Medicare Telehealth Rules: What Changed and What's Extended Through 2027

If you're on Medicare and you've been using telehealth for regular appointments, you probably lived through some real uncertainty over the past year. Federal flexibilities that made it possible to see your doctor by video from home expired on September 30, 2025, then briefly lapsed again in January 2026 during a government shutdown. Both times, Congress eventually stepped in with retroactive extensions.

The good news: as of February 2026, the Consolidated Appropriations Act, 2026 (H.R. 7148) extended most Medicare telehealth flexibilities through December 31, 2027. For beneficiaries and providers, that's the longest stretch of certainty since the pandemic-era rules began. But permanent policy still hasn't happened, and the same cycle could repeat when the 2027 deadline approaches.

Here's what's currently covered, what's permanent, and what to watch for going into 2028.

TL;DR: Key Takeaways

• Medicare telehealth flexibilities were extended through December 31, 2027 by the Consolidated Appropriations Act, 2026 (H.R. 7148), signed February 3, 2026.
• The extension covers geographic and originating-site flexibilities (you can be at home), expanded practitioner eligibility, audio-only visits, and FQHC/RHC telehealth.
• Telehealth for mental and behavioral health services is permanently covered by Medicare under separate legislation, regardless of what happens with the broader flexibilities.
• Medicare Advantage plans may offer additional telehealth benefits beyond Original Medicare, but plan rules vary.
• Whether private insurance covers telehealth depends on the specific plan, and coverage isn't universal.
• Rules can shift with Congressional action. Verify current coverage before assuming a specific telehealth visit will be covered.

Have a health concern and want to see a US-licensed clinician today, without navigating insurance uncertainty? Book a $39 online urgent care visit with August AI. A US-licensed clinician can review your symptoms and prescribe when clinically appropriate, with same-day pharmacy pickup across all 50 states. The visit does not guarantee a prescription. August online urgent care is a flat-fee cash service and isn't billed to Medicare or private insurance. Emergencies and conditions that require in-person examination or testing aren't appropriate for virtual care.

What actually happened in 2025 and early 2026?

The last year has been a case study in policy uncertainty for Medicare beneficiaries.

Before COVID, Original Medicare barely covered telehealth. Coverage was mostly limited to specific rural areas, patients who traveled to designated clinics for the video visit, and a narrow set of services. Getting a video appointment from your kitchen wasn't really an option for most beneficiaries.

The pandemic changed that fast. Congress and CMS relaxed the rules so most beneficiaries could get routine care by video from home. Since then, those broader flexibilities have been extended several times, always temporarily.

Here's the timeline of the last year:

• March 2025: Congress extended flexibilities through September 30, 2025 as part of a spending bill
• September 30, 2025: Flexibilities expired
• October 1, 2025: Government shutdown began
• November 12, 2025: After a 43-day lapse, Congress passed a continuing resolution extending flexibilities retroactively through January 30, 2026
• January 30, 2026: Flexibilities briefly expired again during a short partial shutdown
• February 3, 2026: President Trump signed H.R. 7148, the Consolidated Appropriations Act, 2026, which extended Medicare telehealth flexibilities retroactively through December 31, 2027

That two-year extension is the longest stretch of stability Medicare telehealth has had since the pandemic. But it isn't permanent, and the cycle could repeat in 2027.

What's covered under the current extension?

CMS covers a broad range of Medicare telehealth services under the current flexibilities, all extended through December 31, 2027:

Geographic and originating-site flexibilities. You can receive telehealth from anywhere, including your home. No more requirement to travel to a designated rural clinic.

Expanded practitioner eligibility. Occupational therapists, physical therapists, speech-language pathologists, and audiologists can furnish Medicare telehealth services through the end of 2027.

Audio-only telehealth. Non-behavioral health services can still be delivered by audio-only call for beneficiaries who can't or don't want to use video.

FQHC and RHC telehealth. Federally Qualified Health Centers and Rural Health Clinics can continue serving as distant-site telehealth providers.

Behavioral health telehealth without in-person requirement. Medicare patients receiving mental health services via telehealth can continue without needing a prior in-person visit through January 1, 2028.

What's permanently covered no matter what?

Some Medicare telehealth coverage is permanent under separate legislation and doesn't depend on any Congressional extension.

Mental and behavioral health telehealth is the big one. Medicare permanently covers mental health services delivered by telehealth, including audio-only visits in some circumstances, without geographic limits or originating-site restrictions. This isn't going away in 2027 regardless of what Congress does.

