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The landscape of telehealth services within Medicare is undergoing significant shifts, primarily due to policy changes and strategic decisions by major insurers. UnitedHealthcare, the nation’s largest Medicare Advantage provider, has announced its commitment to maintaining expanded telehealth coverage for its members through 2026, positioning itself as a leader in accessible, at-home healthcare solutions. This move comes amidst a broader industry effort to adapt to the evolving healthcare environment, where technological innovations like virtual and augmented reality are transforming patient engagement and treatment options. For providers and beneficiaries alike, understanding these developments is crucial to navigating the future of Medicare coverage and optimizing care delivery.

What UnitedHealthcare Will Cover in 2026

Comprehensive In-Home Telehealth Services

UnitedHealthcare’s Medicare Advantage plans will continue to offer a broad array of telehealth services, ensuring members can access essential medical and mental health care from the comfort of their homes. These benefits include:

✓ Medical telehealth consultations with in-network physicians and non-physician practitioners such as nurse practitioners and physician assistants.

✓ Mental health teletherapy sessions that do not require in-person visits when provided by in-network mental health professionals.

✓ Both audio-only and video-enabled visits for services listed on the Centers for Medicare & Medicaid Services (CMS) Medicare Telehealth List, expanding access for those with limited internet connectivity.

✓ No restrictions based on geographic location, allowing members to receive care from their homes regardless of where they live.

These comprehensive benefits are designed to address the needs of an increasingly tech-savvy population that expects flexible, remote healthcare options. As digital health tools become more sophisticated, including innovations like virtual reality applications in medicine, the scope of telehealth services is expected to grow further, enhancing diagnostic and treatment capabilities. For more insights on these advancements, explore virtual reality in medicine perspectives and features.

Network and Plan Requirements

For Medicare Advantage PPO plans, telehealth services must be provided by in-network providers to ensure coverage and reimbursement. Conversely, Medicare Advantage PFFS (Private Fee-for-Service) plans offer members the flexibility to access telehealth services from any Medicare-eligible provider, broadening options for those seeking care. This strategic flexibility allows plans to tailor offerings to different beneficiary needs and regional healthcare landscapes.

The Context: Changes Implemented on October 1, 2025

The Retreat of Original Medicare Telehealth Flexibilities

Following the expiration of temporary COVID-19 telehealth policies on September 30, 2025, beneficiaries enrolled in traditional Medicare are now subject to stricter regulations. Congress did not extend these pandemic-era flexibilities, which had temporarily relaxed restrictions on telehealth delivery. As a result, Original Medicare now enforces:

• Geographic restrictions requiring patients to be in rural areas or designated facilities to access telehealth services.

• Originating site requirements that prevent patients from receiving most services directly from home.

• In-person visit mandates for mental health services within a specified period.

• Limited coverage for audio-only services, with most requiring video capabilities.

This creates a notable divide between traditional Medicare and Medicare Advantage plans, which continue to offer more flexible, home-based telehealth options. This divide exemplifies the ongoing debate over equitable access in healthcare and the role of policy in shaping beneficiary experiences.

The Growing Two-Tier System and Strategic Implications

This divergence effectively establishes a two-tier system, where Medicare Advantage enrollees benefit from broader telehealth access, while original Medicare beneficiaries face restrictions. During the upcoming open enrollment period from October 15 to December 7, 2025, beneficiaries will likely weigh these differences heavily when selecting plans. Telehealth access can influence plan attractiveness, especially for seniors with mobility challenges or those living in rural areas who depend on remote care options.

The strategic move by UnitedHealthcare not only solidifies its competitive position but also signals a shift toward more expansive, benefit-rich Medicare Advantage offerings. As plans incorporate additional features such as dental, vision, and hearing coverage, integrating robust telehealth services enhances their value proposition. This approach leverages the statutory flexibility Medicare Advantage plans have to provide benefits beyond traditional Medicare, including innovative care delivery methods like virtual reality applications in medicine, which are enhancing diagnostic and therapeutic processes.

Implications for Healthcare Providers

Managing the Two-Track Telehealth System

Providers now face increased operational complexity due to differing telehealth rules based on patient insurance status. For patients with Original Medicare, providers must verify compliance with geographic and originating site restrictions, document in-person visits for mental health services, and limit the use of audio-only services. Failure to meet these criteria risks claim denials and audits.

Conversely, for patients enrolled in UnitedHealthcare Medicare Advantage, providers can deliver fully covered, flexible telehealth services without geographic restrictions or in-person mandates. This shift underscores the importance of accurate insurance verification and understanding each plan’s coverage nuances.

Revenue Cycle and Compliance Strategies

Claims submitted for telehealth services under expired flexibilities are at risk of denial, emphasizing the need for updated billing protocols. Providers should:

• Conduct audits to identify the proportion of patients enrolled in Medicare Advantage versus original Medicare.

• Update billing systems to flag insurance types before scheduling telehealth visits.

