Several high-impact COVID-era benefits end in 2025. The big dates: Sept 30, 2025 (Medicare telehealth + Hospital at Home) and Dec 31, 2025 (ACA enhanced subsidies and DEA tele-prescribing). Here’s what’s expiring, who’s affected, and what to do now—with exact deadlines and prep checklists. KFF+3telehealth.hhs.gov+3American Hospital Association+3
What’s ending in 2025? (Quick answer)
- ACA enhanced marketplace subsidies (ARP/IRA “enhanced PTCs”) — Expire Dec 31, 2025, affecting 2026 premiums unless extended. KFF
- Medicare telehealth flexibilities (home as originating site; no geographic limits; broader provider list) — Set to expire Sept 30, 2025 without new legislation. Behavioral/mental health telehealth has separate, ongoing authorities. telehealth.hhs.gov
- Acute Hospital Care at Home (AHCaH) waivers — Set to expire Sept 30, 2025. American Hospital Association
- Telemedicine prescribing of controlled substances (e.g., stimulants, benzodiazepines, buprenorphine) — Flexibilities extended through Dec 31, 2025; cliff on Jan 1, 2026 if no final DEA rules. DEA+1
- Emergency Rental Assistance 2 (ERA2) — Period of performance ends Sept 30, 2025, with a 120-day window to pay obligations (local sunset timing varies). U.S. Department of the Treasury+1
Bottom line: Mark Sept 30 and Dec 31, 2025 on your calendar; act now to avoid coverage and access gaps.
ACA enhanced subsidies end Dec 31, 2025: who’s at risk of premium shock?
The Inflation Reduction Act extended the American Rescue Plan’s enhanced premium tax credits (ePTCs) through end of plan year 2025. If Congress doesn’t extend them, 2026 premiums owed by enrollees jump, especially for middle-income households who gained eligibility above 400% FPL. KFF’s latest analysis and calculator quantify how much more people would pay if ePTCs lapse. KFF+1
What changes if ePTCs lapse?
- The “subsidy cliff” above 400% FPL returns; many in their 50s/60s face steep increases.
- People below 400% FPL still get PTCs, but net premiums rise because enhanced amounts disappear.
- The effect shows up in 2026 (not 2025) bills during Nov–Jan open enrollment.
Illustrative scenarios (national examples)
(Based on KFF methodology snapshots—actual 2026 rates will vary by state/insurer.) KFF
| Household | Income | 2025 monthly (with ePTCs) | 2026 monthly if ePTCs expire | Change |
|---|---|---|---|---|
| 45-year-old single | 350% FPL | ~$130 | ~$330 | +$200 |
| 60-year-old couple | 450% FPL | ~$420 | ~$1,000 | +$580 |
| Family of 4 (2 adults 40, 2 kids) | 300% FPL | ~$240 | ~$520 | +$280 |
Source: KFF analysis & interactive tool, last checked Sept 24, 2025. KFF
What to do now
- Price out 2026 with KFF’s estimator; budget for a higher share if no extension. KFF
- Update income in your marketplace profile before open enrollment; even small changes can alter subsidies.
- Compare Bronze/Silver/Gold trade-offs (deductibles vs. premiums).
- Watch Congress—extensions are being debated; enroll early to avoid sticker shock. (We’ll update this page as bills move.) Axios
Bottom line: If enhanced ACA subsidies aren’t renewed, millions will pay more in 2026; model your risk today. KFF
Medicare telehealth flexibilities may end Sept 30, 2025
During the PHE and subsequent laws, Medicare allowed telehealth from home with no geographic restrictions and a broader set of eligible practitioners. Without new legislation, these flexibilities expire Sept 30, 2025, and many services revert to pre-pandemic limits (e.g., rural originating site rules; home no longer broadly eligible). Behavioral health telehealth keeps separate, more permanent authorities. telehealth.hhs.gov
What could change on Oct 1, 2025 (if no bill passes)?
- Home may no longer qualify as an originating site for most non-behavioral services.
- Urban beneficiaries could lose access to certain telehealth visits unless they travel to an eligible site.
- Some practitioner types may lose distant-site eligibility outside behavioral health.
