Some important Medicare updates took effect on Jan. 1. One of the biggest changes is a $2,000 cap on out-of-pocket prescription drug costs, which could save some households a lot of money in 2025. But not all the changes were positive.
Medicare premiums went up for Parts A and B again. And one benefit that's been a lifesaver for seniors over the last few years has been quietly restricted.
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New telehealth restrictions for Medicare beneficiaries
When the COVID-19 pandemic took hold, many seniors no longer felt comfortable visiting a doctor's office in person due to fear of exposure. The Department of Health and Human Services responded by giving Medicare beneficiaries broader access to telehealth services. This enabled them to speak with a doctor from anywhere with an internet connection, saving them travel time and money.
This expanded access to telehealth was supposed to end when COVID-19 was no longer considered a public health emergency. However, the government extended it through the end of 2024. But now seniors are back to the old restrictions.
This doesn't mean Medicare's stopped covering telehealth altogether. It's still an option for those who live in rural areas where the local hospital staff may lack the expertise to provide effective treatment. Even then, you typically must be in a rural doctor's office or medical facility at the time of your telehealth visit if you want Original Medicare to cover it.
The program will also cover telehealth from anywhere for the following:
- Monthly End-Stage Renal Disease (ESRD) visits for home dialysis
- Services for the diagnosis, evaluation, or treatment of symptoms of an acute stroke
- Services to treat a substance use disorder or a co-occurring mental health disorder or for the diagnosis, evaluation, or treatment of a mental health disorder
- Behavioral health services
- Diabetes self-management training
- Medical nutrition therapy
You'll still be responsible for your 20% Medicare Part B copay if you use telehealth for any of the above conditions.
What this means for seniors
This change may not make a significant difference for you if you haven't used telehealth services much over the last few years. But if you'd gotten used to hopping on a call with your doctor rather than visiting their office in person, it could be a significant adjustment.
A lot depends on your individual health insurance coverage. If you have a Medicare Advantage or Medicare supplement plan, review your policy to see whether it includes any additional coverage for telehealth services. Reach out to your insurer if you're unclear about what it covers.
If telehealth isn't covered for you, it might be worth investigating how much it would cost you to pay for a telehealth visit out of pocket to see how that compares to the 20% copay you'd have under Original Medicare. Telehealth appointments cost between $40 and $90 on average, according to GoodRx.
You may have to reach out to your local hospital to get this information, and you may need to take it on a case-by-case basis. If you're unsure what your best option is, consider consulting your doctor as well. Telehealth isn't the best choice for all situations.
