Important Information About Your Medicare Telehealth Coverage
If you currently receive health insurance through Medi-Cal or the Children’s Health Insurance Program (CHIP), you must provide the county with your updated information so you can continue receiving important information about your Medi-Cal coverage.
Q: What is happening with Medicare telehealth coverage?
Beginning October 1, 2025, virtual visits are no longer covered for patients with Medicare Part B and Railroad Medicare coverage. This means that after this date, Medicare will most likely not pay for these services.
Q: Why is this happening?
During the COVID-19 pandemic, the federal government issued temporary waivers to expand telehealth access. These waivers have now expired. While Congress may decide to extend these waivers, at this time, Medicare coverage for telehealth visits ended effective October 1, 2025.
Q: What happens if I have a scheduled telehealth visit?
Our teams will be proactively reaching out to all Medicare patients with scheduled telehealth appointments after October 1, 2025. We will work with you to reschedule your appointment to an in-person visit, to ensure you continue to receive the care you need. If you have any questions before we contact you, please call your local clinic office for assistance.
Q: Are telehealth visits still covered for Medicare Advantage patients?
Yes. Medicare Advantage (Part C) plans will continue covering telehealth appointments.
Q: What if I have Medicare as a secondary insurance, can I still be seen via telehealth?
Maybe. If you have Traditional Medicare or Railroad Medicare as a secondary insurance, your telehealth services might still be covered by your primary insurance provider. We recommend you contact your primary insurance provider directly for clarification on their telehealth coverage policies. You can find their phone number on your insurance card.
Q: Are there any exceptions to these changes that will allow telehealth coverage?
Yes, there are a few important exceptions:
- Behavioral health services have been granted permanent telehealth coverage and will continue without interruption.
- Rural Health Clinics: Special allowances are in place for telehealth services provided by these types of clinics. This applies to our Sierra Nevada location in Grass Valley, which operates as a Rural Health Clinic. Please confirm with your specific clinic if you believe this exception might apply to you.
- Pharmacy telehealth: Medicare telehealth appointments without pharmacy teams are not impacted and will continue as usual.
Q: Can I still choose to receive telehealth services, even though they are not currently covered by Medicare?
Yes, you can still choose to have a telehealth visit. However, if your Traditional Medicare or Railroad Medicare plan no longer covers the service, you may be personally responsible for the full cost of the visit.
Before your virtual appointment, we will ask you to review and sign a short form to confirm your understanding and agreement to the financial details.
Q: How much will a telehealth visit cost if Medicare doesn’t cover it?
The cost can vary depending on the type of service you receive. If you choose to have a telehealth visit that Medicare will not cover, we will provide you with a good-faith estimate of cost before your appointment and ask you to sign a financial responsibility form. Please contact your local clinic office for specific pricing inquiries.