Medicare covers a wide variety of medical and health-related services, including telehealth. Telehealth uses electronic communication technology to allow long-distance healthcare visits and education. Continue reading to learn more about telehealth, what parts of Medicare cover it, and more.
Medicare is made up of several parts that each provide a different type of coverage. The main parts include:
- Medicare Part A (hospital insurance)
- Medicare Part B (medical insurance)
- Medicare Part C (Advantage plans)
- Medicare Part D (prescription drug coverage)
Telehealth is covered by Medicare parts B and C. We’ll break this down further below.
What does Medicare Part B cover?
Medicare Part B covers some telehealth services. Together, Medicare Part A and Part B are sometimes called original Medicare.
A telehealth visit is treated the same as if you went to an in-person outpatient visit. The types of telehealth service that are covered include:
- office visits
Some examples of healthcare professionals who can provide telehealth services include:
- physician assistants
- nurse practitioners
- clinical psychologists
- certified nurse anesthetists
- registered dietitians
- licensed nutrition professionals
- clinical social workers
In some cases, you can get telehealth services from your home. In others, you’ll need to go to a healthcare facility.
What does Medicare Part C cover?
Medicare Part C is also referred to as Medicare Advantage. Private insurance companies sell Part C plans. Part C includes the same coverage as original Medicare but may also include additional benefits.
In 2020, changes were made to Part C that may allow it to offer more telehealth benefits than original Medicare. These changes include increased access to telehealth benefits from home instead of requiring a visit to a healthcare facility.
Additional benefits can vary based on your Part C plan. Check your specific plan to see what type of telehealth benefits are offered.
When should i use telehealth?
Below are some examples of when telehealth might be used:
- training or education, such as learning techniques for diabetes monitoring
- care planning for a chronic medical condition
- getting a consultation with a specialist who’s not in your area
- mental health services
- screenings, such as those for depression or alcohol use disorder
- advance care planning
- nutritional therapy
- receiving help to quit smoking
- getting a health risk assessment
If you have Part B, you’ll be responsible for a coinsurance payment of 20 percent of the cost of the telehealth services you receive. Keep in mind that you must first meet your Part B deductible, which is $203 for 2021.
Part C plans are required to provide the same basic coverage as original Medicare. However, you’ll want to contact your plan’s provider before using telehealth services to make sure a particular service is covered and to get an estimate on any out-of-pocket cost.
Once you’re enrolled in original Medicare, you’ll be eligible for telehealth services.
You may be eligible for Medicare if you’re 65 years old and over, have end stage renal disease (ESRD) or amyotrophic lateral sclerosis (ALS), or if you’re unable to work because of a diagnosed disability.
People with Part B coverage often need to go to a healthcare facility for telehealth services. Check with your plan to find out if you should go to an approved facility for your visit. These types of facilities include:
- doctor’s offices
- skilled nursing facilities
- community mental health centers
- rural health clinics
- critical access hospitals
- hospital-based dialysis facilities
- federally qualified health centers, which are federally funded nonprofits that provide medical services to those who can’t afford them
The type of telehealth services that you can receive with original Medicare can depend on your location. This means you must be located in a county that’s outside the Metropolitan Statistical Area or a rural Health Professional Shortage Area.
These areas are determined by government agencies. You can check your location’s eligibility on the Health Resources and Services Administration website.
Remember that only specific types of healthcare providers and appointments are covered. If you aren’t sure if something is covered, check with your insurance provider before initiating telehealth services.
The 2018 Bipartisan Budget Act expanded telehealth coverage for those with Medicare. There are now some situations when you may be exempt from the usual Medicare rules related to telehealth. Let’s take a closer look:
If you have ESRD and are receiving at-home dialysis, you may receive telehealth services either at home or at your dialysis facility. Location restrictions related to telehealth are also eliminated.
However, you must have occasional in-person visits with a healthcare professional after beginning at-home dialysis. These visits should take place once a month for the first 3 months and then every 3 months going forward.
Telehealth services may help you get quicker evaluation, diagnosis, and treatment of a stroke. Therefore, telehealth services may be used for an acute stroke no matter your location.
Accountable care organizations (ACOs)
ACOs are groups of healthcare providers that work together to coordinate care for people with Medicare. This type of coordinated care will make sure that if you’re ill or have chronic health conditions, you’ll get the care that you need.
If you have Medicare and use an ACO, you’re now eligible to receive telehealth services at home. Location restrictions don’t apply.
Medicare virtual check-ins and E-visits
Medicare also covers some additional services that are very similar to telehealth visits. These services are available to all Medicare beneficiaries across the country, regardless of location.
- Virtual check-ins. These are brief audio or video communications you request from your healthcare provider to avoid unnecessary office visits.
- E-visits. These give you another way to communicate with your healthcare provider through a patient portal.
Like a telehealth visit, you’ll only be responsible for 20 percent of the cost for a virtual check-in or an E-visit. To set up virtual check-ins or E-visits, you must first speak with your healthcare provider.
Telehealth in the time of covid-19
In light of the COVID-19 pandemic, some changes have been made to telehealth services covered by Medicare. These changes were made to help prevent the spread of the virus, particularly to those are at risk of serious illness.
The following changes are currently in effect:
- Medicare beneficiaries can receive telehealth services from any type of originating facility, including in their own home.
- Restrictions on location are lifted, so Medicare beneficiaries anywhere across the country can use telehealth services.
- Healthcare providers can now waive or reduce cost-sharing for telehealth services that are paid for by federal healthcare programs such as Medicare.
- You no longer need to have an established relationship with a specific healthcare provider to use telehealth services.
Telehealth has several potential benefits. First, it can help protect Medicare beneficiaries during high-risk situations. This has been particularly true during the COVID-19 pandemic but could also be good practice during flu season.
Telehealth also helps streamline health services. For example, things like routine follow-ups and monitoring of chronic conditions often can be done using telehealth. This may potentially reduce the volume of in-person visits in an already overstressed healthcare system.
Telehealth can also be useful if you’re in rural, hard-to-reach, or lower-resourced locations. It provides ready access to various healthcare professionals or specialists who may not be located in your area.
Even though telehealth offers several benefits, not everyone knows that it’s an option. One small 2020 study at a dialysis facility found that only 37 percent of participants had heard of telehealth. This shows that efforts are needed to increase awareness.
Telehealth is when long-distance medical services are provided through the use of technology, such as videoconferencing. Medicare covers some types of telehealth, and it looks like this coverage will increase going forward.
Medicare Part B covers telehealth when it’s used for an office visit, psychotherapy, or a consultation. Only certain healthcare professionals and locations are covered. Medicare Part C may offer additional coverage, but this may vary by your specific plan.
Typically, there are location restrictions for Medicare-covered telehealth services. However, these have been expanded by the 2018 Bipartisan Budget Act and the COVID-19 pandemic.
If you’re interested in receiving telehealth services, speak with your healthcare provider. They’ll let you know if they provide them and how to schedule an appointment.