• Train staff on the different requirements to ensure compliance during documentation and claim submission.

• Maintain current in-network credentialing with plans like UnitedHealthcare to safeguard revenue streams.

Additionally, keeping abreast of potential legislative actions—such as bills like the CONNECT for Health Act and the Telehealth Modernization Act—may allow for future policy adjustments, possibly restoring expanded telehealth access to all Medicare beneficiaries.

Practical Steps for Providers

• Audit your patient databases to assess how many rely on telehealth and their insurance plans.

• Modify scheduling workflows to verify insurance coverage upfront.

• Communicate proactively with patients, especially those losing access due to policy changes, to discuss alternatives like in-person visits or Medicare Advantage enrollment during open enrollment.

• Verify credentialing status with Medicare Advantage plans to ensure ongoing access to telehealth reimbursement.

The Broader Market and Future Outlook

Medicare Advantage’s Expanding Market Share

The current policy divergence is likely to accelerate the trend toward Medicare Advantage enrollment, which is projected to encompass a majority of Medicare beneficiaries in the coming years. With plans available to 94% of eligible seniors in 2026, UnitedHealthcare’s stance on telehealth sets a standard that other carriers may soon follow or surpass, especially as beneficiaries increasingly prioritize digital access.

Cost Considerations and Policy Uncertainty

The Congressional Budget Office estimates that extending telehealth flexibilities until December 2024 would cost approximately $2.4 billion. However, evidence suggests that expanded access reduces emergency department visits and improves medication adherence, potentially offsetting costs by decreasing acute care expenses. The economic viability of these benefits within Medicare’s capitated payment models makes expanding telehealth a strategic priority for insurers.

Future Developments and Legislative Prospects

While legislative efforts like the Artificial Intelligence in Healthcare and telehealth bills aim to restore broader flexibilities, political gridlock remains a barrier. Until definitive policies change, the current two-tier system is likely to persist, compelling providers to adapt swiftly.

The New Normal and Policy Debates

UnitedHealthcare’s commitment signals a potential shift toward a healthcare environment where supplemental benefits and digital health innovations become standard in Medicare Advantage plans. This evolution raises questions about equity in access and whether coverage should be contingent upon plan selection, especially as technologies like virtual reality in medicine continue to advance, offering new avenues for patient engagement and treatment.

Key Recommendations for Billing, Credentialing, and Practice Management

For Medical Billing Companies

• Immediately update billing software to incorporate the October 2025 policy changes.

• Implement eligibility checks before telehealth appointments.

• Prepare for increased denials from original Medicare for services that no longer qualify under new rules.

• Keep abreast of legislative developments that could impact reimbursement policies.

For Credentialing Specialists

• Prioritize enrollment with Medicare Advantage plans offering telehealth benefits.

• Verify specific credentialing requirements related to telehealth for each payer.

• Expedite credentialing processes to prevent coverage gaps.

• Maintain detailed documentation of provider telehealth capabilities and compliance standards.

For Practice Administrators

• Conduct thorough insurance audits to identify affected patient populations.

• Establish protocols for verifying insurance eligibility prior to telehealth visits.

• Educate staff and patients on coverage changes to minimize confusion.

• Develop communication strategies to inform patients about their options during enrollment periods.

Clarifications and Additional Notes

Although many temporary telehealth flexibilities expired at the end of September 2025, certain behavioral health, primary care, and substance use disorder services remain eligible for remote delivery under specific conditions. Providers should verify current CMS and Medicare Administrative Contractor guidance to ensure compliance when billing for these services.

It’s important to recognize that UnitedHealthcare’s coverage policies are specific to its Medicare Advantage plans and do not automatically apply to Original Medicare or other private insurers. The strategic extension of telehealth benefits underscores a broader industry trend towards integrating digital health solutions, including virtual reality applications, to improve patient outcomes and satisfaction.

The ongoing debate over equitable access and plan-driven disparities in Medicare coverage will likely continue, making it essential for providers to stay informed about legislative efforts and adapt their operations accordingly. As the market evolves, understanding the distinctions and requirements for each plan type will be critical to maintaining revenue and delivering high-quality care.

References

• UnitedHealthcare Provider. (October 2025). “UnitedHealthcare Medicare Advantage telehealth benefits continue through 2026.”
• UnitedHealthcare. (October 2025). “UnitedHealthcare’s 2026 Medicare Advantage Plans Deliver Value, Access and Consumer Choice.”
• U.S. Department of Health and Human Services. (2025). “Telehealth Policy Updates.”
• Centers for Medicare & Medicaid Services. (2025). “Telehealth Insurance Coverage.”
• McDermott Will & Emery. (October 2025). “Medicare telehealth flexibilities expire: Immediate impacts and next steps.”
• Kaiser Family Foundation. (October 2024). “What to Know About Medicare Coverage of Telehealth.”
• AARP. (2025). “Medicare Telehealth Coverage Expired Sept. 30.”