WASHINGTON — Health care providers across the country are canceling telehealth visits with Medicare beneficiaries or warning patients they will have to pay out of pocket for appointments because Congress let coverage lapse.

When government funding expired Sept. 30, so did several health care policies mostly involving payments, and among them are provisions that allowed Medicare to cover telehealth services for millions of people who are 65 and older or have disabilities.

Congress typically extends this telehealth coverage before it expires, but the provision became a casualty in the broader impasse on funding the government.

“It’s already leading to widespread disruptions and it’s something that need not have happened,” said Kyle Zebley, executive director of American Telemedicine Association Action, which advocates for permanent Medicare telehealth coverage. “Patients desperate to stay out of in-person settings out of absolute necessity are now being told for no reason other than lack of congressional action now they’re out on their own.”

Before 2020, Medicare’s coverage of telehealth services was very limited, mostly to people living in rural communities. Those people still had to travel to a provider’s office to do a telehealth appointment with another provider.

But the pandemic changed the landscape. Restrictions on access for beneficiaries in traditional Medicare — also called fee-for-service — were removed during the first Trump administration, allowing people to have appointments from home. Telehealth use has since increased significantly among Medicare beneficiaries. In the first quarter of this year, 15% of traditional Medicare beneficiaries had a telehealth service, according to the Centers for Medicare and Medicaid Services.

Congress then allowed those flexibilities to continue after the COVID-19 public health emergency.

While Medicare telehealth coverage enjoys bipartisan support in Congress, lawmakers have only temporarily extended it — mostly due to concerns about cost. Beneficiaries can still use telehealth for behavioral health services because Congress made that coverage permanent in 2021.

But the lapse for other telehealth services is especially impacting people with disabilities, who are more likely to use such coverage, according to CMS data.

Of people who are eligible for Medicare because of disability, nearly 30% received a telehealth service in the first quarter of 2025, according to CMS. That compares to about 11% of Medicare beneficiaries who are eligible for Medicare because they are over 65.

One is Northern California resident Charis Hill, 38, who was told Tuesday by their rheumatologist’s office that an Oct. 7 telehealth appointment would not be covered by Medicare. Hill, who has a telehealth appointment every three to four months for ankylosing spondylitis, a type of chronic inflammatory disease, was advised they could book an in-person appointment. But Hill is immunocompromised.

“I said I can’t do that. It’s not safe for me to do that without masks in the office. What are my options?” Hill said. “I was basically told, ‘You need to contact Medicare.’”

Hill is exploring other options, including whether their Medicaid coverage could defray the cost.

The rheumatologist can still prescribe Hill’s medications, but Hill doesn’t know how long that will last.

“I am worried that if I can’t find a solution that will allow me to continue getting care via telehealth I’ll lose access to my specialist, and then lose access to medications and treatment that slow the progression” of the illness, Hill said. “This disproportionately impacts disabled people who have been fighting for years to have equitable access to health care. Telehealth has improved lives for millions of people, especially people who have become disabled by long COVID.”

Provider uncertainty

The lapse also poses challenges for health care providers, who must decide whether to continue offering telehealth services with no guarantee they will be reimbursed by Medicare.

“There’s an expectation that Congress will provide a retroactive fix, but there’s obviously no guarantee that will happen,” said Jeffrey Davis, a director at health policy consultant McDermott+, where he focuses on Medicare policy.

Providing coverage as though nothing has changed isn’t a risk every provider can take, Davis notes. Those not well-steeped in the latest from Washington saw that telehealth coverage expired on Oct. 1 and have stopped offering those services to Medicare beneficiaries. CMS is telling providers they can offer the services, but should inform patients Medicare may not pay for them.

“Folks are confused,” Davis said.

A bill, sponsored by Sen. Brian Schatz, D-Hawaii, has 65 co-sponsors — enough support to pass the Senate if it were to receive a vote today.

But the projected cost — $25 billion over 10 years — has been a roadblock for a Congress that typically demands that health care spending be offset.

The House-passed short-term government funding bill that the Senate has been voting on this week would extend Medicare telehealth coverage for the length of the continuing resolution — about seven weeks. But the bill hasn’t gotten enough support to pass the Senate. Democrats are demanding the bill extend expiring health care subsidies that help people buy insurance in the individual market.

Zebley said he hopes the chaos caused by this lapse will push Congress to make Medicare telehealth coverage permanent.

“I’m hopeful this will be an opportunity to work with President Trump and Congress and use this as a rallying cry for why we need permanence,” Zebley said.

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