- FQHC/RHC telehealth flexibilities persist for behavioral care. telehealth.hhs.gov
Checklist — Medicare members & clinics
- Patients:
- Book late-Sept telehealth visits before the deadline; ask your clinic about October plans.
- If mobility/transport barriers exist, discuss in-person alternatives or Medicare Advantage options that may continue tele-options.
- Clinics:
- Run a September schedule audit; contact patients with October tele-visits to convert as needed.
- Update billing/eligibility workflows and staff scripts for possible originating-site rules.
- Watch HHS/CMS telehealth updates and payer bulletins. telehealth.hhs.gov
Bottom line: Plan as if the cliff is real on Sept 30, 2025—unless Congress extends it, traditional Medicare will scale back non-behavioral telehealth. telehealth.hhs.gov
Hospital at Home: waivers set to end Sept 30, 2025
CMS’s Acute Hospital Care at Home (AHCaH) waivers, launched during the PHE, let approved hospitals provide inpatient-level care at home. Multiple deadlines have been pushed, but current waivers end Sept 30, 2025, and extension bills are in play. American Hospital Association+1
Why it matters
- Over hundreds of hospitals built programs; abrupt sunset could disrupt patient flow, capacity, and costs for systems that invested in command centers and home services. (Hospitals vary by state; check your facility.) American Hospital Association
Pros/cons snapshot (patients/providers)
- Pros: Lower exposure risk; comfort of home; high patient satisfaction; potential cost savings.
- Cons: Program availability uneven; tech/logistics burdens; payer coverage uncertainty post-sunset.
Bottom line: If the waiver ends, new hospital-at-home admissions may stop October 1, and reimbursement could revert—confirm with your hospital and plan. American Hospital Association
Telemedicine prescribing of controlled substances ends Dec 31, 2025 (unless new rules arrive)
DEA and HHS issued a third temporary extension allowing clinicians to prescribe Schedule II–V medications via telemedicine without an initial in-person exam under defined conditions—effective through Dec 31, 2025. If final rules aren’t in place, flexibilities end Jan 1, 2026. Federal Register+1
Who’s affected: Patients receiving ADHD stimulants, anxiety meds, sleep meds, and those in OUD care (e.g., buprenorphine) who began via telemedicine. telehealth.hhs.gov
Checklist — patients & prescribers
- Patients:
- Ask your prescriber now whether an in-person visit will be required for 2026 refills.
- Request medical records and ensure PDMP information is correct in your state.
- Clinicians:
- Track DEA rulemaking; review documentation of tele-initiation dates and any in-person contact.
- Update treatment agreements to reflect potential in-person requirements in 2026. Federal Register
Bottom line: Plan for a possible in-person requirement in early 2026; don’t wait until December to convert care. Federal Register
Emergency Rental Assistance (ERA2) winds down Sept 30, 2025
Treasury’s ERA2 funds must be obligated by Sept 30, 2025; jurisdictions then have 120 days to complete payments, with closeout reporting into early 2026. Practical impact varies locally based on remaining balances and prior reallocations. U.S. Department of the Treasury+2U.S. Department of the Treasury+2
Checklist — tenants, landlords, counselors
- Confirm your local ERA2 program’s last day to accept applications (many will close before Sept 30).
- If funds are obligated, ensure paperwork is complete to allow payment within the 120-day window.
- For ongoing need, pivot to Housing Choice Vouchers, state/local rental aid, or legal aid for eviction defense.
Bottom line: Treat Sept 30, 2025 as the functional deadline for new ERA2 help; local portals may close sooner. U.S. Department of the Treasury
Your 2025 timeline (clip-and-save)
- Now through Sept 30, 2025: Medicare patients and clinicians finalize tele-visits; hospitals plan for AHCaH status. telehealth.hhs.gov+1
- October–December 2025: DEA tele-rx still allowed; start in-person conversions for 2026 continuity. Federal Register
- Fall 2025: Watch Congress on ACA subsidy extension; preview 2026 premiums. KFF
- Sept 30, 2025: ERA2 obligation deadline; telehealth/Hospital-at-Home cliff. 120-day ERA2 payment window starts. U.S. Department of the Treasury
- Dec 31, 2025: ACA enhanced subsidies and DEA tele-rx flexibilities expire absent action. KFF+1
How to protect your coverage, care, and budget
- Marketplace enrollees: Use the KFF calculator to estimate a 2026 worst-case; consider plan metal shifts or HSA strategies if subsidies lapse. KFF
- Medicare beneficiaries: Ask your clinic how telehealth scheduling changes in October; arrange in-person options or MA plans that maintain broader tele-benefits. telehealth.hhs.gov
- Patients on controlled meds: Schedule a fall 2025 check-in to map a compliant path for 2026; anticipate an in-person visit if DEA doesn’t finalize permanent rules. Federal Register
- Tenants/landlords: If your locality still has ERA2 funds, apply immediately; otherwise connect with HUD-certified housing counselors for alternatives. U.S. Department of the Treasury
Disclaimers
- Health/coverage: This article is informational, not medical or legal advice. Confirm benefits with your plan, clinic, state agency, or attorney.
