Does Medicare Cover Telehealth?

Telehealth services are virtual visits that providers offer through a phone, tablet, or computer.

While telehealth appointments may include video and audio, or just audio, most doctors prefer video appointments because they make it easier for them to understand patients' concerns, needs, symptoms, and questions. Telehealth services are relatively new, and as a result, many people are uncertain whether Medicare covers them.

Medicare Part B Covers Some Telehealth Services

Medicare Part B (Medical Insurance) covers telehealth services such as consultations, psychotherapy sessions, and office visits if the service provider is eligible and not located in your area. Medicare Part B covers telehealth services for various reasons. These include ensuring that diagnosis is conducted quickly and treating symptoms for acute stroke.

The insurance also covers telehealth services for patients who are on treatment for substance abuse or are suffering from mental disorders that keep occurring. It is important that you check with your healthcare provider to make sure the telehealth service you are interested in is covered by medical insurance.

Ideally, you should note that Medicare Advantage plans started offering extra telehealth benefits that were not in Part B of Medicare as of 2020. These benefits vary based on the provider and the plan, they can also be easily enjoyed at home.

Location Determines the Type of Telehealth Service You Can Receive with Part B

Your location plays a role in determining the type of telehealth services you can receive with Medicare Part B. In other words, you have to reside in a county outside the Metropolitan Statistical Area (MSA) or a rural Health Professional Shortage Area.

Since government agencies determine these areas, you can check if yours is eligible on the Health Resources & Services Administration site. As mentioned earlier, Part B only covers particular healthcare providers and appointments. For this reason, it is recommended that you check with your insurance provider before committing to telehealth services.

Medical Insurance Also Covers E-visits and Virtual Check-ins

Part B of Medicare covers both e-visits and virtual check-ins despite the fact that they are not in the category of “true” telehealth services.

E-visits

Under e-visits, you use an online patient portal to communicate with your healthcare provider, and before you start it, you have to notify your doctor. Additionally, many healthcare professionals offer e-visits, and they include:

• Physician assistants

• Nurse practitioners

• Doctors

• Speech-language pathologists

• Occupational therapists

• Physical therapists

E-visits also allow you to see licensed clinical social workers and clinical psychologists, however, this is only done under special conditions.

Virtual Check-ins

Virtual check-ins eliminate the need to go into the physician’s office by letting you talk with your doctor as well as other healthcare practitioners, like a physician assistant and nurse practitioner, via a recorded video, an integrated audio/video system, or a phone.

The doctor or the provider uses a patient portal to send you a response via secure text message, phone call, or email, they may also use a provider visit to send a response. It is worth noting that virtual check-ins differ from telehealth services in the sense that they come with some stipulations.

The first stipulation is that you have to talk with your practitioner or doctor before starting a virtual check-in. The second is that communication during a virtual check-in should not be related to a recent medical visit that happened within the previous week. It should also not lead to a medical visit with the “soonest appointment available” or the next 24 hours. Last but not least, verbal consent is a must and has to be documented in the patient’s medical record.

The Cost of a Medicare Telehealth Visit

Patients with medical insurance are supposed to make a coinsurance payment of 20% of the cost of the telehealth services the healthcare provider gives them. Ideally, you have to meet your deductible for Part B. To get an estimate of any cost that may be out of pocket, contact your provider, who will also offer detailed information about whether a particular service is covered.

How to Know If You Are Eligible for Telehealth Services

You become eligible for telehealth services by enrolling in Original Medicare. Individuals who are at least 65 years old are eligible for Medicare. Other groups of people who may also be eligible for Medicare are those with amyotrophic lateral sclerosis (ALS) and end-stage renal disease (ESRD). Additionally, you may be eligible for Medicare if a diagnosed disability makes you unable to work.

Summary

One of the main benefits of telehealth is that it can protect a beneficiary of Medicare during high-risk situations like the flu season. Furthermore, this was the case during the Covid-19 pandemic. Telehealth also plays a role in streamlining health services by allowing practitioners to virtually carry out such tasks as monitoring chronic conditions and conducting routine follow-ups.

Yes, it is true that medical insurance covers some telehealth services, however, it is still advisable that you contact your doctor for more information about which specific services are covered. You should also check whether your location makes you eligible for Medicare telehealth services.