Does Medicare Cover Telehealth Services?
Medicare Part B covers a portion of certain telehealth services including office visits, consultations and psychotherapy, but you are still responsible for your deductible and 20 percent of the cost. Medicare Advantage plans may offer more telehealth services than Original Medicare.
What Is Telehealth?
Telehealth is the delivery of health services remotely through digital communications or telecommunications. This can include through live video conferencing, over smartphones and tablets through mobile health apps.
It is part of a much larger field called telemedicine that applies to wide-ranging virtual health and medical services.
Telehealth applies to a relatively narrow list of virtual services including long-distance clinical health care, health-related education for both patients and medical professionals and public health efforts.
- Live video conferencing
- These are real-time video communications including office visits and consultations you can make over your phone, tablet or computer.
- Mobile health apps
- Mobile health apps — also known as mHealth — are health care apps you can download to your smartphone, tablet or laptop. They allow you to track health measurements and set reminders for medications and appointments.
- “Store and forward” transmission
- Store and forward refers to capturing, storing and transmitting patient information electronically. It uses secure systems to distribute your CT scans, MRIs, X-rays and other health information to your health care team of specialists and other doctors or health care professionals.
- Remote patient monitoring (RPM)
- RPM uses wearable or mobile devices, apps and internet-connected computers to gather and send your personal health data securely to your doctor. This may include updates when you measure your weight, blood pressure, heart condition or respiratory rates.
What Telehealth Services Are Covered by Medicare
Not all telehealth services are covered by Medicare. Those that are will be covered by Medicare Part B medical insurance. They are also covered by Medicare Advantage plans, but the list of services and costs may vary.
Medicare covers office visits, consultations, psychotherapy and certain other services. Medicare may adjust the services covered as new ones emerge. The services have to be provided by an eligible health care provider using an interactive two-way communications system — typically real-time audio and video.
You still have to pay 20 percent of the Medicare-approved amount for the services. Your Medicare Part B deductible also applies. You will generally pay the same amount as if you received the services in person.
- Telehealth services you receive for dialysis at a renal dialysis facility or at home
- Services that provide faster diagnosis, evaluation and treatment of acute stroke symptoms regardless of where you are
- Home telehealth services if you’re being treated for substance use or certain mental health disorders
- Virtual check-ins – using your phone, tablet or computer to talk to your doctor or other health care professional
- Virtual E-visits – using your doctor or other health care provider’s online patient portal instead of going to into their office
Original Medicare only reimburses health care providers for certain, specific telehealth services. For instance, Medicare prohibits coverage for store and forward services except for demonstration programs run by Medicare in Alaska and Hawaii.
How COVID-19 Has Affected Medicare Telehealth Privileges
The U.S. Centers for Medicare & Medicaid Services, which administers Medicare, expanded telehealth coverage early in the COVID-19 pandemic. CMS added 135 new services it would cover — effectively doubling the number of covered telehealth services.
- Emergency department visits
- Initial nursing facility and discharge visits
- Occupational therapy
- Physical therapy
- Speech therapy
CMS also guaranteed that doctors and other health care providers would be paid for telehealth services at the same rate for in-person care. It also let providers offer services in different healthcare settings including home health, hospice and inpatient rehabilitation facilities.
Prior to the pandemic, telehealth services were typically limited to people in rural areas who could not easily travel to the appropriate health care professionals’ offices.
“Before the public health emergency, approximately 13,000 beneficiaries in fee-for-service (FFS) Medicare received telemedicine in a week,” CMS Administrator Seema Verma wrote in Health Affairs in July 2020. “In the last week of April, nearly 1.7 million beneficiaries received telehealth services.”
The pandemic-related expansions of Medicare-covered telehealth services are meant to be temporary, lasting only until the health emergency is over.
But more than nine million beneficiaries took advantage of telehealth services in the first three months of the pandemic, according to Verma. She said that the “rapid explosion” of telehealth visits raised the question of whether Medicare should roll back these expansions after the pandemic has passed.
8 Cited Research Articles
- O’Brien, S. (2020, August 13). Medicare Telehealth Expansion Could Be Here to Stay. Here’s Where Things Stand. Retrieved from https://www.cnbc.com/2020/08/13/medicare-telehealth-expansion-could-be-here-to-stay.html
- Verma, S. (2020, July 15). Early Impact of CMS Expansion of Medicare Telehealth During COVID-19. Retrieved from https://www.healthaffairs.org/do/10.1377/hblog20200715.454789/full/
- American Psychological Association Services. (2020, May 6). Temporary Changes to Federal Medicare Telehealth Policies. Retrieved from https://www.apaservices.org/practice/reimbursement/government/medicare-telehealth-temporary-changes
- Brandon, E. (2020, March 27). How to Use Medicare’s New Telehealth Coverage. Retrieved from https://money.usnews.com/money/retirement/medicare/articles/how-to-use-medicares-new-telehealth-coverage
- NEMJ Catalyst. (2018, February 1). What Is Telehealth? Retrieved from https://catalyst.nejm.org/doi/full/10.1056/CAT.18.0268
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Telehealth. Retrieved from https://www.medicare.gov/coverage/telehealth
- Center for Connected Health Policy. (n.d.). Telehealth and Medicare. Retrieved from https://www.cchpca.org/telehealth-policy/telehealth-and-medicare
- American Speech-Language-Hearing Association. (n.d.). Providing Telehealth Services Under Medicare During the COVID-19 Pandemic. Retrieved from https://www.asha.org/Practice/reimbursement/medicare/Providing-Telehealth-Services-Under-Medicare-During-the-COVID-19-Pandemic/