Medicare Telehealth Coverage: What’s Allowed and What’s Changed

What Medicare Telehealth Is

Telehealth means getting care from a doctor or other provider using technology instead of sitting in the same room. For Medicare purposes, that usually means a live video visit on a phone, tablet or computer. In some cases it can mean a live audio-only call.

Original Medicare pays for telehealth under Part B. Medicare.gov describes covered examples that include office visits and consultations, outpatient psychotherapy, depression screening, cognitive assessment, diabetes self-management training, medical nutrition therapy, cardiac and pulmonary rehabilitation, speech therapy, advance care planning, and caregiver training. Medicare.gov also notes that Medicare may cover more telehealth services than the ones it lists. CMS publishes the official list of services, and any additions or removals take effect each January 1 through the annual payment rulemaking process.

Not everything can be done remotely, of course. A procedure, a blood draw or a physical exam that needs hands-on care still requires an in-person visit. Telehealth works best for conversations, reviews, follow-ups, and evaluations that do not depend on touch or equipment.

What Changed Over the Years

	Before the pandemic-era flexibilities	Under the current flexibilities
Where you can be	Generally at a medical facility	At home or elsewhere in the United States
Rural requirement	Generally yes	No
Audio-only	Very limited	Allowed in some cases
Scheduled end	Not applicable	Currently set for the end of 2027, unless extended

To understand why people find the rules confusing, it helps to know the history. Before the pandemic, Medicare telehealth was quite limited. In general, you had to live in a rural area, and you had to be at a medical facility such as a clinic or hospital when you connected with a provider elsewhere. The idea of seeing a doctor on your laptop at home was mostly not covered.

When the COVID-19 public health emergency began in 2020, Medicare temporarily lifted many of those limits. You could connect from home. You did not have to live in a rural area. Some services could be done by audio alone. A broader range of providers could bill for telehealth. Telehealth use among Medicare beneficiaries grew substantially during that period.

When the public health emergency ended, Congress extended many of these flexibilities rather than letting them lapse. They have been extended more than once, sometimes close to a deadline, which is why you may remember news coverage warning that telehealth could end. As of this writing, Medicare.gov states that through December 31, 2027, you can receive Medicare telehealth services from anywhere in the United States, including your home. After that date, coverage may change unless Congress acts again. Because this is a rule tied to legislation, it is smart to confirm the current status with Medicare.gov or your provider if you rely on it.

Where You Can Be When You Connect

Under the current flexibilities, you can be at home or other location in the United States when you take a covered telehealth visit. That is the biggest practical change from the older rules. If the flexibilities were to end, the rule that generally applies is the earlier, more limited one, with its rural and medical-facility requirements. Some categories, such as certain behavioral health care, have different rules, which we discuss next.

If you travel, check with your provider before you connect from another state. State licensing rules vary, but in general the provider needs to be licensed to treat patients in the state where you are located during the visit, so a visit from a winter home may not be possible with your regular doctor. Ask the office how it handles this before you leave.

Mental Health Telehealth Is Treated Differently

CMS states that Medicare covers telehealth for mental health and behavioral health care on a permanent basis, including when the patient is at home. Providers are expected to offer interactive audio and video, but they may use audio-only when a patient’s technology, abilities or preferences make video impractical. There is one catch to know about. Under a separate rule, when you receive mental health telehealth at home, Medicare requires an in-person visit with the provider (or a colleague in the same practice) within the six months before your first at-home telehealth session, and then at least one in-person visit every 12 months, with limited exceptions. CMS says that requirement has been delayed and applies only after December 31, 2027, and that people who start at-home mental health telehealth before 2028 are treated as established patients who need an in-person visit every 12 months afterward. Ask your provider how this applies to you. That puts therapy, psychiatric care and treatment for substance use disorders on firmer footing than many other types of telehealth. Our post on Medicare and mental health care goes through what is covered, who can provide it, and what you pay.

Audio-Only Visits

Medicare.gov says telehealth can use audio and video, or audio-only in some cases. That matters for people who do not have a smartphone with a camera, a reliable internet connection, or the comfort to use video. The key phrase is “in some cases.” Not every service can be delivered by phone, and not every provider offers it. If you prefer or need to use the phone, tell the office when you schedule so they can tell you whether that visit will be billed to Medicare as a covered service.

What You Pay

In Original Medicare, telehealth costs generally match the cost of an in-person visit. After you meet your Part B deductible, which is $283, you pay 20% of the Medicare-approved amount. A Medicare Supplement plan, depending on its type, may pick up some or all of that 20%. Our pages on Plan G and Plan N show how each handles the 20%. Some Medigap plans involve small copays for certain visits, so ask your insurer how it treats telehealth.

If you have Medicare Advantage, your plan must cover what Original Medicare covers, and it may offer additional telehealth benefits. Medicare.gov notes that Advantage plans and Original Medicare providers in Accountable Care Organizations may offer expanded telehealth. Cost-sharing varies. Some plans have a lower copay for a virtual visit than for an in-person one, and some offer access to a dedicated virtual-care service. Check your plan’s Evidence of Coverage for the copay and for any rules about which telehealth providers you must use. Our post on checking a plan’s network applies here as well, since the virtual provider may need to be in the network.

How to Make Sure a Visit Qualifies

A few questions before the appointment can prevent a billing surprise.

• Is this service on Medicare’s list of covered telehealth services, and will you bill it that way?
• Is this visit a video visit, or an audio-only visit, and is audio-only allowed for this service?
• Is the provider enrolled in Medicare and licensed in the state where I will be during the visit?
• If I have Medicare Advantage, is the provider or the virtual-care platform in my plan’s network?
• What will my cost be, and will there be any separate fee for using the platform?