Other permanent categories include telehealth for end-stage renal disease, treatment of substance use disorders, and acute stroke evaluation.

Medicare Advantage plans work differently from Original Medicare. Because they're structured as supplemental coverage, plans have flexibility to offer additional telehealth benefits beyond what Original Medicare requires. If you're on Medicare Advantage, your plan may keep offering telehealth features even if Original Medicare rules narrow after 2027.

What could change after December 31, 2027?

If Congress doesn't extend the flexibilities again (or make them permanent), the same reversion risks return:

• Where you can be: Geographic restrictions could come back, meaning you'd need to be in a designated rural area for many telehealth visits
• Where you have to go: You might need to physically travel to a specific clinic to do the video visit from there, rather than from your home
• What services are covered: The list of Medicare-covered telehealth services would narrow
• Who can bill: Fewer types of clinicians would be able to bill Medicare for telehealth
• How you can start care: Telehealth-only clinical relationships would face new restrictions

The pattern of last-minute Congressional extensions creates real uncertainty for both patients and providers. Permanent legislation has been proposed multiple times but hasn't passed. Whether the 2027 deadline follows the same pattern as 2025 depends on Congressional priorities over the next two years.

Does insurance cover telehealth for people not on Medicare?

For people with private insurance, employer-sponsored plans, or Medicaid, the answer is: sometimes yes, sometimes no, depending on the specific plan.

Details that vary between plans include:

• Whether telehealth is covered at all
• Which types of telehealth services are covered
• Copays or coinsurance for telehealth
• Coverage for in-network vs out-of-network telehealth
• Coverage for telehealth from providers in other states
• Prior authorization requirements for certain services

Some plans cover telehealth similarly to in-person visits. Others have different cost-sharing or restrictions. Medicaid coverage of telehealth varies significantly by state, and individual state Medicaid programs have their own rules.

If you have questions about whether a specific telehealth visit is covered under your plan, contact the insurer or your plan administrator directly. Coverage confirmation before your visit saves you from surprise bills after.

What should you do if you rely on Medicare telehealth?

The 2027 extension gives you breathing room, but it's worth staying prepared:

• Confirm which services you use are covered. Some services stay covered under permanent rules. Others depend on the extended flexibilities. Your provider's billing office can tell you which category yours falls into.
• Check your Medicare Advantage plan. If you're on Medicare Advantage, plans can offer additional telehealth coverage beyond Original Medicare. Your specific plan may offer more (or different) telehealth benefits than the baseline.
• Stay informed heading into 2027. The current extension expires December 31, 2027. If history is any guide, Congressional action will happen close to the deadline. Watching for updates in mid-2027 will help you plan for any transition.
• Have a backup option ready. Some telehealth services operate on a cash-pay basis, which means they aren't dependent on insurance or Medicare policy. That won't replace all Medicare-covered care, but it can fill gaps for straightforward, non-emergency needs.

Cash-pay telehealth: what it is and when it might help

Not all telehealth visits are billed to insurance or Medicare. Some services operate on a flat cash-pay basis, which means you pay a set fee directly for the visit regardless of whether or how you're insured.

Cash-pay telehealth can be helpful when:

• You don't have insurance coverage for a specific visit
• Insurance coverage rules are complicated or unclear
• You want a same-day, flat-fee alternative for routine care
• You're checking on an issue that isn't complex enough to justify a traditional office visit

Cash-pay isn't right for everyone or every situation. Ongoing care, complex chronic conditions, and services that require insurance coordination often make more sense through your regular healthcare providers.

Cash-pay services also aren't a substitute for Medicare or private insurance for care requiring specialists, hospital care, or complex ongoing treatment.

For more on how state and federal rules affect what a clinician can prescribe online, see our guide on telehealth prescription rules for controlled substances.

Conclusion

Medicare telehealth coverage in 2026 has stabilized after a rough year. The Consolidated Appropriations Act, 2026 extended most flexibilities through December 31, 2027, which means beneficiaries can continue to see clinicians by video from home, use audio-only visits, and access telehealth from a broad range of providers.

Some coverage is safe no matter what happens: mental and behavioral health telehealth is permanent. But the broader flexibilities remain temporary, and the same policy cliff that caused disruption in 2025 could return in late 2027 if Congress doesn't act on permanent legislation.

If you rely on Medicare telehealth, use the two-year window to make sure you know which services you use are permanent versus temporary, check your Medicare Advantage plan for additional benefits, and keep an eye on Congressional action heading into 2027. Cash-pay telehealth is a backup option for straightforward, non-emergency care from a licensed clinician.