Medicare will continue to cover telehealth services, but the rules are changing. The expanded access that has been available since the COVID-19 pandemic – allowing Medicare beneficiaries to receive telehealth services from anywhere in the United States – ended on January 30, 2026.
Starting January 31, 2026, telehealth coverage under Original Medicare has reverted to the pre-pandemic model, though with some permanent exceptions that didn’t exist before 2020. Here’s what’s changing.
EDITOR’S NOTE: A House spending bill released on January 20, 2026 included a provision that would extend the expiring telehealth provisions, but it’s not yet clear whether there will be enough Congressional support for that extension. Check back for updates.
What’s changing with Medicare telehealth coverage in 2026?
For most Original Medicare beneficiaries, the end of the expanded access means telehealth will no longer be a covered option from home. Instead, it shifts back to its original role under Medicare, which is to help beneficiaries in rural or hard-to-reach areas connect with healthcare professionals they might not otherwise be able to see, but with a few important updates.
The primary telehealth coverage changes coming to Original Medicare include:
- Rural, facility-based rules return: For most medical issues, you must live in a rural area to qualify for telehealth coverage under Medicare, and you generally cannot have these visits from home. You’ll need to go to an “originating site,” such as a doctor’s office, clinic, or hospital in a rural location for the telehealth visit.
- Changes to covered providers: Some healthcare professionals who were temporarily allowed to provide telehealth will no longer be covered for these services. This includes physical therapists, occupational therapists, speech-language pathologists, and audiologists.
- Technology requirements: While audio-only (phone) calls were widely allowed under the 2020 expanded access, most non-mental health telehealth visits will now require a two-way, real-time video connection once again.
- Hospital-based services restricted: Hospitals will no longer be able to bill Medicare for outpatient therapy, diabetes self-management training, and medical nutrition therapy services when provided remotely to beneficiaries in their homes.
Permanent telehealth exceptions
While the rural and facility-based rules are returning, Medicare has permanently updated its telehealth coverage policy for certain types of care. For the services listed below, you can continue to use telehealth from home or elsewhere, regardless of whether you live in a city or a rural area.
- Mental health and substance use disorder treatment: Visits for mental health or substance use disorder treatment can continue to take place in your home, whether you live in a rural or urban area. Audio-only (phone) visits are allowed when preferred or if video isn’t possible. However, there’s now an in-person visit requirement: you’ll need to see your provider in person within six months before your first telehealth mental health visit, then at least once every 12 months. If you started receiving mental health telehealth services before January 31, 2026, the initial in-person visit within six months isn’t required, but you’ll still need one in-person visit per year.
- Monthly home dialysis visits: Beneficiaries with End-Stage Renal Disease (ESRD) receiving dialysis at home can continue with their required monthly clinical assessments via telehealth, without needing to travel to a facility.
- Acute stroke evaluation and treatment: Beneficiaries experiencing stroke symptoms can receive evaluation, diagnosis, and treatment via telehealth from any location, including in a mobile stroke unit.
Will these rule changes apply to Medicare Advantage coverage of telehealth?
The rule changes described above apply to Original Medicare. Many Medicare Advantage plans, and some providers participating in Accountable Care Organizations (ACOs), offer telehealth access without geographic restrictions as an added benefit. If you have Medicare Advantage or see an ACO provider, your telehealth options may not change, so it’s worth checking with your plan or provider.
How to prepare for telehealth coverage changes
If these telehealth changes impact your current healthcare routines, taking proactive steps now can help avoid interruptions in your care.
Original Medicare beneficiaries in non-rural locations will need to transition most telehealth appointments back to in-person visits. Contact your healthcare providers soon to schedule in-person appointments and discuss any concerns about transportation or mobility. If going to a clinic is challenging, ask the provider’s office to connect you with a social worker or patient navigator who can locate resources.
Similarly, physical, occupational, and speech therapy appointments must move back to in-person settings under Original Medicare. If you are currently in the middle of a treatment plan, talk with your therapist about transitioning to facility-based care.
For Original Medicare beneficiaries living in rural areas, telehealth remains a covered option for many services, but it generally must take place at an eligible facility instead of at home.
While telehealth services for mental health remain covered from home, the new in-person visit requirement means early planning. If you have difficulty coordinating an in-person appointment with your provider for the required annual visit, ask if another mental health professional in the same practice can see you instead. Medicare allows a different practitioner of the same specialty within the same group practice to fulfill this requirement if your regular provider is unavailable. Discuss scheduling these visits early to maintain uninterrupted telehealth access.
Medicare Advantage members and those seeing ACO providers should check directly with their plan or provider about what telehealth services will remain available. Though coverage varies by plan, many may continue offering telehealth from home.
How many Medicare beneficiaries have used telehealth?
Telehealth use among Medicare beneficiaries surged during the COVID-19 pandemic and has since leveled off at rates well above what they were before. According to the Centers for Medicare & Medicaid Services (CMS) data, about 48% of Original Medicare beneficiaries (approximately 14.8 million people) used telehealth services in 2020, accounting for 52.7 million total Medicare telehealth visits that year. That represented a 63-fold increase from 2019, when there were approximately 840,000 Medicare telehealth visits.
Usage has since declined but remains significantly higher than pre-pandemic levels. By 2024, about 25% of Original Medicare beneficiaries (6.7 million people) were using telehealth.
How has telehealth affected provider visits?
Even with millions more Medicare beneficiaries using telehealth, research shows that the expansion did not lead to more overall provider visits. A University of Michigan analysis of 60 million beneficiaries found that total visit volume remained stable or even declined through mid‑2024. This was true even in specialties that used telehealth the most, such as behavioral health. Overall, telehealth appears to have replaced in-person appointments, rather than increasing how often beneficiaries see healthcare providers.
Maggie Aime is a health, wellness and medical personal finance writer. With over 25 years in healthcare and a passion for education, she draws on her rich experience across nursing specialties, case management, revenue management, medical coding, and utilization review nurse consultant roles to create content that informs, inspires, and empowers. She’s passionate about educating people about all aspects of disease prevention, health and wellness, and how to navigate the U.S. healthcare system. She’s the owner of The Write RN, LLC.
