November 11, 2024
Medicare telehealth flexibilities should be here to stay
We urge Congress to extend policies that have improved access to care and increased equity.
Medicare patients use computers and phones to have convenient appointments with doctors.
The numbers seem unreal.
Medicare patients’ use of telehealth jumped 63-fold in 2020 compared to 2019.
During the COVID-19 pandemic, the federal government eased restrictions on telehealth for older adults in traditional Medicare. This helped more Medicare patients get care while staying safe at home.
High rates of telehealth use among all Medicare patients continued from 2021 to 2023. But the flexibilities allowing more Medicare participants to use telehealth expire at the end of 2024.
Now, lawmakers are asking important questions about the future of telehealth:
- Should these flexibilities be continued?
- Does telehealth replace in-person care?
- Does it lead to more in-person care (if the patient's issue wasn't resolved by the virtual visit)?
- Does it lead to higher costs?
At Kaiser Permanente, our experience and research provide answers.
Flexibilities we support
Before the pandemic, Medicare didn’t cover telehealth visits for most patients in traditional Medicare. This was because of an old policy that only covered telehealth visits for Medicare patients in rural areas of the country. And because Medicare only covered video visits (not visits by phone).
Kaiser Permanente’s Medicare Advantage plan has always had more flexibility to offer telehealth services to a wider array of Medicare participants. But the 50% of Medicare participants who have traditional Medicare were not as fortunate.
Recognizing the value of telehealth as a care delivery method, we were a leading voice in urging Congress to change that policy.
Then, the pandemic changed everything.
When the federal government declared COVID-19 a public health emergency, the U.S. Department of Health and Human Services had more authority. It could waive or relax many federal regulations to keep people safe and healthy.
HHS temporarily adopted new policies that we supported. For patients in traditional Medicare, HHS allowed Medicare to cover:
- Telehealth visits in any location (urban or rural, including at home)
- Telehealth visits with a wider variety of clinicians
- Phone and video appointments
The option for phone appointments has been especially helpful to patients who don’t have reliable internet access or struggle to use video technology. The change supported more equitable access to care.
These policies were temporary. But lawmakers saw the growing importance of telehealth for all Medicare patients. In 2022, Congress extended the telehealth flexibilities through December 31, 2024.
Telehealth doesn’t lead to more patient visits
Some policymakers worry expanded telehealth access could lead patients to use more health care.
If telehealth visits leave patients with unanswered questions, they may seek in-person care. This would drive up health care costs.
However, we are seeing evidence that telehealth visits can substitute for in-person visits. This data counters policymakers’ concerns that telehealth leads to more total visits. This evidence comes from a study published in fall 2024 analyzing Kaiser Permanente data.
Return visits after video and phone visits are not common, according to a 2021 Kaiser Permanente study. Emergency room visits following phone or video appointments also are rare, with just a small percentage (1.8% of phone appointments and 2.1% of video appointments) followed by an ER visit. The study looked at data on almost 1.6 million patients.
Meanwhile, telehealth remains an attractive option for many patients. In 2023, Kaiser Permanente provided 5.5 million phone and video visits to our Medicare patients.
Overall, telehealth use at Kaiser Permanente is almost 3 times higher than it was before the pandemic.
Congress must act
As we approach the end of 2024, health care leaders are growing concerned about maintaining access to care for the millions of older adults and people with disabilities who have come to rely on telehealth.
In response, Congressional Committees have approved legislation that would extend the telehealth flexibilities by 2 years. But if the full Congress doesn’t vote to adopt this legislation before January 1, 2025, the telehealth flexibilities for patients in traditional Medicare will end.
While our members at Kaiser Permanente will continue to enjoy the convenience of telehealth, a large percentage of Medicare patients would fall back into a world where in-person visits are their only way to get care.
Extending these flexibilities is essential. All Medicare patients deserve more options, more convenience, and more equitable care — not less.
