Millions of Americans, including over 35,000 residents in Maui County, may lose access to telehealth services covered by Medicare if Congress does not act before a critical September 30 deadline. Pandemic-era provisions that expanded virtual healthcare access are set to expire, creating uncertainty for patients and providers who have come to rely on the service, especially in areas with significant physician shortages like Hawaiʻi.
Key Takeaways
- Expanded Medicare telehealth coverage, introduced during the pandemic, is scheduled to expire on September 30.
- If no action is taken, Medicare patients in non-rural areas will lose coverage for many virtual health services.
- Hawaiʻi faces a severe physician shortage, with Maui County having a 41% deficit, making telehealth a critical service.
- Bipartisan legislation has been introduced to make the telehealth provisions permanent, but its passage is uncertain.
The End of an Era for Pandemic-Era Healthcare
During the COVID-19 pandemic, the federal government eased restrictions on telehealth, allowing Medicare to reimburse a wider range of virtual services for patients regardless of their location. This change led to a dramatic increase in the use of remote healthcare.
According to the U.S. Centers for Disease Control and Prevention, telemedicine use among physicians surged from 15.4% in 2019 to 86.5% in 2021. Patients benefited from the convenience and lower costs associated with virtual appointments.
Cost Savings of Virtual Care
The Center for Telehealth and e-Health Law reports that an average telehealth visit costs $79, significantly less than the $146 average for a traditional in-person visit. This cost difference has been a major benefit for both patients and the healthcare system.
However, these expanded benefits are temporary and set to expire. Without congressional intervention, the rules will revert, requiring most Medicare patients to be physically present at a medical facility in a designated rural area to receive covered telehealth services. This change would primarily affect the large population of beneficiaries living in suburban and urban areas.
Hawaiʻi's Healthcare System Under Pressure
The potential loss of telehealth coverage is particularly concerning for states like Hawaiʻi, which grapple with significant healthcare access challenges. A 2024 University of Hawaiʻi report revealed that Maui County has the worst physician shortage in the state, with a deficit of 174 doctors, or 41%.
This shortage makes remote consultations not just a convenience but a necessity. Cliff Alakai, administrator of Maui Medical Group, which serves approximately 30,000 patients, expressed concern over the potential changes.
"I think it’s a mistake. I think it’s going to make things busier and make health care more cumbersome."
Maui Medical Group sees about 1,000 patients daily, with 5% to 10% of those appointments conducted virtually. Alakai noted that telehealth helps manage patient volume, allowing sicker individuals to be seen in person while others receive necessary follow-up care from home.
Medicare Beneficiaries in Hawaiʻi
As of May 2024, Hawaiʻi had 310,594 total Medicare beneficiaries. Maui County alone accounted for 35,314 of these individuals. While not all will be immediately affected, those in non-rural designated areas face the greatest risk of losing access to many virtual services.
Patients Voice Support for Remote Care
While their insurance is not Medicare, the experiences of Maui residents like Rodney Figueroa and Patrick “PK” Higa illustrate the profound impact of telehealth. Figueroa, diagnosed with multiple myeloma, found virtual appointments invaluable during the pandemic, saving him trips from Maui to Oʻahu or the mainland.
Higa, who is on a liver transplant waiting list, must travel to Oʻahu for specialized care. He explained that virtual follow-ups save him significant time and expense. "For me, it’s huge, because one meeting or conference, it saves me a lot of time," Higa said, noting the costs of flights, car rentals, and parking for appointments that can be as short as 20 minutes.
Kealiʻi Lopez, executive director of AARP Hawaiʻi, compared modern telehealth to an old practice. "It’s like house calls," she said. "We’re kind of going full circle. It’s the doctor coming to your home now out of the convenience of your telephone."
A Bipartisan Push in Congress
There is broad, bipartisan support for extending or making telehealth coverage permanent. In April, U.S. Sen. Brian Schatz of Hawaiʻi led a group of 60 senators in introducing a bill to make the expanded provisions permanent. A companion bill was introduced in the House of Representatives.
Hawaiʻi's congressional delegation has been vocal about the need for a long-term solution. U.S. Rep. Jill Tokuda warned against short-term extensions, stating they fall "far short of what our communities need."
"If Congress fails to act, many vulnerable populations in Hawaiʻi and across the country, including seniors, rural residents, and those with limited mobility, will lose critical access to convenient, affordable care," Tokuda stated.
U.S. Sen. Mazie Hirono echoed these sentiments, emphasizing that telehealth has been a success. "Millions of people — including tens of thousands of patients in Hawaiʻi — rely on telehealth services and they should not have to face continuous uncertainty about their access to health care," she said.
Navigating the Uncertainty
If the deadline passes without a solution, Medicare will still cover some telehealth services from a patient's home, including mental and behavioral health care and monthly visits for home dialysis patients. However, a wide range of other consultations would no longer be covered for those outside rural zones.
Candace Nakamoto, a program specialist with Hawaii SHIP (State Health Insurance Assistance Program), advised patients to prepare. "All we can really do is just make sure people are clear about qualifications to get covered," she said. Patients are encouraged to speak with their doctors and review their specific plans.
Major insurance providers in Hawaiʻi have stated their commitment to telehealth. Kaiser Permanente, which provided 5.5 million virtual visits to its Medicare patients in 2023, confirmed it will continue to offer these services under its Medicare Advantage plans. Similarly, the Hawaii Medical Service Association (HMSA) affirmed it will continue covering telehealth services for its members.
Despite these assurances from private insurers, Alakai of Maui Medical Group worries about a ripple effect. He is concerned that if Medicare restricts coverage, "then other health insurers may follow that and not allow that service," creating a disjointed and confusing system for patients.
As the September 30 deadline approaches, patients and providers are left waiting for Congress to act, hoping to preserve a mode of healthcare that has become essential for many.
