Medicare Telehealth Coverage: What Original Medicare Pays For Now, and What Changes in 2028

Through December 31, 2027, Original Medicare covers telehealth visits from anywhere in the U.S., including your living room. On January 1, 2028, unless Congress acts again, most of that goes away: for anything other than behavioral health, you'd generally have to be in a medical facility in a rural area for Medicare to pay for a video visit.

The details matter if you see a therapist over video, get physical therapy at home through a screen, or spend winters in Florida and keep a doctor up north. Florida adds one more wrinkle: a licensing rule that snowbirds trip over.

Source: Medicare.gov, Telehealth; CMS Telehealth FAQ (updated Oct. 2026); CMS, 2026 Part B premiums and deductibles. CMS had not published 2027 Part B amounts as of Nov. 8, 2026.

What's covered now vs. after 2027

Medicare.gov's telehealth page says it plainly: "Through December 31, 2027, Medicare covers telehealth services that you can get from anywhere in the U.S., including your home." Telehealth here means a real visit with a provider located somewhere else in the U.S., by audio and video, or audio-only in some cases. Examples Medicare.gov lists include office visits, psychotherapy, consultations, cognitive assessments, depression screenings, diabetes self-management training, medical nutrition therapy, cardiac and pulmonary rehabilitation, caregiver training, advance care planning and speech therapy.

CMS's own Telehealth FAQ spells out what flips on January 1, 2028 under current law. Here's how it lines up for the services Medicare beneficiaries use most:

Source: CMS Telehealth FAQ, Q1 to Q6 and Q11; Social Security Act §1834(m), 42 U.S.C. 1395m(m); Medicare.gov, Telehealth.

Read the right-hand column as "what happens if Congress does nothing." Congress has extended these rules each time so far, though twice only after a lapse (about six weeks in fall 2025, a few days in early 2026). That's a pattern, not a promise. I wouldn't plan care around either outcome until there's a law on the books.

The permanent rule: rural, and in a facility

The baseline lives in Section 1834(m) of the Social Security Act, written long before video calls were normal. Under it, Medicare pays for a telehealth service only when you are at an approved "originating site," and that site is in one of these places:

• an area designated as a rural health professional shortage area,
• a county that is not part of a Metropolitan Statistical Area, or
• an entity in a federal telemedicine demonstration project approved as of December 31, 2000.

The approved sites are facilities: a doctor's or practitioner's office, a hospital, a critical access hospital, a rural health clinic, a federally qualified health center, a skilled nursing facility, a community mental health center, a hospital-based dialysis center, or a rural emergency hospital. Your home qualifies only for the specific exceptions in the next section.

What that means in practice: under the permanent rule, a retiree in a metro county who wants to see a doctor by video from the kitchen table isn't covered. The temporary law (§1834(m)(4)(C)(iii)) is what replaces that with "any site in the United States," and it's the piece with the December 31, 2027 end date.

Permanent exceptions

Several categories already have permanent carve-outs from the rural and facility limits. These don't depend on the 2027 deadline:

Source: 42 U.S.C. 1395m(m)(5), (6) and (7); CMS Telehealth FAQ, Q5, Q11 and Q14.

On the ACO row: Medicare.gov suggests asking your doctor whether they participate in an Accountable Care Organization and what telehealth benefits may be available through it.

The in-person visit rule for mental health

Mental health telehealth from home is permanent, but it comes with a string attached that Congress keeps postponing. Under §1834(m)(7)(B), starting with services on or after January 1, 2028, Medicare won't pay for a mental health telehealth visit unless the same practitioner has seen you in person, without telehealth, within the six months before the first telehealth visit, and again at intervals CMS sets.

CMS's FAQ fills in the intervals: after the first telehealth mental health visit at home, there has to be an in-person, non-telehealth service within 12 months of each telehealth service, with limited exceptions. If your regular clinician isn't available, a practitioner of the same specialty in the same group practice can do the in-person visit.

The detail that matters for current patients: CMS says if you began receiving mental health telehealth services on or before December 31, 2027, you're treated as established. You won't need the six-month in-person visit before continuing, but you will need at least one in-person visit every 12 months after that date.

Two groups aren't affected. Substance use disorder treatment is exempt from the in-person requirement under the statute. And for behavioral health visits through rural health clinics and federally qualified health centers, CMS says the in-person requirements continue not to apply until at least January 1, 2028.

Phone-only visits

CMS's FAQ: "Under current law, beneficiaries may continue to receive audio-only telehealth services in their homes through December 31, 2027." After that, audio-only is allowed only for behavioral health services to a patient at home, and only when the practitioner is able to do video and you either can't use video or don't consent to it. It works for new and established patients.

If video is a struggle or your internet is unreliable, this is the change to watch. A phone call with your primary care doctor can count as a telehealth visit today where audio-only is permitted. In 2028, under current law, it won't, unless it's behavioral health.

