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Join us for a conversation with patient advocate Stephanie Marcovici as we explore the potential rollback of Medicare telehealth coverage in 2025. Stephanie shares her personal story and highlights the devastating impact this change could have on vulnerable populations, including the disabled and elderly. Discover why extending telehealth coverage is essential for equitable, accessible, and life-saving care.
Stephanie Marcovici is a patient advocate.
She discusses the KevinMD article, “Medicare’s decision to stop telehealth coverage in 2025: an urgent call to action.”
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Transcript
Kevin Pho: Hi, and welcome to the show. Subscribe at KevinMD.com/podcast. Today, we welcome back Stephanie Marcovici. She is a patient advocate. Today’s KevinMD article is “Medicare’s decision to stop telehealth coverage in 2025: an urgent call for action.” Stephanie, welcome back to the show.
Stephanie Marcovici: Thank you for having me.
Kevin Pho: So tell us what your latest article is about for those who didn’t get a chance to read it.
Stephanie Marcovici: Well, unfortunately I can even quote Medicare’s website. They say, “Absent congressional action beginning January 1st, 2025, the statutory limitations that were in place for Medicare telehealth services prior to the COVID-19 PHE will retake effect for most telehealth services.” So basically, that means that, except for rural areas or mental health, most people on Medicare will not be able to have telehealth appointments with their doctors or nurse practitioners come January 1st.
Now, this came to me as a huge shock in recent weeks because doctors’ offices don’t even know that this is happening. They’re scheduling appointments into 2025, which actually happened to me. That’s how I found out about it: I had a telehealth appointment scheduled for January, and I was messaging with the doctor about a couple other issues. She said, “Oh, you have an appointment in January. Let’s make that December because Medicare is not going to pay.” So I started trying to find out ways that we could fix this. Because this is going to be disastrous for me—I’m a patient, disabled—and there are millions of people who this is going to take a very bad toll on. People are not going to get the help that they need. They’re not going to have doctor’s appointments. They’re not going to end up on the treatments that they need, because there are so many people, for various medical reasons, who are stuck at home. They can’t get to a medical office.
This is a huge problem. It’s extremely urgent, because as of this taping, we’re getting to the end of 2024, and it says, “Absent congressional action by the end of 2024, telehealth will no longer be an option.” So I don’t know if the current Congress has to take action—if they are able to—or if this will have to move to the new Congress come January. But either way, I can talk about this later, too, about what we can do to try and get Congress to act.
Kevin Pho: And just a reminder, the fact that we’re in this situation was, of course, during the pandemic, Medicare made these rules because they wanted to encourage more virtual visits, of course, because of social distancing and because of the pandemic itself, right?
Stephanie Marcovici: Exactly. So COVID was horrendous for a million reasons, but one positive that did come out of it was that people who have trouble going to a doctor’s office could do it from their own home. It’s much easier on the body, on the mind. It’s more affordable. The quality of care is the same, so it just makes sense to continue it. There’s no reason to get rid of it because it’s a good thing that’s working. Yes, it was genius when they came up with it during COVID, and it needs to be continued.
Kevin Pho: So tell me about your own personal situation, about how these virtual visits and telehealth visits—how did you utilize them over the past few years?
Stephanie Marcovici: For the most part, most of my medical visits are telehealth. I have doctors—I live in New York, but I have them out of state—so that is very important. But even my local doctors… you can’t tell it from my demeanor, because I have what people call an invisible illness, but I really can’t do much. I can tell you an average day for me: I need at least 12 hours of sleep just to feel OK enough to do anything, like this, or something else. Then I wake up, try and get myself together, wash up, eat some breakfast, then I can do one or two tasks—maybe take a shower could be what I do one day or something for a medical appointment, filling out some forms. Then I take a nap because my brain and body are so exhausted, and soon enough it’s time to get ready for bed again because I have these routines and my body runs slowly. I’m extremely fatigued, and my nervous system is shot. Everything just does not run in me the way that it should.
I have an autoimmune disease that affects the autonomic nervous system, and I have ME, which is myalgic encephalomyelitis—pretty much unknown for most people—but it basically is extreme fatigue, post-exertional malaise, which means if you do something, you get worse. That’s also a huge problem for telemedicine—because of post-exertional malaise, if I were to push myself, get my nervous system going, push myself with adrenaline and lose sleep and get to a doctor’s appointment somehow, and then come back, all that effort and pushing will make me feel worse, and my symptoms will get worse. So yes, I went to my doctor’s appointment, and they’re supposedly helping me with my illness, but now my illness is worse. If I keep doing that for all the doctors I see, for all the different areas of my body, I’m just going to be in a constant cycle of getting worse. When do I recover?
Kevin Pho: And when you talk to your fellow patients about the upcoming expiration of Medicare’s coverage of virtual telehealth visits, tell us some of the thoughts—some of the things they’re seeing among the patient community.
