Medicare Has Expanded its Telehealth Coverage. But Are You Taking Advantage?
The COVID-19 pandemic reshaped the way many of us think about, talk about and seek out our health care. People from all over the world who had never engaged in telehealth were now suddenly conversing with doctors over Facetime, having their condition monitored by a wearable device or following the workout instructions of a virtual trainer on a computer.
With health and medical facilities operating with limited staff and the fear of the coronavirus keeping people home, the use of telehealth soared in 2020. In fact, telehealth visits accounted for 23.6% of all health care interactions during the first four months of the pandemic, compared to just 0.3% in the months prior.
Telehealth has been especially useful for Medicare beneficiaries, many of whom do not get around well physically or for which transportation can be a chore. And with older adults becoming more tech savvy all the time, telehealth and Medicare makes for a natural pairing.
In late 2020, Medicare approved coverage of dozens of additional telehealth services that had not previously been covered by Medicare insurance. Some of these telemedicine services are covered until the end of the pandemic. Others will be (or already have been) made permanent.
As it turns out, the pandemic made the Centers for Medicare & Medicaid Services (CMS) rethink telehealth as well. So how do you know if you’re taking fully advantage of your Medicare telehealth benefits?
How does Medicare pay for telehealth?
Telehealth services are covered by Medicare Part B and Medicare Advantage (Medicare Part C) plans.
- You have to meet your annual Part B deductible (which is $233 in 2022) before your Part B coverage kicks in. Once you hit your Part B deductible for the year, you typically pay 20% Part B coinsurance of the Medicare-approved amount for outpatient services for the rest of the year.
- If your current insurance is a Medicare Advantage plan, your plan deductibles and coinsurance or copayment amounts will depend on your plan. Some Medicare Advantage plans may offer more telehealth services at lower costs than Original Medicare (Medicare Parts A and B). All Medicare Advantage plans are required to cover everything Original Medicare covers, including telehealth. Most Medicare Advantage plans also offer extra benefits Original Medicare doesn’t cover, such as dental, vision, prescription drugs and more. Some Medicare Advantage plans may offer expanded telehealth benefits that go beyond what Original Medicare would pay for
What telehealth services are covered by Medicare?
The list of telehealth services covered by Medicare is numerous and includes (but is not limited to):
- Doctor’s office visits
- Preventive health screenings
- Emergency department visits
- Physical and occupational therapy
- Behavioral health
- Patient education services
- Cognitive and physical performance tests
- Prosthetic training
- Alcohol screenings
- Speech therapy
- Obesity counseling
- Depression screenings
- Diabetes management
- Wheelchair management training
- Therapeutic exercises
- Caregiver health risk assessments
- Hearing tests
- Eye exams
The complete list of telehealth services covered by Original Medicare numbers into the hundreds. Check with your health care provider about which telehealth services are offered and which ones are covered by Medicare.
If you have Original Medicare, call 1-800-MEDICARE (1-800-633-4227) to find out if a particular telehealth service is covered by Medicare. If you have a Medicare Advantage insurance plan, contact your plan directly using the phone number on your plan ID card.
What type of facilities offer telehealth covered by Medicare?
Medicare-covered telehealth can be found in:
- Critical access hospitals
- Renal dialysis centers (both hospital-based and non-hospital-based)
- Doctor’s offices
- Community mental health centers
- Rural health clinics
- Federally qualified health centers
- Skilled nursing facilities
- Mobile stroke units
- Community mental health centers
What are examples of telehealth?
Telehealth can come in many forms. Some examples include:
- Virtual visits with a health care professional using a computer, smartphone or tablet. While telehealth appointments can be audio-only, most health care providers utilize video calls so you and your doctor can see each other during your discussion.
- Wearable sensors that track vital signs and other metrics of your health and relay information back to your doctor.
- Online videos about how to take certain medications, use an inhaler or other activities of self-care that may require some instruction.
- Live online chats or nurse hotlines.
- Mobile health and fitness apps that track and share health metrics, set reminders for appointments and prescriptions and more.
“Telehealth” and “telemedicine” are often used interchangeably. Telemedicine is a more narrowly focused term that refers to clinical services, while telehealth is a broader spectrum that includes telemedicine but also encompasses education and training, administrative meetings and more.
What are the benefits of telehealth?
Some of the benefits of telehealth include:
Increased access to care
Telehealth allows patients to connect with health care providers from just about anywhere in the world. With telehealth, you no longer have to re-arrange your schedule to accommodate a doctor’s appointment or postpone because of transportation issues.
Telehealth can even offer round-the-clock access to health care professionals during times that would otherwise not be possible.
