial literacy instructor for the University of Tennessee at Martin, told Newsweek: “During the pandemic, telehealth became a gamechanger for millions of Americans needing medical assistance, but either not able or concerned to go into a medical facility. In the years following it, telehealth has become increasingly popular, especially in rural communities that have seen numerous hospital and clinic closures and rely on those services more heavily. The extension through January 31, 2026 ensures Medicare recipients will continue to have coverage in this area and even retroactively in the time that the extension had yet to be passed.”
What Happens Next
After January 30, the telehealth flexibilities will no longer be permissible, but it’s possible that Congress could extend them further.
Medicare is also implementing an artificial intelligence pilot in six states next year. Several outpatient services, including orthopedic, spinal, and other procedures, now require prior authorization, and those requests will be supported by AI tools operated by private contractors.
“That’s a material departure from how original Medicare has historically worked and brings it closer to the utilization management frameworks seniors typically associate with Medicare Advantage,” Ganesh Padmanabhan, founder and CEO of Autonomize AI, told Newsweek.
“In the near term, patients are going to feel this as added friction: more documentation, more ‘Is this authorized?’ conversations, and a real risk of delays if the underlying rules or incentives aren’t designed well. Prior authorization already slows care today, and simply adding AI on top of a flawed process won’t solve that.”
