Remember the Peanuts storyline where Lucy yanked the football just as Charlie Brown was about to kick it? Congress recently pulled a similar stunt on Medicare beneficiaries.
But in this case, the result was more than just disappointment and frustration.
Instead, people on Medicare won’t get the two years of continued coverage for telehealth appointments and five years’ for acute hospital at home programs that were in the bill Congress nearly voted into law in December 2024.
Medicare coverage in and out of year-end legislation
That’s because President-elect Donald Trump and his government efficiency advisor Elon Musk said the 1,500-page legislation, to keep the government running, needed trimming. So, those Medicare coverage extensions—known as waivers—didn’t make it into the bill that ultimately became law.
Instead, Medicare coverage for telehealth and hospital at home (continuous hospital care provided where you live) was extended for just three months—through March 2025.
What happens after that is anyone’s guess.
Medicare’s hospital at home initiative appears to be budget neutral so far, but the Congressional Budget Office estimated that a two-year telehealth extension would cost Medicare around $4 billion. That makes telehealth an especially ripe target, since Trump, Musk and Republicans in Congress have signaled interest in reducing Medicare spending.
“It’s certainly something we must be mindful of,” says Kyle Zebley, head of public policy for the American Telemedicine Association. “However, it was Donald Trump’s administration, working on a bipartisan basis with Congress, that put all these flexibilities in place. And Donald Trump has campaigned as a champion of Medicare, in general.”
What April 1 could mean for Medicare beneficiaries
If the waivers aren’t extended, Medicare will go back to restrictive rules for telehealth, only allow mental health telehealth appointments if beneficiaries first see health providers in person and end coverage for acute hospital at home.
The brief, three-month extensions leave Medicare beneficiaries in limbo if they’ll want to receive medical care through telehealth or hospital at home after March.
“The short extension will mean uncertainty for patients and providers until Congress adopts a longer-term fix,” says Tricia Neuman, executive director for program on Medicare Policy at the KFF health research and news group.
Currently, about 380 health systems offer hospital at home through Medicare. Studies have shown patients in these programs recover more quickly and have fewer hospital readmissions than those treated in medical facilities. The telehealth option has proved popular with patients and physicians; three quarter of doctors now provide telehealth appointments, according to the American Medical Association.
The pandemic and telehealth
Before the pandemic, traditional Medicare largely limited telehealth coverage to people in rural areas and required going to certain clinical sites for appointments (private insurers’ Medicare Advantage plans had more flexibility).
But in March 2020, when COVID began making it hard, if not impossible, to see doctors in person, the Medicare restrictions were waived by President Trump. Soon, telemedicine visits represented 42% of Medicare outpatient visits, according to Dr. Ateeev Mehrotra of Harvard Medical School.
Congress and President Joe Biden extended Medicare telehealth availability through December 2024.
Who uses telehealth and why
Telehealth usage has generally declined dramatically recently, though, other than for mental health appointments.
“We’re seeing a return to the norm, which is predominantly in-person services,” says Jessica Aptman, chief communications officer for ZocDoc, a digital medical booking service. “People have found that telehealth works really well, but it’s more of a supplement for most of the care they need.”
Still, people 65 and older can’t always travel to doctors’ offices easily; some live in places without the physicians they need. That makes Medicare coverage of telehealth either a convenience or a necessity for them.
“Our patients may take three buses when they have a medical appointment on our campus, says Dr. Brad Spellberg, chief medical officer of Los Angeles General Hospital. “Telemedicine is lifesaving for these patients.” Says KFF’s Neuman: “While the number and share of telehealth users has declined since the pandemic, telehealth remains an important way for millions of Medicare beneficiaries to get care.”
If Medicare doesn’t cover telehealth
Extending Medicare’s coverage of telehealth for just three months “has a lot of real-world implications,” says Chris Adamec, executive director of the Alliance for Connected Care, a telehealth advocacy group. “Many health care providers schedule appointments more than 90-days out.”
Medicare beneficiaries with chronic conditions and periodic physician check-ins that don’t require in-person visits have no idea whether they’ll be able to have those appointments virtually come April.
“You’ve got a lot of health-systems advocates lobbying to make these waivers permanent,” says Eric Wickland, senior editor for innovation at HealthLeaders news site. “Three months is nothing.”
A freeze on new hospital at home programs
That’s especially true for medical centers considering ramping up hospital at home programs. Arranging staffing and technology for them is costly and time-consuming. Medicare coverage requires hospitals regularly send health care providers to patients’ homes, monitor them remotely and offer access to emergency help.
Jiang Li, CEO of Vivalink, a company offering hospital at home technology, says uncertainty about the future of Medicare’s hospital at home coverage will stop some programs from launching.
“Within the next three months, a lot of people are probably going to pause their action a little bit to see what happens,” he says.
Rachel Jenkins, senior associate director of federal relations at the American Hospital Association (AHA), says: “A three-month extension doesn’t provide stability to the program, which is certainly key for our members.”
Added Jennifer Holloman, senior associate director of policy at AHA: “Having a longer-term duration like a five-year extension would give hospitals and health systems the appropriate bandwidth to stand some of these programs up, execute the contracts necessary and make the updates for staffing and workflows.”
Unaffected hospital at home programs
Hospitals already running Medicare-approved acute hospital at home programs will see no interruption in service over the next three months, says Dr. Pippa Shulman, chief medical officer of the hospital at home company Medically Home.
Also, some hospitals, like Los Angeles General Hospital, have at-home options that aren’t done through Medicare’s program. So, they’re unaffected by the three-month extension.
LA General Hospital’s Safer@Home program is free for Medicare beneficiaries, says Spellberg. “We eat the cost” for the 5% to 10% of Safer@Home patients on Medicare, he added. Most others are on Medicaid or have private health insurance.
What the future holds
No one knows whether Congress and President Trump will extend Medicare’s coverage of telehealth and hospital at home past March. But advocates for those services, who’d like to see the coverage made permanent, are optimistic about prospects for extensions.
They believe a likely scenario is that Medicare coverage for telehealth will be extended through 2025, possibly 2026.
It’s possible, however, that Congress could make Medicare reimburse doctors less for telehealth appointments than in-person ones. “If providers see that, they will say, ‘Okay, we won’t do telehealth; we’ll just stay with in-person,’” says Wickland.
Hospital at home supporters believe the Medicare benefit might be approved to continue for several years or more. “We are confident that in some way, shape or form, they will extend the program,” says Shulman.
If the waivers aren’t extended, beneficiaries should prepare for jolts.
Older people receiving hospital at home in late March could be relocated to hospital rooms in April, for example.
“Without Medicare reimbursements, hospitals are going to shut down some of their hospital at home programs,” says Wickland.
More on Medicare:
- 3 big changes coming to Medicare in 2025. Here’s what they'll mean for you
- What Medicare beneficiaries need to know about generic medications
- Medicare has a new pilot program to help people with dementia. Here's how it works
