The great telehealth rollback: How Oct. 1 changed patient access and what it reveals about America's health care priorities

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When Medicare’s COVID-19-era telehealth flexibilities expired on Oct. 1, the change was more than a technical policy update. The nation is in a test of whether the U.S. health care system will embrace the lessons of the pandemic or retreat to pre-2020 norms. The answer so far is mixed: Telehealth has proven effective, but policy compromises reflect deep tensions between evidence, economics, and politics.

A tale of two patients

Olga Khabinskay
_{© WCH}

Consider two Medicare beneficiaries, both 68 years old, both with chronic conditions, both comfortable with technology.

• Patient A has diabetes and for years connected monthly with her endocrinologist by video. Her health stabilized, and she avoided long commutes. As of Oct. 1, those virtual visits no longer qualify for Medicare reimbursement. She must now appear in person.
• Patient B, treated for depression, still receives monthly therapy sessions via telehealth. Her coverage remains intact, with no geographic limits.

Same practice. Same insurance. Different rules.

This disparity is not accidental; it reflects deliberate policy design. The federal government preserved broad telehealth for behavioral health while rolling back flexibilities for most other conditions. The question it raises: If virtual care works for mental health, why not for chronic disease management, cardiology, or other specialties?

Geography as gatekeeper

The rollback reintroduces geographic restrictions: Most non-mental health telehealth visits are covered only for patients in rural Health Professional Shortage Areas or counties outside metropolitan zones. The original rationale was that telehealth should address rural access gaps, not serve as a convenience for urban patients.

But this framing misses the broader impact telehealth demonstrated during the pandemic. It allowed:

• Urban seniors with mobility issues to avoid difficult travel
• Caregivers to fit appointments into workdays
• Immunocompromised patients to reduce infection risk
• Specialists to expand their reach
• Safety-net clinics to manage panels more efficiently

In practice, these benefits mattered as much in suburbs and cities as in rural towns. Policy now draws hard lines between “access” and “convenience,” but for patients, the difference is often meaningless.

What the evidence shows

Restricting telehealth assumes in-person care is inherently better and that patients prefer it when given a choice. Yet five years of research suggest otherwise.

• Clinical outcomes: For chronic disease management, medication monitoring, and routine follow-ups, virtual visits consistently produced results comparable to in-person care.
• Patient satisfaction: Surveys show seniors value convenience, reduced travel time, and flexibility. Many reported telehealth improved their ability to stick to treatment plans.
• System efficiency: Telehealth helped providers manage larger panels, reduce no-shows, and maintain access during surges in demand.

In short, telehealth isn’t inferior care — it’s a different delivery model that works for many conditions. By ignoring this evidence, current policy narrows access where it could improve efficiency and outcomes.

Why mental health was treated differently

The mental health sector fought hard to keep telehealth coverage. Professional groups, patient advocates, and providers highlighted strong data showing parity between virtual and in-person therapy. Patients also benefited from reduced stigma and greater privacy when receiving care from home.

The success of this advocacy shows how policy can adapt when evidence is clear and stakeholders unite. But it also highlights inequities: Conditions with less lobbying power or entrenched revenue models face tighter restrictions, regardless of clinical outcomes.

The economics of policy inertia

Telehealth disrupts traditional health care economics.

• Physical facilities lose revenue if patients don’t come on-site for lab tests, imaging, or pharmacy pickups.
• State licensing barriers weaken if patients can see out-of-state specialists online.
• Fee-for-service incentives erode when encounters shift to lower-cost virtual visits.

These dynamics create winners — telehealth-first companies, tech platforms, adaptable providers — and losers, including brick-and-mortar practices heavily dependent on in-person revenue streams.

Congressional hesitation reflects these competing interests. Fraud and quality concerns are real, but so is the fear of destabilizing existing business models. The October rollback represents a compromise: preserving telehealth for mental health while limiting disruption elsewhere.

How providers are responding

Health care organizations are adapting in different ways:

1. Absorbing costs – Some large systems continue telehealth for chronic conditions, even without Medicare reimbursement, prioritizing continuity and betting on future policy changes.
2. Strict compliance – Others limit virtual visits strictly to reimbursable services, redirecting patients to in-person care.
3. Hybrid models – Many encourage patients to come into clinics for “facility-based telehealth” visits. The patient sits in an exam room while the provider appears on a screen — clinically identical to a home call but reimbursable under Medicare.

Notably, few providers have abandoned telehealth altogether. Pandemic-era investments in technology and workflow are too significant to discard, even if reimbursement is more restrictive.

Patients caught in the middle

For patients, the changes are confusing and frustrating. They don’t understand why geography or diagnosis determines whether a virtual visit is covered.

One striking example: A Denver woman with heart failure had stable monthly video visits. As of Oct. 1, she must either travel 45 minutes for an in-person appointment or drive to a clinic to connect with her cardiologist via video from a different exam room.

Clinically, nothing changes. But reimbursement rules dictate which version “counts.” This disconnect between policy logic and patient experience erodes trust in the system.

Technology and access gaps

The rollback also sharply curtails audio-only telehealth, which was a lifeline during the pandemic for patients without internet or digital literacy. Now, phone-only visits are covered only for behavioral health if video is unavailable.

This disproportionately impacts older adults, low-income populations, and rural residents — the very groups telehealth was meant to serve. For services like medication refills or care coordination, audio-only may provide sufficient value at lower cost. Yet policy now treats it as inadequate for most conditions.

WCH’s recommendations: transitioning back without leaving patients behind

Redesign appointment schedules

• Expand in-office availability for high-demand specialties (endocrinology, cardiology, primary care).
• Stagger telehealth-eligible visits (behavioral health, substance use disorder, dialysis) to free up space for in-person needs.

Educate patients proactively

• Communicate clearly: Pandemic-era telehealth coverage ended Sept. 30, 2025.
• Provide written notices, emails, and front-desk scripts explaining which visits still qualify.

Strengthen front desk and admin teams

• Train staff to check eligibility, copays, and reimbursement rules at scheduling.
• Rewrite scheduling workflows to prevent claim denials.

Support patient transitions

• Offer transportation resources or partner with ride services for elderly/disabled patients.
• Build buffer time in visits for patients adjusting from virtual back to in-person.

Reimagine telehealth strategically

• Continue offering behavioral health and substance use disorder telehealth where coverage remains.
• Track outcomes to demonstrate to payers that broader telehealth coverage is clinically effective and cost-efficient.

The incomplete rollback

The Oct. 1 rollback is neither a return to the past nor a full embrace of telehealth’s potential. Instead, it reflects unresolved tensions: access vs. cost, innovation vs. tradition, patient preference vs. provider economics.

Telehealth is not disappearing. Five years of evidence prove it works. The question is not whether virtual care has a role in U.S. health care — it does — but how broad that role will be.

For now, patients face a patchwork system: behavioral health covered broadly, chronic disease treated narrowly, geography defining eligibility, and phone calls sometimes counting, sometimes not. Clinically, the rules make little sense. Politically, they reflect compromise.

The story is still unfolding. The next chapter depends on Congress, advocacy, and the willingness of providers to document, adapt, and push for policies that reflect both evidence and patient reality.

Olga Khabinskay is director of operations at WCH Service Bureau, a national health care practice management services company that provides billing, coding and credentialing as well as provider technology services. She is also a board member of the Healthcare Business Management Association (HBMA).