Guide to Telehealth and Medicare

Guest

Last Updated: January 15th, 2021

Guest Post by Lindsay Engle

Technology offers increased access to health care via telehealth and telemedicine. For years, expanding telehealth has been a priority in the United States, especially to improve health care in rural areas. Yet, due to the global health crisis, these services are more widely available than before through Medicare. Beneficiaries should be aware of what types of virtual care receive coverage.

What's covered

Telehealth is a broader term that includes telemedicine, which refers to virtual, clinical services. Its use began as a way for people who live in rural areas to access medical professionals whose care was previously unavailable to them. Further, utilizing this technology reduces the burden on health care workers. Since the beginning of the pandemic, and even before, Medicare has been expanding telehealth coverage.

As the goal is to replicate an in-person office visit as much as possible, telehealth visits must happen in real-time. The visits most commonly take place over video conference. The only exceptions are in Alaska and Hawaii, where Medicare pays for the use of asynchronous store-and-forward technology.

One of the first questions participants have is what virtual services Medicare covers. Telehealth services that receive coverage from Medicare include:

  • Doctor visits, including preventive health visits
  • Evaluations for physical therapy and occupational therapy
  • Speech therapy
  • Psychotherapy and other mental health services
  • Treatment for substance abuse disorders
  • COVID-19 evaluation

To receive this care, the patient must be at home or in a permitted facility. However, there is no location restriction for the practitioner. The practitioner then determines whether subsequent care is necessary.

Telehealth receives coverage through Part B of Medicare. Part B is outpatient coverage, which also pays for standard doctor visits.

The Medicare Telehealth Parity Act of 2017 expanded telehealth under Medicare. Telehealth is part of Medicare's chronic care management program, which provides care for such conditions as cancer, diabetes, and arthritis. Virtual services offer patients a way to check in easily with their physicians and prevent future hospital stays.

As of 2019, CMS made some changes that made telehealth more widely available, including the ability for those in need of renal dialysis to receive these services at a facility or home. Additionally, the services are available to those suffering from an acute stroke no matter their location.

Medicare also covers remote patient monitoring for chronic and acute conditions. Remote patient monitoring utilizes technology to obtain patient data, such as heart rate and blood pressure. Physicians can review and analyze this data to make recommendations for health care.

Medicare telehealth costs

Those with Original Medicare pay 20 percent while Medicare covers the remaining 80 percent. If you have a Medigap plan, that 20 percent also receives coverage. Before scheduling a telehealth appointment, make sure Medicare covers the service that you need.

The cost of telehealth services varies due to several factors. The best way to find out how much you'll be paying is by speaking to your provider. To keep telehealth costs low, make sure your provider accepts Medicare assignment. If you have an Advantage plan, make sure they are in your network.

The amounts that doctors charge vary, and the type of facility where your doctor practices can also influence the price. Although telehealth is convenient, its costs are comparable to those for in-person health care. Thus, the pricing is consistent with the contention that telehealth is an equivalent form of care. Yet, some health care providers have been waiving their telehealth costs during the COVID-19 pandemic.

Medicare Advantage plans and telehealth

Since 2020, Advantage plan participants have access to a wide range of telemedicine benefits. These plans may offer more of this type of benefit than Original Medicare, meaning that they include services not covered by Part B. However, what's covered may differ by plan. The best way to find out what your Advantage plan offers is to check with your carrier.

Expansion of telehealth coverage during COVID-19

During the global health crisis, the Centers for Medicare and Medicaid Services (CMS) is increasing its coverage for telehealth services. The Coronavirus Aid, Relief and Economic Security (CARES) Act makes this possible.

Due to temporarily relaxed HIPAA guidelines, beneficiaries and doctors can now use their smartphones and tablets to communicate. Audio-only telehealth services are allowed under these waivers, which will continue until the end of the public health emergency. Generally, Medicare will only reimburse a live videoconference.

The waiver also makes these remote services available to new patients, rather than only established patients, as outlined previously. Adjustments such as these increase the number of people telehealth can help at this time.

This expansion is essential to slow the virus's spread, as it protects the patient and others with whom they might otherwise come into contact. Many providers waive fees for telehealth appointments to screen for COVID-19.

Several changes will be here to stay beyond the pandemic to make health care more accessible. These include telehealth for group psychotherapy, neurobehavioral status exams, and home visits with patients and/or family.

Medicare covers virtual check-ins and E-visits during the pandemic to treat COVID-19 and for other medically necessary purposes. These are not technically telehealth services, but they involve technology and receive coverage through Part B of Medicare.

Through a virtual check-in, you can use audio or video to communicate, and your practitioner can respond via phone, secure text message, email, patient portal, or audio/visit. E-visits involve the use of a patient portal to talk to providers. It's necessary to speak with your practitioner before starting either virtual check-ins or E-visits.

Also important to note is that virtual check-ins cannot be related to visits from the past week or lead to an appointment the next day (or soonest available). Practitioners can also remotely assess images or videos provided by the patient. Both virtual check-ins and E-visits are only for established patients, unlike telehealth visits, which new patients can access during the pandemic waiver.

The future of telehealth and Medicare

Medicare beneficiaries are generally at a higher risk for contracting COVID-19, so the program must offer protections. As technology improves and the pandemic continues, telehealth will become a mainstay in health care. The convenience of remote health care is sure to leave its mark on the population, and Medicare will likely adjust to accommodate more of these services in the near future.

Lindsay Engle is the Medicare expert for MedicareFAQ. She has been working in the Medicare space since 2017. She is featured in many publications and writes regularly for expert columns. She has a passion for sharing her expertise about Medicare to beneficiaries so they can better prepare for health care costs after retirement. You can find her on YouTube where she is featured on a channel for Medicare beneficiaries to become educated on all their options.

For more on telemedicine, visit these BestCompany.com articles:

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