A doctor’s office waiting room full of sick people is one of the last places someone with a compromised immune system should be. Telehealth keeps people away from germs and other health hazards that may be encountered during a trip to a medical facility.
This benefit of telehealth was brought to the forefront with the highly contagious coronavirus.
For someone with mobility issues, a journey to a doctor’s office can be quite an ordeal. And that’s not to mention the hard chairs and tables a patient has to sit on once there.
Telehealth allows you to remain in the comfort of your own home – even your own bed – while receiving the medical attention you need.
An older adult may lean on an adult child or sibling for help managing their care. And if that person lives in a faraway place, they are of little help during in-person appointments. But with telehealth, a loved one can be looped into the virtual meeting to assist with taking notes, asking questions and managing care.
What are some tips for using telehealth?
Below are five things you can do to make the most of your telehealth benefits and experience.
1. Find a good place to do it.
A quiet, comfortable place to sit with good lighting and a strong internet connection is important when conducting a telehealth appointment. Turn off all surrounding distractions and make sure you and your doctor can see and hear each other clearly.
Communication is vital in health care, so you don’t want to jeopardize it with background noise or a poor connection.
2. Log in early.
Your time with your doctor is valuable (and often expensive). It’s wise to log into your appointment early to make sure your camera, audio and everything else with your device is working properly so you can spend your appointment time troubleshooting your body and not your technology.
3. Have a pen and paper ready.
Have a paper and pen handy to take notes and jot down follow-up questions.
It also helps to write down any questions you may have before the appointment begins so you don’t forget anything once the discussion gets underway. Also make note of any changes to your health since your last appointment.
4. Have your medications with you.
Have your medications with you during the session so you can accurately reference brands, dosages and how often you take them. Having your medications with you will also help facilitate a discussion about your need for any refills.
If you’re taking any over-the-counter products, have those with you as well, so you can discuss how they interact with your prescriptions.
5. Check your vital signs.
Weigh yourself before your telehealth appointment and record any vital signs that you can such as blood pressure, heart rate and temperature.
How can you maximize your Medicare telehealth benefits?
While Original Medicare offers a number of telehealth benefits, one way to really maximize your coverage for this type of care is to sign up for a Medicare Advantage plan or to apply for a Medicare Supplement Insurance (Medigap) plan.
Medicare Advantage plans and Medicare Supplement plans are very different, and they help cover Medicare telemedicine in different ways. You cannot have a Medicare Advantage plan and a Medicare Supplement plan at the same time.
- Medicare Advantage plans cover everything found in Medicare Part A and Part B, and most plans offer extra benefits not found in Original Medicare like dental, vision, hearing and prescription drug coverage.Some Medicare Advantage plans also offer more telehealth services than Original Medicare covers. For example, it’s common for Medicare Advantage plans to include access to a 24/7 nurse hotline where plan members can connect with a certified nurse practitioner at any time of day or night for questions and concerns about their health.
- Medigap plans are used in conjunction with Original Medicare to help cover many of the out-of-pocket costs required by Part A and Part B. These covered costs can include the Medicare Part B coinsurance requirement for which telehealth patients are charged.In exchange for a monthly premium for a Medigap plan, your Part B coinsurance can be covered in full when receiving telehealth services after you meet your Part B deductible.
A Medicare Supplement plan can’t offer more telehealth benefits than your Original Medicare coverage, but it can help pay your coinsurance costs.
If you’ll be shopping for Medicare coverage during your next Medicare open enrollment period, you might instead consider a Medicare Advantage plan with expanded telehealth benefits so you can take full advantage of your coverage from the comfort of your own home.
About the Author
Christian Worstell is a senior Medicare and health insurance writer with HelpAdivsor.com. He is also a licensed health insurance agent. Christian is well-known in the insurance industry for the thousands of educational articles he’s written, helping Americans better understand their health insurance and Medicare coverage.
Christian’s work as a Medicare expert has appeared in several top-tier and trade news outlets including Forbes, MarketWatch, WebMD and Yahoo! Finance.
While at HelpAdvisor, Christian has written hundreds of articles that teach Medicare beneficiaries the best practices for navigating Medicare. His articles are read by thousands of older Americans each month. By better understanding their health care coverage, readers may hopefully learn how to limit their out-of-pocket Medicare spending and access quality medical care.
Christian’s passion for his role stems from his desire to make a difference in the senior community. He strongly believes that the more beneficiaries know about their Medicare coverage, the better their overall health and wellness is as a result.
A current resident of Raleigh, Christian is a graduate of Shippensburg University with a bachelor’s degree in journalism.