Brief check-ins, patient-portal messages and other virtual contacts can be billed separately from a formal telehealth visit, and some may carry cost-sharing. Ask the office how they handle these, particularly if you expect to message your doctor often.

For follow-up care after a procedure, or for services like therapy, ask whether virtual sessions are an option. Our posts on physical therapy and home health care describe services that are usually delivered in person but may have virtual components.

When In-Person Care Is Still the Right Choice

Telehealth is a good tool, but not a substitute for everything. Some conditions require an examination, testing or procedures that cannot be performed remotely. If you are experiencing chest pain, trouble breathing, sudden weakness, or another emergency, do not use a telehealth visit. Call 911 or go to an emergency room. And if a telehealth provider recommends an in-person visit, that is a normal part of how the model works.

Think too about the practical side. Telehealth works better when you can see and hear well. Some people with hearing, vision or memory difficulties find video visits harder, and a family member or caregiver can help set up the call. Our caregiver’s guide to Medicare includes tips for supporting someone with appointments.

Watch for Telehealth Scams

Telehealth has also opened a door for fraud. Be careful if you receive a call, text or ad offering a “free telehealth visit” in exchange for your Medicare number, or if a company you do not know asks you to talk to a doctor you have never seen so that it can order braces, genetic tests, or medical equipment on your behalf. A legitimate provider will not pressure you to share your Medicare number outside a real care relationship. If you are unsure, hang up and call the number on your Medicare card or plan card. Our guide to Medicare fraud and scams lists warning signs and what to do if you suspect a problem.

How Telehealth Works for Each Type of Coverage

Original Medicare alone. Part B pays for covered telehealth services, and you pay the deductible and 20% the same way you would for an in-person visit. The provider must bill Medicare, so ask the office whether it does.

Original Medicare with Medigap. Medigap pays Part B cost-sharing according to the plan letter. Since telehealth is billed to Part B, it generally follows the same rules as an in-person service, though you should ask your insurer if you have a plan with copays.

Medicare Advantage. The plan must cover what Original Medicare covers and may add more, such as additional virtual care or a dedicated virtual-care service. It may also set its own copays and network rules for virtual providers.

Part D. Telehealth visits do not change drug coverage, but a prescription from a virtual visit still has to go to a pharmacy covered by your plan.

A Step-by-Step Way to Set Up a Visit

• Step 1: Ask the office if telehealth is an option for this problem. Some conditions need an in-person exam.
• Step 2: Ask whether it will be billed to Medicare as telehealth. Confirm whether the visit is video or audio-only.
• Step 3: Check your coverage. If you have Advantage, look at the copay and whether the provider is in network.
• Step 4: Test your technology. Check your device, camera, microphone and internet connection before the appointment.
• Step 5: Gather your information. Have your medication list, recent readings you take at home, and questions written down.
• Step 6: Choose a private spot. A quiet room helps you speak freely.
• Step 7: Confirm follow-up. Before the visit ends, ask about prescriptions, tests, and whether you need an in-person visit.
• Step 8: Review your statement. Compare your Medicare Summary Notice or plan statement with the visit you had.

Three Scenarios

These are hypothetical.

Picture a retiree with a medication question. A short video visit with their regular doctor handles it. They pay their usual cost-sharing, and no travel is needed.

Picture someone who spends winters in another state. They want to see their home doctor by video, but the provider may need to be licensed where the patient is located. They ask the office before leaving.

Picture someone with limited internet. They ask whether audio-only is allowed for their visit. The office confirms it is for this service, and the visit goes ahead by phone.

Costly Mistakes to Avoid

• Assuming every service is covered by video. The Medicare list controls, and it changes each January.
• Using a service that does not bill Medicare. You could be responsible for the whole cost.
• Relying on the end date without checking. The current end date comes from legislation and could change.
• Giving your Medicare number to unsolicited callers. Only share it with providers you have chosen.
• Skipping in-person care when advised. A provider who recommends an in-person visit is following normal practice.

What to Do If It Goes Wrong

If you are billed for a visit you believed was covered, first ask the provider how it was billed and whether it was submitted to Medicare. If you have Advantage, call the plan and ask about its appeal process. If the bill is from an unfamiliar company, treat it with caution and use the fraud resources described in our guide to Medicare scams. You can also call 1-800-MEDICARE.

Frequently Asked Questions

Does Medicare cover telehealth visits?

Yes. Part B covers many telehealth services, including office visits, psychotherapy and certain screenings. You generally pay 20% of the Medicare-approved amount after your deductible, the same as in person.

Can I take a telehealth visit from home?

Yes, under the current flexibilities. As of this writing, Medicare.gov says this is allowed through December 31, 2027. Mental health telehealth at home is covered on a permanent basis, according to CMS, though an in-person visit requirement for it is scheduled to start after 2027.

Does Medicare cover phone-only visits?

In some cases. Audio-only is allowed for certain services and situations, but not all. Ask the provider whether your visit qualifies before you schedule it.

Do I pay more for telehealth than for an in-person visit?

Generally no. In Original Medicare the cost sharing is the same. Medicare Advantage plans set their own copays, which may be different for virtual visits.

What happens if the telehealth flexibilities end?

Unless Congress extends them, the earlier, more limited rules would apply starting January 1, 2028, which generally require patients to be in rural areas and at a medical facility. According to CMS, physical, occupational and speech therapists and audiologists could also no longer provide Medicare telehealth. Mental health telehealth has separate rules on location that are permanent, though an in-person visit requirement is scheduled to begin after 2027.