Today it’s become a common practice for business and services providers to offer contact less consultations and services through digital or virtual platforms and Medicare is no different. Everyday more and more healthcare providers are offering telehealth services.
Telehealth services is a term used when referring to health care services such as virtual consultations and visits using a smartphone, tablet, or computer. When looking at Telehealth services it’s possible that your services may include audio and video. While quality audio will help you communicate effectively, video will allow your health care provider to better understand your questions, symptoms, concerns and needs. Since telehealth services are relatively new it’s important to understand how Medicare coverage for telehealth works.
Due to the Coronavirus (COVID-19) Public Health Emergency, doctors and other health care providers can use telehealth services to treat COVID-19 (and for other medically reasonable purposes) from offices, hospitals, and places of residence (like homes, nursing homes, and assisted living facilities) as of March 6, 2020. Coinsurance and deductibles apply, though some healthcare providers are reducing or waiving the amount you pay for telehealth visits.
If you have coverage through a Medicare Advantage Plan, you won’t have to pay out-of-pocket costs (called cost-sharing) for COVID-19 tests. They may also offer more telehealth services than what was included in their approved 2020 benefits.
To find out how much your test, item, or service will cost, talk to your doctor or health care provider. The specific amount you’ll owe may depend on several things, like:
Other insurance you may have
How much your doctor charges
Whether your doctor accepts assignment
The type of facility
Where you get your test, item, or service
Medicare and Telehealth Services.
Medicare Part B will provide coverage for various telehealth services such as office visits, psychotherapy sessions and consultations. The coverage of these services will be dependent upon the eligibility and location of your provider.
Medicare Part B will also cover telehealth services that enable a rapid diagnosis, evaluation and treatment of symptoms for acute stroke. Coverage for telehealth services from home is also provided for individuals that are suffering from substance abuse, or a co-occurring mental health disorder. It’s important that you check with your provider regarding the coverage of telehealth services prior to use.
For most telehealth services, you'll pay the same amount that you would if you got the services in person.
As of 2020, many Medicare Advantage Plans may offer additional telehealth benefits that are not covered by the Medicare Part B.
Will Geographical Locations Impact Medicare Coverage for Telehealth Services?
Geographical locations may impact your Medicare coverage for telehealth services. If you currently reside in a rural area, under predefined conditions, additional telehealth services are covered. Telehealth services are covered for the locations mentioned below:
Doctor’s office.
Hospital.
Critical access hospital (CAH).
Rural health clinic.
Federally qualified health center.
Hospital based dialysis facility.
Skilled nursing facility.
Community mental health center.
Renal dialysis facility.
Virtual Check-ins and E-Visits.
Medicare also provides services for virtual check-ins and e-visits. Although virtual check-ins and e-visits are not categorized as true telehealth services Medicare Part B does provide coverage for both.
Virtual check-ins allow you to talk to your doctor or certain other practitioners, like nurse practitioners or physician assistants, using a device like your phone, integrated audio/video system, or captured video image without going to the doctor’s office.
Your doctor or other practitioner can respond to you using:
Phone
Audio/visit
Secure text messages
Email
Use of a patient portal
However, there are some stipulations that are applied on virtual check-ins in order for coverage to be provided.
You must talk with the doctor or other practitioner to start a virtual check-in.
Communication during a virtual check-in can’t be related to a recent medical visit that was done in the past 7 days and cannot lead to a medical visit within the next 24 hours.
Verbal consent is mandatory and must be documented in your medical records.
E-visit makes use of an online patient portal that allows you to communicate with your doctor or any other provider. It’s important to talk to your provider so that you may start an E-visit. Provided below are health care providers that are allowed to provide E-visits:-
Doctors
Physical therapists
Occupational therapists
Speech language pathologists
Nurse practitioners
Physician assistants
Clinical psychologists and licensed clinical social workers are also allowed to provide E-visits under special circumstances.
Telehealth services can offer an easy way to take care of your health from home. It is important to understand what is covered and your costs. Contact your plan provider for more details on exactly what is available to you.
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