Stephanie Marcovici: As soon as I found out, I went into a couple online patient groups, and people were shocked because, as I was mentioning before, doctors’ offices are still scheduling appointments into 2025. Nobody is saying that telehealth—there won’t be Medicare telehealth anymore. I was lucky that one doctor told me. Nobody else is saying it. The reaction: people are shocked, they’re angry, frustrated, and they’re nervous. People are scared because there are many people who are worse off than me. Yes, I can force myself to get to a doctor’s office if I have to, but there are people who cannot go no matter what. They’re scared that this is the end of their medical care, that they’re not going to have access to care anymore, and what are they going to do? So they’re also saying, “What can we do? How can we get it back?” It’s—I don’t know if I said it before, but it’s really life or death, and it’s quality of life.
Kevin Pho: Now, earlier, you mentioned that the care you receive virtually, you think that it’s similar to the care you receive face-to-face with a clinician?
Stephanie Marcovici: Absolutely. There are positives to being in person with somebody—I think most people would agree with that, that when you’re in person, you can have different readings of facial expressions or body language. But for me and for the people I’ve spoken to or been in communication with, the care has been consistently great. I saw medical professionals before COVID, and then during COVID, and nothing changed—it was only better because it took less of a toll on me.
Kevin Pho: So, in a way, with this Medicare coverage expiring, it almost seems like the most vulnerable populations—those who are disabled and unable to go to an in-person visit, those with chronic illnesses—would be disproportionately affected.
Stephanie Marcovici: Absolutely. There are people with, as you mentioned, disabilities, chronic illness, people who don’t have energy, people with mobility issues, the elderly, of course, on Medicare, people who are frail, people with dementia, other neurological issues—yes, we’re all going to be affected. I’m not sure what regular health insurance is doing for telehealth, but in terms of Medicare, we need to have this coverage.
Kevin Pho: And to your knowledge, is there some type of movement—some type of media or political outcry—to get this coverage back before it expires?
Stephanie Marcovici: I was surprised that when I found out, I didn’t see advocacy organizations doing much about this. I did see that the AMA was in support of continuing telehealth. Other than that, I reached out in my patient groups, and one person mentioned that there is a petition on actionnetwork.org, where it’s easy and automatic. You can go on and basically put in your information, and it sends a letter. You can customize it if you want, but it sends letters to your representatives telling them that you want legislation passed. It’s quick and easy to do. To find it, the easiest way I found is if you Google “Action Network dot org preserving telehealth.” That should be in the first results that come up. If you click that, so far, there are about 14,000 signatures. That’s what I found so far to be the most successful.
I’ve tried reaching out to some newspapers, and also organizations for my illnesses—some have started to take some action. We do need, if the media could cover it, that would be tremendous, because that would put much more pressure. I mean, I’m reaching out to everybody, people on Medicare, people not on Medicare, people who know people on Medicare, or just if you’re a kind-hearted person who cares about the health of others. I think the Senate leader Chuck Schumer needs to be inundated. I think House Majority Leader Johnson needs to be inundated to push votes in the House and the Senate. If this goes into January and there’s a new Congress, we’ll have to go after whomever. And then Senator Thune, at that point, will be the leader of the Senate. So if it comes to January, we’ll have to go after new people, and hopefully, with the push of representatives, and hopefully if we can get the media involved, we can move this along.
Kevin Pho: Are you preparing yourself, however, for a world where telehealth is not covered by Medicare?
Stephanie Marcovici: I have to face that reality. I do have a very packed schedule in December with a lot of telehealth appointments with my providers so I can squeeze in at least however many months with them that I can. But it’s not going to be fun. If I have to do it, I will have to force myself to get to doctors because I need my medicine, I need their guidance. Unfortunately, hopefully it won’t become reality, but yes, I’m unhappily preparing for the other reality.
Kevin Pho: We’re talking to Stephanie Marcovici. She’s a patient advocate. Today’s KevinMD article is “Medicare’s decision to stop telehealth coverage in 2025: an urgent call for action.” Stephanie, as always, we’ll end with some take-home messages that you want to leave with the KevinMD audience.
Stephanie Marcovici: I just ask anybody who is willing and able, who has just a few minutes, to please contact your representatives. We really need your help to get this movement, to have Congress pay attention and pass the legislation to continue telehealth—to have Medicare pay for telehealth in 2025. Again, this is a matter of saving lives, improving lives. It’s a serious matter. There are people like me, who are a little better on the spectrum, and there are worse people on the spectrum, and we can’t let people hang—not in this country.
Kevin Pho: Stephanie, as always, thank you so much for sharing your story, time, and insight, and thanks again for coming back on the show.
Stephanie Marcovici: Thanks for having me.
