There are three primary concerns holding Congress back from pursuing a long-term extension of telehealth flexibilities: cost, quality, and fraud. 

Cost 

Since 2020, research has demonstrated that telehealth is increasingly substitutive for care, not additive. This means that patients are largely using telehealth in place of in-person care, which would not result in additional health spending. This is counter to the long-held belief that telehealth is being overutilized by the “worried well” or that patients are using both telehealth and in-person care for the same service. 

In 2025 alone, numerous studies have been published evaluating telehealth’s cost impact. These add to a growing body of literature supporting telehealth as not only a cost-effective service modality but potentially even a cost-saving one:  

• Cost Impact of Telehealth: A National Analysis of COVID-19 Data (2025): Telehealth was associated with a reduction in costs ranging from $445,000 to $33 million for Medicare and $155,000–$181 million for Medicaid. 

• Telemedicine Adoption and Low-Value Care Use and Spending Among Fee-for-Service Medicare Beneficiaries (2025): In this cohort study, telemedicine adoption was associated with modestly lower use of 7 of 20 examined low-value tests (most point-of-care) and no changes in the use of other low-value tests, despite a small rise in total visits that might offer more testing opportunities. Results suggest possible benefits of telemedicine and mitigate concerns about telemedicine contributing to increased spending. 

• Telehealth and Outpatient Utilization: Trends in Evaluation and Management Visits Among Medicare Fee-For-Service Beneficiaries, 2019-2024 (2025). Overall outpatient utilization remained stable post-pandemic, and increased telehealth adoption was not associated with a rise in total outpatient E&M visits. These findings suggest that broad telehealth adoption has not led to increased healthcare utilization among Medicare FFS beneficiaries. 

• Association Between Telehealth Use and Downstream 30-Day Medicare Spending (2025). Telehealth-initiated episodes of care were associated with lower 30-day Medicare spending and reduced utilization of labs and imaging. These findings suggest that telehealth, when used as a substitute for office visits, may reduce overall Medicare spending. 

Additional studies also indicate this. 

• The impact of expanded telehealth availability on primary care utilization (2022). Results suggest telehealth availability is not resulting in additional primary care visits and federal policies should support telehealth use. 

• Use telehealth as needed: telehealth substitutes in-person primary care and is associates with changes in unplanned events and follow-up visits (2023). Patients and providers treated telehealth and in-person visits as substitutes and used either depending on medical needs and availability. Telehealth did not lead to sooner or more follow-up visits than in-person services. 

• Urgent and non-emergent telehealth care for seniors: Findings from a multi-site impact study (2023). [W]hen deployed within the confines of a patient's existing primary care and health system provider, telehealth can be an effective alternative to in-person care for urgent and non-emergent needs of seniors without increasing downstream utilization. 

Quality 

The same standards of care that guide in-person care also guide the practice of telehealth. Properly implemented telehealth systems are capable of providing care that is of a similar level of quality compared to in-person care. Telehealth visits still require the same amount of providers’ time as in-person care and still require the same level of professional skills and knowledge. The convenience and flexibility offered by telehealth can also contribute to increased care quality by reducing no-shows and improving treatment adherence. 

• Receipt of Telehealth Services, Receipt and Retention of Medications for Opioid Use Disorder, and Medically Treated Overdose Among Medicare Beneficiaries Before and During the COVID-19 Pandemic (2022). In this cohort study including 175 778 beneficiaries, receipt of OUD-related telehealth services during the COVID-19 pandemic was associated with improved MOUD retention and lower odds of medically treated overdose. 

• Comparison of Quality Performance Measures for Patients Receiving In-Person vs Telemedicine Primary Care in a Large Integrated Health System (2022). Findings suggest that telemedicine exposure in primary care poses a low risk for negatively affecting quality performance, highlighting its potential to suitably augment care capacity. 

• Comparison of in-person vs. telebehavioral health outcomes from rural populations across America (2022). In our very large pragmatic study comparing behavioral health treatment delivered to a population of patients in rural, underserved communities, we found no clinical or statistical differences in improvements in depression or anxiety symptoms as measured by the PHQ-9 and GAD-7 between patients treated via telehealth or in-person. 

• Comparisons of Communication in Medical Face-To-Face and Teleconsultations: A Systematic Review and Narrative Synthesis (2024). Quantitative coding studies overwhelmingly suggested that there were few significant differences between modalities. 

• Telehealth vs In-Person Early Palliative Care for Patients With Advanced Lung Cancer: A Multisite Randomized Clinical Trial (2024). The delivery of early palliative care virtually vs in person demonstrated equivalent effects on quality of life in patients with advanced NSCLC, underscoring the considerable potential for improving access to this evidence-based care model through telehealth delivery. 

Fraud 

Telehealth is not inherently more prone to fraud compared to in-person care. Robust fraud monitoring and prevention mechanisms can help prevent fraud system-wide, whether it is done in person or via telehealth. 

• HHS OIG: Medicare Telehealth Services During the First Year of the Pandemic: Program Integrity Risks (2022). This data brief describes providers' billing for telehealth services and identifies ways to safeguard Medicare from fraud, waste, and abuse related to telehealth. This information can help CMS, Congress, and other stakeholders determine what safeguards may be needed as they consider permanent changes to telehealth policies in Medicare. 

• Lack of evidence for telehealth fraud (2023). This article reviews previous efforts to assess the risk of fraud associated with the delivery of virtual care in America, concluding that there is little evidence for higher levels of fraud and abuse related to the use of telehealth.