Telehealth isn’t a new concept. In fact, it traces its roots all the way back to at least 1925, when a doctor diagnosed a patient over the radio. But as with any technology, it has become more and more advanced through the years, and continues to become an even more viable option. The global pandemic of 2020 and beyond made it even more important, and now its availability and use are more widespread than ever.
But it’s important to know what your health insurance covers in terms of telehealth, especially as 2025 will see some coverage changes. Today we’re going to talk about the biggest changes – which revolve around Medicare – before highlighting what most private insurers cover for telehealth.
Medicare Telehealth Coverage Updates
Throughout the COVID-19 public health emergency, the federal government introduced many telehealth flexibilities to make sure Americans were getting the help they needed without needlessly putting themselves or others at risk. Many of those flexibilities have been extended well beyond the end of the PHEIC according to the WHO, but not all of them are permanent. In fact, on September 30, 2025, many things will change. First, here’s a list of what medicare will still cover after that date:
- Non-behavioral/mental health telehealth services will still be allowed to take place in the patient's home, with no geographic restrictions being implemented.
- Both Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs) may continue to serve as distant site providers for non-mental health telehealth services.
- Patients who cannot use or do not consent to the use of video devices will still benefit from coverage for audio-only telehealth visits.
- Both behavioral and mental health services will not require an in-person visit prior to telehealth treatment, but this will change on January 1, 2026.
But, as we mentioned, some things will be changing on that date, so here they are as well:
- Most non-mental health telehealth services will require patients to be in a rural medical facility to qualify for coverage, meaning they can no longer take place at home.
- Many types of care will see the return of geographic restrictions.
- Provider capabilities and patient consent may lead to a scaling back of audio-only coverage.
As you can see, telehealth will still be a viable resource for those who need it, but Medicare recipients need to be cognizant of these changes so they can plan ahead and adapt.
Private Insurance Coverage Trends
Individuals with their own health plans or those sponsored by an employer can often benefit from telehealth coverage as well, but it’s far less standardized and will vary from provider to provider. So, we can’t say anything definitively on this matter, but we can highlight some emerging trends that you can look out for and ask about when shopping for coverage.
- Increased mental health coverage
- Therapy, counseling, psychiatric care, and more are now being offered with relatively robust options. These services are typically covered at the same rate as in-person visits, with many plans even waiving copays for virtual mental health sessions.
- Expanded primary care access
- Virtual visits with primary care providers are now being widely covered, especially for things like routine checkups, prescription refills and the management of chronic conditions.
- Cost-sharing and deductibles
- Some providers will treat telehealth as a fully separate category of benefits, complete with its own copays and deductibles, while others bundle it together with traditional office visits. Make sure you’re aware of the differences so you don’t experience any surprises.
- Platform restrictions
- It’s becoming increasingly prevalent that providers will have their own preferred telehealth platform, and many will require you to use that platform in order to receive coverage.
If you have any questions about these updates, trends or details, you can of course reach out to us right here at Glover Family Independent Insurance. We’d be happy to answer any questions you have and even help you find the right provider to suit your needs. We look forward to hearing from you!
