Telehealth Flexibilities Expire January 30 - What Texas Practices Must Do Now

Primary Care Perspective - Texas Edition | Thursday, January 8, 2026

Strategic intelligence for independent primary care physicians in Texas. Curated insights on Medicare policy, Medicare Advantage, practice management, AI technology, market dynamics, and the Texas healthcare landscape.

Article 1: Telehealth Coverage Hangs in Balance - AMA Pushes for Permanent Medicare Flexibilities

The American Medical Association and dozens of provider groups are urgently pressing Congress to make Medicare telehealth flexibilities permanent before they expire again on January 30th. The current piecemeal extension approach, they argue, is creating chaos for practices and limiting patient access to care. For Texas independent practices that have integrated telehealth into their care models, the clock is ticking.

Analysis

Since the pandemic, telehealth has evolved from emergency stopgap to strategic asset for independent primary care practices. But here’s the problem: nobody can build a sustainable business model on 30-day policy extensions.

For Texas practices, this uncertainty is particularly painful. Our state’s geography-from the urban corridors of Houston and Dallas to rural West Texas-makes telehealth essential for efficient care delivery. Many independent practices have invested in telehealth platforms, trained staff, and redesigned workflows around virtual visits. They’ve discovered that telehealth doesn’t just serve isolated rural patients; it’s become a competitive advantage for managing the growing Medicare and Medicare Advantage populations that every practice is targeting.

The demographic opportunity is massive. As Baby Boomers flood into Medicare eligibility, practices that can efficiently manage larger panels will win. Telehealth is a critical tool for this strategy-enabling quick check-ins, chronic disease monitoring, and medication management without the overhead of in-person visits for every interaction.

But here’s what the AMA letter doesn’t emphasize enough: Medicare Advantage plans are watching this closely. Over 50% of Medicare beneficiaries nationally are now enrolled in MA plans, and Texas markets like Houston, Dallas-Fort Worth, and San Antonio are MA growth hotspots. These plans love telehealth because it reduces costs, but they’re waiting to see what Congress does before finalizing 2027 contract terms. If Medicare telehealth flexibilities become permanent, expect MA plans to build telehealth expectations into value-based arrangements and quality metrics.

Smart practices aren’t just hoping Congress acts-they’re preparing for both scenarios. They’re tracking which services generate meaningful revenue via telehealth, which patient populations prefer virtual care, and what the true cost per encounter looks like. This requires real-time data visibility that most practice management systems don’t provide without customization.

The bigger strategic point: practices that build flexible, data-driven operations can pivot quickly when policies change. Those still operating on gut feel and generic software will scramble every time Congress kicks the can down the road.

Key Takeaways

• Current Medicare telehealth flexibilities expire January 30, 2026 - Congress may extend again, but uncertainty continues
• Texas geography and rapid population growth make telehealth strategically valuable - not just a nice-to-have anymore
• Medicare Advantage plans (covering 50%+ of Medicare beneficiaries) are building telehealth into value-based expectations - your contract terms may require virtual care capabilities
• Practices need accurate cost and revenue data for telehealth encounters - essential for proving value and negotiating MA contracts
• Don’t assume permanent flexibilities are guaranteed - have contingency plans for different policy scenarios

What Smart Practices Are Doing

They’re running monthly analyses of telehealth utilization by payer, service type, and patient demographics-using this data to inform both immediate operations and long-term contract negotiations with MA plans positioning themselves for 2027.

Article 2: Why This Telehealth Battle Matters for Your MA Strategy

While the AMA’s letter focuses on Medicare coverage, the real story is how this affects your Medicare Advantage positioning-and that directly impacts your practice’s revenue trajectory.

Analysis

Let’s connect the dots that most coverage of this issue misses: Medicare Advantage penetration in Texas is accelerating, and MA plans are using telehealth as both a patient recruitment tool and a cost management strategy.

UnitedHealthcare, Humana, Aetna, and other major players in Texas markets are advertising $0 premium MA plans with telehealth benefits that traditional Medicare doesn’t guarantee. Patients love the convenience. Plans love the cost savings. But here’s what matters to your practice: if Medicare’s telehealth flexibilities expire while MA plans continue offering virtual care access, you’ll face intense pressure to provide telehealth services at MA contract rates-which are often worse than traditional Medicare reimbursement.

This creates a strategic dilemma. You can’t ignore telehealth because your competitors and the MA plans will use it against you in patient recruitment. But you also can’t afford to offer unprofitable services just to keep patients happy.

The solution isn’t to stop offering telehealth-it’s to get dramatically more sophisticated about when, how, and for which patients you deploy it. This requires workflow automation and AI-powered decision support that most off-the-shelf telehealth platforms don’t provide. You need systems that can instantly verify eligibility, flag high-value billable services (CCM, RPM, BHI codes that pair beautifully with telehealth), suggest appropriate coding, and track profitability by encounter type and payer.

Key Takeaways

• MA plans are using telehealth guarantees as patient recruitment tools - your practice needs competitive virtual care capabilities
• MA reimbursement for telehealth often lags traditional Medicare - know your numbers before committing to service levels
• Telehealth pairs strategically with high-margin digital health codes (CCM, RPM, BHI, APCM) - expand revenue per encounter
• Contract negotiation leverage requires data - show MA plans your quality metrics and cost efficiency to demand better terms

What Smart Practices Are Doing

They’re building telehealth into broader chronic care management programs, stacking multiple revenue codes per patient relationship while using virtual visits to efficiently manage larger panels-then using that performance data to negotiate stronger MA contracts.

Position Your Practice for What’s Next

The practices that thrive through industry transformation share common traits: they leverage data strategically, automate intelligently, and make decisions based on market intelligence rather than gut instinct.

Whether you’re evaluating your contract portfolio, navigating Medicare Advantage negotiations, considering digital health programs, or planning for succession - having the right systems and insights makes the difference.

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