The October 2025 telehealth cliff caused a 24% drop in Medicare telemedicine visits in 17 days

On October 1, 2025, the U.S. government shut down, and with it, key Medicare telehealth flexibilities that had been in place since 2020 expired. For 17 days, providers could no longer be reimbursed for telehealth visits delivered to Medicare beneficiaries in their homes. Geographic originating site restrictions snapped back, meaning patients outside designated rural Health Professional Shortage Areas lost Medicare coverage for most telehealth services. Federally Qualified Health Centers and Rural Health Clinics could no longer serve as distant site providers. The result was immediate: telemedicine visits for Medicare fee-for-service beneficiaries dropped 24% in the first 17 days of October, and 13% for Medicare Advantage beneficiaries. The downstream consequences are severe. Many of these patients are elderly, have mobility limitations, and chose telemedicine specifically because they cannot easily travel to a clinic. A 24% drop in visits does not mean 24% of patients found alternative care -- it means a significant fraction simply went without care during that period. For patients managing chronic conditions like heart failure, diabetes, or COPD, even a two-week gap in monitoring and medication management can trigger hospitalizations. For patients in behavioral health treatment, disruption of the therapeutic relationship can set back months of progress. The financial hit to providers was also immediate -- small practices and FQHCs that had built telehealth into their care delivery model saw revenue drop overnight with zero advance warning. This problem persists because Congress treats telehealth flexibility as a budget negotiation chip rather than permanent policy. Since 2020, Medicare telehealth provisions have been extended through at least six short-term continuing resolutions, never for more than 12-18 months at a time. Each extension is attached to a must-pass spending bill, which means telehealth policy is always hostage to unrelated political disputes. The result is that neither patients nor providers can plan long-term, and every provider who builds a telehealth-dependent practice is building on a foundation that could disappear with the next government shutdown.