Does Medicare Cover Telehealth Services?

Telehealth is the modern version of a house call. You can receive healthcare services and guidance without leaving your home using an electronic device. The COVID pandemic made clear the benefits of telehealth services, providing a practical and safer way for many to visit with healthcare providers.

During the height of the pandemic, people who suspected they had COVID were asked to self-quarantine, making phone calls and video chats the optimal way to communicate with healthcare providers. As telehealth became more well-known, more people used it to avoid exposure to COVID and other illnesses.

Telehealth services can be especially beneficial to elderly populations concerned about underlying health conditions and at a greater risk of contracting COVID-19. Which can easily lead you to ask – Does Medicare cover telehealth services? Please continue reading to learn more about telehealth and what parts of Medicare cover it.

Does Medicare Cover Telehealth Services?

Telehealth services have become more commonplace and more acceptable, allowing you to have a virtual visit with a healthcare provider from anywhere. They’re often done on a computer, phone, or tablet and feature a live or video connection, but a phone call or audio-only visit can also be considered telehealth.

Medicare does cover telehealth visits, but because it is relatively new, it can be confusing, and there are some upcoming changes in coverage.

Original Medicare (Parts A and B)

Part A often deals with people staying in a healthcare facility or who need a skilled professional to visit them; these services are not possible remotely, which is why Part A does not cover telehealth. Part B covers doctor visits, outpatient care, and mental health visits. Therefore, those differences explain why Part B is required to cover telehealth services.

Telehealth Visits

Medicare Part B covers certain telehealth visits, whether video or audio-only. These can be office visits, consultations, or psychotherapy appointments. There are some limitations on what types of visits are covered, so it’s best to check with Medicare or your provider first. Assuming it’s a covered telehealth service, Medicare will treat it just as they would an in-person visit, giving you the same level of coverage.

Virtual Check-ins

A virtual check-in is categorized differently than a telehealth visit, but Medicare Part B still covers it. These check-ins require you to speak with your practitioner and provide verbal consent, which is also standard in a telehealth visit. The stipulation that sets a check-in apart is that it cannot be related to a recent medical visit that occurred within the past 7 days and cannot lead to an in-person medical visit within 24 hours or the “next available” appointment.

Your healthcare provider will know the difference, and the billing department will know how to categorize this visit.

E-visits

E-visits are another form of telehealth service that is categorized a bit differently. E-visits are done virtually and require clinical decision-making by the health care professional; therefore best used for short-term care.

Medicare Advantage (Part C)

Medicare Part C (or Medicare Advantage) is required to cover the same services as Medicare Parts A and B. Therefore, Medicare Advantage does cover telehealth visits. The nuance between them lies in that while Medicare Parts A and B are segments of Original Medicare, Part C is not. Private health insurers provide Part C plans, in contrast to Parts A and B.

Some types of Medicare Advantage plans go above and beyond Medicare telehealth regulations, offering extended benefits. These benefits are plan-dependent, so a close inspection of each plan is necessary to determine the level of coverage.

Benefits of Telehealth

Telehealth was around before COVID-19 but became especially useful during this period as people were trying to limit their exposure and self-quarantine. As it became more popular, even more benefits from telehealth medical services have been discovered, including:

• Comfort and convenience: People don’t have to drive or get a ride to a doctor’s office and can even stay in bed if they’re very sick.
• Control the spread of infectious diseases: COVID-19 isn’t the only contagious ailment, and it proved that keeping people who are ill away from others can help control the spread of viruses and other illnesses.
• Better assessment: Some healthcare providers, especially those in specialty areas, can evaluate better in a home environment. For example, allergists can get a better idea of your surroundings, neurologists can watch you navigate your home, and physical therapists can see how you perform exercises with your at-home equipment.
• Direct caregiver advice: If you live in an assisted living facility or have an at-home caregiver, it can be easier to coordinate a telehealth visit so the caregiver can be involved. This practice facilitates communication on critical caregiver instructions.
• More frequent care management: Quick check-ins can keep medical staff updated on a patient’s progress.
• Saves time: Telehealth can save time for the clinic and you and allow more people to receive necessary health care.
• Better access: Access to doctors is a huge benefit of telehealth services, especially for people living in remote or rural areas. Less geographic limitations open the door for better health care and specialized treatment plans.

Do Any Medicare Supplemental Policies Cover Telehealth?

Supplemental policies might also contribute to your telehealth coverage. Telehealth services are subject to any deductibles and copayments that apply to regular office visits. If you have supplemental insurance, they usually help with these out-of-pocket expenses.

Medigap

Medigap will help with telehealth bills like any other approved Medicare service. The key is ensuring that Medicare first approves your telehealth services.

Medigap is a supplemental policy for Original Medicare only; it’s not necessary with Medicare Advantage. Private insurers sell Medigap plans to help pay for deductibles, copayments, and coinsurance. Additionally, because private insurers sell them, each plan features differences in coverage.

Medicaid

Because each state administers Medicaid independently, there is significant variance in whether it will cover telehealth services.

Medicaid is an assistance program for low-income people of all ages. People who have Medicaid have low or no-charge medical expenses. Each state runs Medicaid, and although they follow federal guidelines, there can be a lot of differences. Those differences also apply to when Medicaid covers telehealth services. It’s best to check with your state and your Medicaid provider to determine what’s covered.

It is possible to have Medicaid, and Original Medicare or Medicare Advantage plans simultaneously. This situation is called dual eligibility, and both insurance providers will coordinate coverage. Again, these plans vary by state, so your insurer will have information on your specific situation and telehealth coverage.

Where Can I Receive Telehealth Services?

E-visits can occur almost anywhere, including your home, nursing home, assisted living facility, and even a family member’s home. Sometimes people need to go somewhere to conduct their telehealth visit, so they have reliable internet or assistance using the required computer programs.

While most people seek telehealth services from their homes, there are situations where you’ll want to take advantage of these services while in another facility. Qualified health centers and rural health clinics often feature telehealth services. More recently, renal dialysis facilities were approved to offer telehealth services.

2024 Telehealth Coverage Changes

Telehealth coverage for Medicare recipients expanded as a result of the COVID-19 pandemic. One of the expansions involved a 151-day extension period following the expiration of the public health emergency on October 13th, 2022. The Consolidated Appropriations Act of 2023 extended many Telehealth flexibilities through December 31, 2024.

Currently, the Centers for Medicare and Medicaid Services (CMS) are reviewing telehealth coverage for the future. It’s become apparent that this type of health care has benefits beyond COVID-19, and there’s a place for telehealth in the future of medicine and patient care. They’ve proposed adding several services to the coverage list, but they’re also looking at dropping some of the services deemed necessary only during the public health emergency.

Many healthcare organizations are offering recommendations that CMS and Congress are reviewing. So far, the House of Representatives has voted overwhelmingly for a bipartisan bill that extends Medicare telehealth payment and regulatory flexibility through the end of 2024.

Because of the fluid nature of Medicare benefits, keep tabs on how the shifts change in the future.