How we got here: the extensions and lapses

The home-and-anywhere rules started as pandemic emergency flexibilities and have lived on short extensions since. They actually lapsed during the fall 2025 government shutdown.

Source: National Law Review (Nov. 2025); Medical Economics (Feb. 10, 2026); JD Supra (Feb. 2026); Noridian, CMS Medicare contractor (Feb. 5, 2026); CMS Telehealth FAQ, Q16; CMS CY 2027 PFS final rule fact sheet.

If you had a telehealth visit in October or early November 2025 and got an odd bill or denial, CMS's FAQ says claims are paid the same way they were before October 1, 2025. Ask the provider to check the claim, and appeal if a denial stands.

What the 2027 physician payment rule changes

CMS published the CY 2027 Physician Fee Schedule final rule fact sheet on November 4, 2026. CMS uses this annual rule to add or delete services on the Medicare telehealth list, effective each January 1. For patients, the 2027 rule changes very little about telehealth, and its fact sheet doesn't announce any change to what you pay for it. What it does:

• The in-person delay. CMS is finalizing conforming changes to carry out section 6209(c) of the Consolidated Appropriations Act, 2026: in-person visit requirements for mental health visits don't apply to services furnished through December 31, 2027.
• Rural clinics and health centers. The fact sheet notes the same law extended CMS's authority to pay rural health clinics and federally qualified health centers for non-behavioral visits by telecommunication through December 31, 2027.
• Remote monitoring. For remote physiologic and therapeutic monitoring services, CMS finalized that remote therapeutic monitoring is for established patients only, and that the practitioner must furnish a separately reportable initiating visit when monitoring starts. A requirement that monitoring be done only by staff employed by the practice, not contractors, was delayed to January 1, 2029.

Separately, CMS's FAQ says two new telehealth billing modifiers are required starting January 1, 2027, with no payment implications. That's a provider paperwork item; you shouldn't see a difference on your Medicare Summary Notice.

The rule can't fix the 2028 cliff. The rural and facility limits are in the statute, and only Congress can change them.

What you pay

Telehealth under Original Medicare is a Part B service, and it costs what in-person care costs. Medicare.gov: after you meet the Part B deductible, you pay 20% of the Medicare-approved amount, and "for most telehealth services, you'll pay the same amount that you would if you got the services in person." The law backs that up: the distant-site practitioner is paid what they would have been paid without the video link, and no originating-site facility fee is paid when you're at home.

Source: CMS, 2026 Medicare Parts A and B premiums and deductibles; Medicare.gov, Telehealth; Medicare.gov, Medicare costs (checked Nov. 8, 2026).

A hypothetical to show the math. Say the Medicare-approved amount for a video follow-up visit is $120, and the doctor accepts assignment:

Source: example amount is hypothetical; cost-sharing rules from Medicare.gov, Telehealth and CMS 2026 Part B deductible.

Medicare.gov lists what moves your actual cost: other insurance you have, how much the doctor charges, whether the doctor accepts assignment, the type of facility and where you get the service. If you have a Medicare Supplement (Medigap) policy, ask how your policy handles the Part B deductible and coinsurance on a telehealth claim, just as you would for an office visit. And ask any new telehealth provider the assignment question before the first visit, especially an online practice you found yourself.

Virtual check-ins and e-visits

Not every remote contact is a full telehealth visit. Medicare.gov describes two lighter options: virtual check-ins, which are brief real-time communications that usually last 10 minutes or less, and e-visits, which are non-face-to-face communications that usually happen through an online patient portal. Medicare.gov lists both on its telehealth page, where the Part B deductible and 20% coinsurance apply. If a portal message turns into a billed e-visit, it should appear on your Medicare Summary Notice. If you didn't expect a charge, ask the office what was billed.

Florida: snowbirds and out-of-state doctors

Medicare's side is simple through 2027: you can be anywhere in the U.S. So a retiree from Ohio spending January in Sarasota can have a video visit with the Columbus doctor, as far as Medicare's location rule goes. The provider also has to be in the U.S.; Medicare.gov defines telehealth as care from a provider "located somewhere else (in the U.S.)."

The state side is where it gets complicated. Florida's rule turns on where the patient is, not where the doctor sits. It's in section 456.47, Florida Statutes:

• A health care professional who isn't licensed in Florida (or through a licensure compact Florida belongs to) may treat a patient located in Florida by telehealth only if they register with the applicable Florida board (or the Department of Health if there's no board).
• To register, the professional needs an active, unencumbered license in another state, D.C. or a U.S. territory, no disciplinary action in the prior five years, a registered agent in Florida and professional liability coverage that includes telehealth to patients outside their home state.
• A registered out-of-state provider can't open an office in Florida or see Florida patients in person.
• Professionals licensed through a multistate licensure compact that Florida belongs to also count as telehealth providers under the statute.
• Florida law limits telehealth prescribing of Schedule II controlled substances to a few situations: psychiatric disorders, inpatient hospital treatment, hospice patients and nursing home residents.

