Telemedicine is now ordinary, which is precisely why it has become political. Patients schedule video visits with the same casual expectation once reserved for pharmacy refills, and health systems have invested in workflows that assume virtual access. Yet the policy structure still behaves as if telehealth is a temporary privilege. The result is a strange mismatch: permanent behavior built on provisional rules. When search interest spikes for “telehealth coverage” or “Medicare virtual visit,” it reflects not only convenience but uncertainty, because expiration dates are now part of healthcare planning.
Medicare telehealth policy is still shaped by deadlines
For Medicare, the question is simple: where can the patient be, and where can the clinician be, when a telehealth visit occurs. During the pandemic-era expansions, patients could receive many services at home without geographic restrictions. That flexibility is time-limited for many service categories. The CMS Telehealth FAQ for calendar year 2026 explains that, through January 30, 2026, beneficiaries can receive telehealth services broadly, and that starting January 31, 2026, geographic and originating-site rules reassert themselves for many non-behavioral services, as specified in the CMS telehealth FAQ.
HHS’s telehealth policy updates summarize the same cliff, noting that non-behavioral telehealth in the home is authorized through January 30, 2026, while certain behavioral health flexibilities remain permanent, including audio-only coverage in Medicare, described on the HHS telehealth policy updates page.
These details sound administrative, yet they translate into real access. If a patient must travel to a facility to receive “telehealth,” the visit ceases to be a convenience and becomes an awkward proxy for in-person care. For rural patients and those with mobility limitations, the difference can be decisive.
Controlled substances policy is the other telehealth cornerstone
Telehealth’s durability also depends on prescribing rules, especially for controlled substances. The Ryan Haight Act framework generally requires an in-person evaluation before prescribing controlled substances via the internet, with certain telemedicine exceptions. During the pandemic, federal flexibilities expanded access. Those flexibilities have been extended repeatedly.
In late 2025, a fourth temporary extension was published in the Federal Register, explaining the legal basis and the continued need for transitional policy, described in the Federal Register notice on telemedicine flexibilities. In January 2026, HHS and DEA announced that the extension would run through December 31, 2026, in order to avoid disruptions while permanent rules are finalized, as stated in the HHS press release. HHS also offers a practical summary for clinicians on prescribing controlled substances via telehealth.
This policy domain matters for patients with ADHD, opioid use disorder, anxiety disorders treated with controlled medications, and chronic pain. A stable pathway is not merely a convenience. It is a continuity-of-care safeguard.
Hybrid care is the emerging clinical norm
Public discourse sometimes treats telemedicine as a substitute for in-person visits. That framing is misleading. In most specialties, the durable model is hybrid. Some encounters must remain physical: examinations, procedures, imaging, and complex diagnostic evaluations. Others are well-suited for virtual platforms: medication titration, chronic disease check-ins, behavioral health, and post-procedure follow-up.
The evidence supports this mixed view. A cohort study in JAMA Health Forum found that telephone and video visits in pediatric primary care were associated with different patterns of prescribing and ordering compared with in-person visits, and modestly different downstream utilization, described in JAMA Health Forum. Another analysis in JAMA Health Forum examined telehealth use in community health clinics by ethnicity and language, illustrating that access patterns can differ across populations, described in JAMA Health Forum’s telehealth utilization study.
These studies should not be read as verdicts against telehealth. They should be read as evidence that telehealth is a clinical modality with strengths and weaknesses, and that policy design must respect those contours.
Equity is not automatic
Telemedicine can widen access for people with transportation barriers and limited time. It can also widen inequity when broadband access, device access, and digital literacy are uneven. Audio-only telehealth has played a crucial role for some populations, which is one reason Medicare’s permanent behavioral health audio-only allowance matters. Yet audio-only visits can also reduce clinical richness when physical examination cues and visual engagement matter.
The equity question is also administrative. Patients with limited English proficiency may face barriers in platform navigation. Clinics may not have integrated interpreter services into their telehealth workflow. Payment rules can discourage investment in accessibility features.
The cost question is politically charged and empirically complex
Skeptics often argue that telehealth increases utilization and spending. Supporters argue it prevents emergency visits and supports chronic disease management. Both can be true, depending on service category and patient population. The American Medical Association’s policy brief on telehealth and expanded access summarizes evidence and highlights scenarios where hybrid models can be cost-effective, as discussed in the AMA’s telehealth issue brief.
Policy debates frequently demand a single answer about cost. Healthcare rarely offers single answers. Telehealth is likely to increase access, which can increase spending in the short term, even if it reduces acute events later. The appropriate measure is not “spending” in isolation. It is value: avoidable admissions, patient satisfaction, adherence, and functional outcomes.
What a mature telehealth policy would look like
A mature policy framework would have four characteristics. First, stability. Temporary extensions create planning problems for clinics and anxiety for patients. Second, clinical specificity. Some services are well-suited for telehealth, others are not. Coverage should reflect evidence, not ideology. Third, equity safeguards, including support for broadband, device access, and interpreter integration. Fourth, accountability, including quality measurement and fraud controls that do not penalize legitimate care.
Telemedicine is no longer an emergency workaround. It is part of how many patients receive care. The policy question is whether society will keep treating it as a provisional favor, or whether it will finally be structured as a durable clinical modality. Hybrid care is the compromise already happening in practice. The rules now need to match it.
