Does Medicare Cover Telehealth Services?
Medicare can cover telehealth services like office visits, consultations and psychotherapy. You will be responsible for 20% of the cost. Some Medicare Advantage plans may offer expanded telehealth services.
What is Telehealth?
Telehealth is the delivery of health services remotely through digital communications or telecommunications. This includes live video conferencing over smartphones, tablets and computers 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 conference
- 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 and share 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, cardiac stats 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 Part B. They are also covered by Medicare Advantage plans, but the list of services and costs may vary.
Part B Coverage
Telehealth services are typically covered under Part B. This is because while the medium is different, the actual services are often the same that you would receive from an in-person doctor’s visit or consultation.
For Medicare to cover them, telehealth services must be provided by an eligible health care provider using an interactive two-way communications system — typically real-time audio and video.
Medicare Advantage Coverage
Medicare Advantage plans are provided through private insurers and are available regionally, so coverage differs from plan to plan. Medicare Advantage plans must at minimum include everything that is covered under Original Medicare, so telehealth services are covered.
These plans often include expanded benefits and coverage beyond what is available in Original Medicare, and that can include expanded or enhanced telehealth coverage. But you do typically have to remain within a network if you have Medicare Advantage.
Examples of Medicare-Covered Telehealth Services
Medicare covers office visits, consultations, psychotherapy and certain other services. Since telehealth is a relatively new field of medicine, Medicare may adjust the services covered as new ones emerge. Just recently, according to AARP, coverage was expanded to increase the availability of mental health services available via telehealth.
There are some disparities in telehealth coverage that may need to be eventually addressed as well. A recent study found that telehealth users were more likely to live in urban areas than rural areas.
This is an interesting development since telehealth seemingly could be most beneficial for those who don’t live in an area where in-person medical services are readily available.
- 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 into their office
Telehealth Costs Under Medicare
As with other Part B-covered services, Medicare will handle 80% of the cost of telehealth. This leaves you to pay 20% of the cost after you have met your Part B deductible.
If you have a Medicare Advantage plan, your costs may vary since each plan is unique. The cost of a telehealth visit is not necessarily less than the cost of an in-person doctor’s visit.
How Has COVID-19 Affected Medicare Telehealth Privileges?
The U.S. Centers for Medicare & Medicaid Services (CMS), 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.
Even as the pandemic has lessened in 2021 and 2022, telehealth expansion has not, with mental health services available via telehealth recently expanding. Telehealth coverage options available through Medicare may continue to grow as these services become more common.
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.
But according to the U.S. Department of Health and Human Services, the total number of telehealth visits in the United States jumped from 840,000 in 2019 to more than 52 million in 2020.
- Emergency department visits
- Initial nursing facility and discharge visits
- Occupational therapy
- Physical therapy
- Speech therapy
The pandemic-related expansions of Medicare-covered telehealth services were originally meant to be temporary when they were first approved, lasting only until the health emergency is over. But as telehealth continues to expand and grow in importance, it is unclear if that will remain the case as the pandemic continues to move toward a conclusion.
10 Cited Research Articles
- AARP. (2022, January 3). Biggest Medicare Changes for 2022. Retrieved from https://www.aarp.org/health/medicare-insurance/info-2022/changes-in-2022.html
- Cao, Y. J., Chen, D., Liu, Y., & Smith, M. (2021, December 13). Disparities in the Use of In-Person and Telehealth Primary Care Among High- and Low-Risk Medicare Beneficiaries During COVID-19. Journal of Patient Experience. Retrieved from https://journals.sagepub.com/doi/10.1177/23743735211065274
- 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, June 4). 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
- 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/
- Center for Connected Health Policy. (n.d.). Telehealth Policy 101: Medicare. Retrieved from https://www.cchpca.org/telehealth-policy/telehealth-and-medicare
- U.S. Centers for Medicare & Medicaid Services. (n.d.). Telehealth. Retrieved from https://www.medicare.gov/coverage/telehealth