- Policy volatility: Dates and rules can change with new federal legislation or agency action; always verify via official sources linked here.
Citations (high-authority):
- ACA subsidies impact & calculator — KFF (interactive, data note). Source: KFF, last checked Sept 24, 2025. KFF+1
- Medicare telehealth status/expiry — HHS Telehealth. Source: HHS Telehealth, last checked Sept 24, 2025. telehealth.hhs.gov
- Hospital at Home deadline — AHA / Better Care Playbook / state Medicaid. Source: AHA & allied resources, last checked Sept 24, 2025. American Hospital Association+2Center for Health Care Strategies+2
- DEA tele-rx extensions — DEA / Federal Register / SAMHSA. Source: DEA & Federal Register, last checked Sept 24, 2025. DEA+2Federal Register+2
- ERA2 closeout — U.S. Treasury official resources. Source: Treasury, last checked Sept 24, 2025. U.S. Department of the Treasury+2U.S. Department of the Treasury+2
Key takeaways
- Two cliffs, two dates: Sept 30, 2025 (Medicare telehealth & Hospital at Home); Dec 31, 2025 (ACA ePTCs & DEA tele-rx). Federal Register+3telehealth.hhs.gov+3American Hospital Association+3
- If ACA subsidies lapse, 2026 marketplace premiums rise for many, especially 50–64 year-olds. KFF
- Medicare patients should front-load tele-visits and prepare for in-person care. telehealth.hhs.gov
- Patients on controlled meds should plan an in-person visit before refills run into 2026. Federal Register
- ERA2 programs hit a Sept 30 obligation cutoff—don’t delay applications. U.S. Department of the Treasury
Next steps
- Put the two deadlines on your calendar.
- Contact your plan/clinic/housing authority this week.
- Re-check this guide in October for any Congressional changes.
FAQs
Q1. What COVID-era benefits are expiring in 2025?
ACA enhanced premium tax credits (Dec 31), Medicare telehealth flexibilities (Sept 30), Hospital at Home waivers (Sept 30), and DEA telemedicine prescribing flexibilities for controlled substances (Dec 31). ERA2 rental aid also hits a Sept 30 obligation deadline. U.S. Department of the Treasury+4KFF+4telehealth.hhs.gov+4
Q2. When do Medicare telehealth waivers end?
Without new legislation, broad non-behavioral telehealth flexibilities end Sept 30, 2025; some behavioral health telehealth authorities are permanent. telehealth.hhs.gov
Q3. What happens to ACA marketplace premiums if subsidies end?
Out-of-pocket premiums increase in 2026, with the biggest jumps for middle-income, older enrollees; see KFF’s tool for estimates. KFF
Q4. Can my doctor still prescribe Adderall or buprenorphine by telehealth in 2025?
Yes, under DEA’s temporary extension through Dec 31, 2025; expect potential in-person requirements in 2026 if new rules aren’t finalized. Federal Register
Q5. Is Hospital at Home going away?
The waiver is set to expire Sept 30, 2025 unless Congress extends it; check with your hospital for program status. American Hospital Association
Q6. Does Emergency Rental Assistance end in 2025?
ERA2 funds must be obligated by Sept 30, 2025; jurisdictions then have 120 days to make payments. Local closure dates may be earlier. U.S. Department of the Treasury
Q7. Will Congress extend any of these benefits?
Debate is active (especially on ACA subsidies and telehealth). Plan as if deadlines will hit; adjust if laws change. Axios