The Florida Department of Health says out-of-state practitioners "must be registered" to provide telehealth to patients in Florida, and section 456.47 requires the department to publish a list of registrants. Doctors already licensed in Florida don't need anything extra.

So the practical question for a snowbird isn't "does Medicare cover this?" It's "can my doctor up north legally treat me while I'm in Florida?" Ask the office before you leave. If the answer is no, you'll want a Florida-based doctor for the winter, and that's a good reason to read our post on Medicare for Florida snowbirds. The reverse applies too: if you live in Florida and summer in another state, check with that state's licensing board or ask your doctor whether they can see you by telehealth while you're there.

If you have Medicare Advantage

Everything above describes Original Medicare. Medicare.gov notes that Medicare Advantage plans "may offer more telehealth benefits than the basic coverage in Original Medicare," for example letting you get some services from home no matter where you live. What any one plan covers, what it costs you, and whether it limits you to network telehealth providers is set in that plan's Evidence of Coverage, and it can change each January. Read your Annual Notice of Change for 2027 and look for the telehealth section.

For a side-by-side look at how Original Medicare, Medigap and Medicare Advantage work in Florida, see our Florida Medicare page. SHINE, Florida's State Health Insurance Assistance Program, gives unbiased counseling at no cost: floridashine.org or 1-800-96-ELDER (1-800-963-5337). More on what SHINE does in our SHINE guide.

What to do now

1. List your telehealth care. Which visits do you take by video or phone today? Mark the ones that aren't behavioral health. Those are the ones exposed on January 1, 2028.
2. If you're in therapy by video, ask your clinician how they plan to handle the yearly in-person visit after 2027, and where it would happen.
3. If you get PT, OT or speech therapy remotely, know that under current law those professionals can't bill Medicare telehealth after 2027. Ask what the in-person plan is.
4. Snowbirds: before you head south, ask your home-state doctors whether they're licensed or registered to treat you in Florida.
5. Check assignment with any new telehealth provider, and read your Medicare Summary Notice for virtual check-in or e-visit charges.
6. Use telehealth for the preventive stuff where it's allowed. Some preventive services, such as depression screening, appear on Medicare.gov's telehealth examples list. See Medicare preventive services and the annual wellness visit for what costs nothing.
7. Watch for news in late 2027. The end date has moved several times; I'll update this post when it moves again.

FAQ

Does Medicare cover telehealth visits in 2026 and 2027?

Yes. Through December 31, 2027, Original Medicare covers telehealth services you get from anywhere in the U.S., including your home. You pay the Part B deductible and 20% coinsurance, the same as in person for most services.

What happens to Medicare telehealth on January 1, 2028?

Under current law, except for behavioral health services, you would generally need to be in a medical facility in a rural area for Medicare to pay for a telehealth visit. Mental health and substance use disorder telehealth from home stays covered.

Does Medicare cover telehealth for mental health?

Yes, permanently, including from home and by phone if you can't or don't want to use video. Starting January 1, 2028, an in-person visit with the clinician is required within six months before the first telehealth visit for new patients and at least every 12 months after that.

Does Medicare cover telehealth physical therapy?

Through December 31, 2027, physical therapists, occupational therapists, speech-language pathologists and audiologists can furnish Medicare telehealth. Starting January 1, 2028, under current law, they can no longer furnish Medicare telehealth services.

Can my out-of-state doctor see me by telehealth while I'm in Florida?

Medicare's location rule allows it through 2027, but Florida law requires a provider not licensed in Florida to register with the Florida board or Department of Health under section 456.47 before treating a patient located in Florida by telehealth.

Medicare rules, your Evidence of Coverage or Medigap policy wording, and state law control your actual coverage. Confirm your situation with a licensed agent, SHINE or 1-800-MEDICARE, and for legal questions, an attorney.

Sources

1. Medicare.gov: Telehealth
2. Medicare.gov: Medicare costs
3. CMS: Telehealth (Medicare coverage page)
4. CMS: Telehealth FAQ, updated October 2026 (PDF)
5. CMS: CY 2027 Medicare Physician Fee Schedule final rule fact sheet (Nov. 4, 2026)
6. CMS: 2026 Medicare Parts A and B premiums and deductibles
7. Social Security Act §1834(m), 42 U.S.C. 1395m (Cornell LII)
8. Noridian (CMS Medicare Administrative Contractor): Telehealth flexibility extension
9. National Law Review: Congress extends Medicare telehealth flexibilities through Jan. 30, 2026
10. JD Supra: Medicare telehealth flexibilities extended (Feb. 2026)
11. Medical Economics: What changed in Medicare telehealth under the 2026 spending bill
12. Florida Statutes s. 456.47, Use of telehealth to provide services
13. Florida Department of Health: Telehealth
14. SHINE, Florida Department of Elder Affairs