The authors of this article are married. Jonathan Schwabish is an Urban Institute senior fellow. Lauren Schwabish, MS, CCC-SLP, is a speech-language pathologist who provides treatment in person and via telehealth services to patients, including Medicare beneficiaries.
Each year, about 7 million Medicare beneficiaries use telehealth (PDF) to access health care.
Telehealth services—health care provided by phone, video, or other electronic methods—offer more than convenience. For those living with serious or chronic health conditions, telehealth services expand access to care, especially among people living in rural or underserved areas, by lowering the burden of traveling to a provider, which can be financially and physically taxing. Telehealth also enables providers to have greater reach. These services offer a high degree of satisfaction for patients and families, leading to greater compliance with health care services and improving health care outcomes.
Despite these benefits, Congress hasn’t permanently codified telehealth services for Medicare beneficiaries into law. Instead, lawmakers have passed temporary extensions of pandemic-era provisions through different appropriations acts.
That means as each temporary extension deadline approaches, patients are faced with uncertainty about how they will access or pay for care. If lawmakers fail to pass an extension before the deadline—as occurred last fall before the extended federal government shutdown—Medicare reverts to prepandemic coverage of telehealth services, which limited coverage for established patients, certain types of providers, and those in rural areas or those experiencing health professional shortages,
Though temporary expansions can help patients in the short term, they also leave patients in limbo as each new deadline nears. By permanently expanding Medicare telehealth services, federal policymakers could help ensure beneficiaries can continuously access the care they need—regardless of where they live.
Who uses Medicare-covered telehealth services?
Based on the most recent available data from the Centers for Medicare and Medicaid Services (CMS), nearly 19 million Medicare beneficiaries were eligible for telehealth services in the second quarter of 2025. About 2 million, or 10.8 percent of those eligible, received care via telehealth—a share that has been stable since the end of the pandemic and is markedly higher than usage in early 2020 before the pandemic (7 percent).
The telehealth take-up rate among people dually entitled to Medicare and Medicaid was more than double (22 percent) in that same quarter. Overall, about 2.7 million people used telehealth services in that quarter, out of nearly 22 million eligible beneficiaries, a take-up rate of 12.5 percent.
Telehealth usage varies across groups. People who identify as Hispanic have the highest usage rate at 16.7 percent, compared with other racial and ethnic groups. Women (13.3 percent) are more likely than men (11.5 percent) to use telehealth services.
Broken down by age, the data reveal much higher usage rates among people younger than 65 (25.8 percent) than those over 65 (around 11 percent), likely reflecting both the greater medical complexity and health care needs of people who qualify before age 65 and higher technology use among younger people.
Usage rates among enrollees living in urban areas (13.4 percent) are slightly higher than those in rural areas (9.5 percent) in the second quarter of 2025, likely reflecting a technological divide between the two types of areas. The two rates were more similar in the first quarter of 2020 before the program was expanded.
Usage rates also vary by state. In the second quarter of 2025, California (24.2 percent); Washington, DC (20.8 percent); and Massachusetts (19.6 percent) had the highest usage, while Iowa (5.0 percent) and Alabama (5.2) had the lowest.
Several factors likely contribute to this variation, including technology adoption among health care providers (PDF), patient demographics, state regulations, and broadband access. The current data mirror findings from the beginning of the pandemic that found telehealth services grew fastest in states in the Northeast.
How telehealth can help people with limited local therapy options access care
One of Lauren’s clients is a 70-year-old Medicare beneficiary living in the rural Tidewater region of eastern Virginia who recently had a major stroke. Before the stroke, he had lived independently, cared for his spouse, and was an actively engaged leader in several community groups in his small town. When he was discharged from his local hospital with aphasia—an acquired language disorder—he was motivated to improve his spoken and written language abilities.
However, to visit an experienced speech-language pathologist in person, he would have to drive more than four hours round trip. Fortunately, his family contacted Lauren, and over several months, they met virtually and worked to restore his communication skills and confidence. These telehealth sessions also permitted one of his family members, who lived six hours from him, to attend the sessions and build skills to support his communication in social conversations.
Ultimately, the patient was able to resume participation in his valued activities, including a book club and local faith-based community organization.
Extending Medicare telehealth services will help people continue to access needed care and services
Though a temporary extension of telehealth services can help patients in the short term, it could still put patient care at risk and impose costs to providers who must plan services and appointments in the long term.
When an extension lapses, patients who rely on telehealth either have to forgo health care services or make alternative arrangements, which may be difficult, especially for people with mobility or other impairments. Providers have to cancel or reschedule appointments or even change staffing schedules and work hours.
By making Medicare telehealth services permanent, federal policymakers could help ensure Medicare beneficiaries have access to the care they need—regardless of where they live.
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