Medicare is an insurance policy for people who are 65 or older. Since the older group is more at risk for contracting COVID-19, the elders had the highest number of trips to online health by 2020. Telehealth usage increased for people over 65 during the first season of COVID-19.
According to the U.S. Department of Health and Human Services — Medicare fees for telehealth programs have risen from 840,000 in 2019 to more than fifty million as of 2020. But, does Medicare cover telehealth services? Let’s find it out.
What is Telehealth
Telehealth refers to the practice of providing medical care over the internet.
It allows people to connect with healthcare providers via computer, tablet, or smartphone to obtain healthcare services.
Telehealth and Original Medicare
In March 2020, the Centers for Medicare & Medicaid Services (CMS) expanded access to telehealth services to protect Medicare enrollees from the coronavirus. Before the pandemic, Medicare only provided limited funding for telehealth services.
Three types of telehealth services are covered by Medicare Part B (medical insurance):
- Telehealth visits replace office visits, hospital visits, psychotherapy, consultations, and other in-person services. Notably, audio and visual communication technology is required for these sessions.
- Virtual check-ins permit you to talk with your physician for a few minutes on the phone, text messages, email, or a dedicated online portal for patients. Verbal consent is necessary to use virtual check-ins, however. This authorization must be documented in your medical record as well.
Medicare Advantage plans are alternatives to traditional Medicare coverage that can be purchased privately. Medicare Advantage also provides telehealth services that Original Medicare does not cover. You must contact your insurance provider to confirm specific coverage.
Telehealth and Medicare Advantage
According to the National Council on Aging, the beneficiaries of a Medicare Advantage (Part C) plan typically have the same coverage for telehealth as those who have Parts of A and B (Original Medicare). However, some Medicare Advantage plans may offer an expanded range of telemedicine services.
Since private insurers run Medicare Advantage plans, the exact telehealth benefits an individual plan provides could differ. Therefore, a person should inquire about the coverage offered by their insurance provider directly before enrolling.
Coinsurance and deductibles apply for Telehealth services. However, certain medical professionals may not charge for the telemedicine visit.
However, some healthcare professionals do not endorse this practice. Therefore, one could ask the healthcare professional if they waive charges for coronavirus screenings or other telehealth services.
There may be a need for transport to a hospital in certain instances. And some plans provide non-urgent transportation to a hospital or doctors’ offices. It is recommended to check with the insurance company to learn about their plan’s transport requirements.
What Are Telehealth Services Available to Medicare Beneficiaries?
Telehealth is a method of delivering healthcare to patients through technology. The services available are:
- Wellness visits
- Urgent care
- Office visits
- Preventive health screenings
- Mental health counseling
- Substance use disorder treatment
- Home dialysis visits for patients with the end-stage renal disease every month.
What is the Coverage of Telehealth Services Under Traditional Medicare?
Services provided through Telehealth are covered by Medicare Part B. The typical cost is 20 percent of the Medicare-approved cost for the services you receive from your provider once you’ve met the Part B threshold. For example, in 2022, your Part B deductible will be $233.
Out-of-pocket costs can vary during the outbreak. Providers can cut or eliminate cost-sharing for health visits via telehealth during the COVID-19 public health crisis. It means that your provider might not be able to charge any or all of the costs you incur out-of-pocket.
Many Medicare Advantage plans cover telehealth. In addition, they may also reduce or even eliminate cost-sharing on health visits to telehealth during COVID-19 emergencies. Contact your insurance company for more information on benefits and costs.
Are There Any Other Medicare Telehealth Benefits I Should Know?
Telehealth services can be accessed at locations other than your own home. For example, you may access telehealth coverage from the renal dialysis center.
The new rules permit telehealth services to be provided in any geographical area for Medicare enrollees. The services are offered through federally certified health centers and rural health clinics during the COVID-19 crisis.
Medicare also provides audio-only telehealth services like calling.
Medicare Advantage plans can provide additional telehealth benefits over original Medicare. Make sure to inquire with your provider for more specific details.
Are there any supplemental policies that cover telehealth costs?
Supplemental coverage can cover out-of-pocket costs for initial Medicare health visits via telehealth. The secondary payers are as follows:
- Medigap insurance, which is supplemental insurance, is sold by private companies.
- Retiree insurance is a group plan provided by a previous employer or union.
- Medicaid can cover deductibles, copays, and coinsurance for people with limited income or resources.
Is telehealth coverage available to all Medicare enrollees or just those in certain areas?
Original Medicare access to telehealth was not as extensive. Telehealth was initially only available in a few locations and settings, such as for those living in rural areas. The pandemic has increased the availability of telehealth services for all first-time Medicare enrollees throughout the United States and in any location, including your own home.
Thanks to telehealth, Medicare beneficiaries can receive care via smartphones, computers, and tablets. Original Medicare covers this care in the same way that in-person appointments do. In addition, your provider may waive or reduce out-of-pocket expenses during the COVID-19 public health emergency. Supplemental insurance may help you pay a portion of your telehealth bill. Medicare Advantage plans may also provide access to telehealth services.
If you’re still looking for a suitable Medicare plan or are hesitant to make the right choice, we can help you with the right decision. Contact our licensed agents specializing in Medicare now!