If you're a retiree who is currently receiving traditional Medicare, you need to be aware that a major change is coming in less than one week. Starting on Jan. 31, 2026, a service that many seniors depend on -- and that Medicare has covered for years -- will have new restrictions.
Those restrictions are so limiting that most seniors will no longer be able to get coverage for the service at all. Here's what you need to know about the Medicare changes that you have less than one week to prepare for.
Image source: Getty Images.
This is the major coverage change
Starting on Jan. 31, Medicare is going to impose major restrictions on coverage for telehealth services. Here's what's happening:
- Since March 6, 2020, waivers were in effect that permitted Medicare recipients to get telehealth services covered. These services could be provided by doctors, nurse practitioners, clinical psychologists, and licensed social workers and could take place in a retiree's home or in a variety of other environments, according to the Centers for Medicare and Medicaid Services (CMS).
- The telehealth waivers will remain in effect through Jan. 30, 2026, allowing Medicare coverage for telehealth services anywhere within the United States and its territories, according to CMS.
- Beginning on Jan. 31, telehealth services will no longer be broadly covered. Instead, coverage will be available only in extremely limited circumstances. The new restrictions are so severe that the vast majority of Medicare beneficiaries will have no further coverage for telehealth.
With the American Medical Association reporting that a plurality of senior patients said their telehealth visits were "the same or better than a traditional visit," and since satisfaction was high even among seniors 75 and up who are less familiar with the technology, this is a major and disappointing change.
What new restrictions are in place for telehealth services under Medicare?
According to CMS, telehealth services will now be covered only for:
- Beneficiaries who are getting behavioral health services, including services aimed at diagnosing, treating, or evaluating a behavioral health disorder, including substance abuse disorders
- Beneficiaries who are in a rural area
- Beneficiaries who go into a medical office or facility for a telehealth visit
- Home dialysis visits for those suffering from End-Stage Renal Disease (ESRD)
- Beneficiaries receiving services to diagnose, evaluate, or treat symptoms of an acute stroke
These narrow situations generally don't apply to most retirees. Unfortunately, seniors who prefer telehealth will need to adjust to the changes in less than a week.
Those who want telehealth care may have to pay the costs out of their retirement savings. A switch to a Medicare Advantage plan that still offers telehealth coverage may also be appropriate during the next open enrollment opportunity.
