Does Medicare Cover Telehealth & Telemedicine?
Key Takeaways
- Medicare Part BMedicare Part B is medical insurance that covers Medicare-approved services — such as medically necessary treatment and preventive services — and certain other costs, like durable medical equipment. Medicare Part B is part of Original Medicare. covers telehealth services, including office visits, consultations, psychotherapy and other Medicare-approved services.
- Telehealth and telemedicine refer to health services performed remotely by a doctor or other provider using video conferencing.
- Medicare covers telehealth services, but some Medicare AdvantageMedicare Advantage (Medicare Part C) is health insurance for Americans aged 65 and older that blends Medicare benefits with private health insurance. This typically includes a bundle of Original Medicare (Parts A and B) and Medicare Prescription Drug Plan (Part D). plans may offer broader telehealth benefits than Original MedicareOriginal Medicare is a fee-for-service health insurance program available to Americans aged 65 and older and some individuals with disabilities. Original Medicare is provided by the federal government and is made up of two parts: Part A (hospital insurance) and Part B (medical insurance). .
How Much Does Medicare Telehealth Visit Cost?
Telehealth services can be very cost-effective in comparison to traditional in-office treatments. According to a study conducted by Health Affairs, the average cost for a telehealth visit is $79, well below the $146 average for office visits. It’s always a good idea to call your provider ahead of time to see what your telehealth coverage includes and how much it costs.
How Much Does Medicare Pay for Telehealth?
Telehealth is covered by Part B and charges Medicare beneficiaries similarly to other services; you’ll pay a 20% coinsurance for Medicare-approved services after your Part B deductible is met. Medicare will cover the remaining 80%. How does telehealth work in comparison to in-person visits? For most telehealth services, you’ll pay the same amount.
Note: COVID-19 testing and related services are an exception. The Families First Coronavirus Response Act waived Part B coinsurance and deductibles (cost-sharing) for COVID-19 testing and results, including related telehealth visits. You may still pay a copay to the provider for these services, but the Federal Government allows doctors to waive this fee.
What Is Telemedicine?
Telehealth is different from telemedicine in that it refers to a broader scope of remote health care services than telemedicine. Telemedicine refers specifically to remote clinical services, while telehealth can refer to remote non-clinical services.
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Does Medicare Cover Telehealth Calls?
Medicare covers many, but not all, phone visits with your doctor. Like telehealth appointments, Medicare-approved phone visits are covered at the same rate as office visits. Also, like telehealth, the types of phone visits covered by Medicare were expanded in response to COVID-19. They now include behavioral health visits, patient education, and more.
What Telehealth Services Are Covered by Medicare?
Telehealth coverage includes hundreds of Medicare-approved benefits. The Centers for Medicare & Medicaid Services (CMS) more than doubled the number of services beneficiaries could receive once the COVID-19 pandemic began. This was done to limit community spread and help keep patients, doctors, and staff members healthy. Some of the changes have even been made permanent, such as allowing Medicare patients to receive behavioral and mental healthcare services at home.
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How Does Medicare Advantage Cover Telehealth?
Your coverage depends on your specific Medicare Advantage (Part C) policy. Many Part C plans offer broader telehealth coverage than Original Medicare. To see how to use telehealth with your policy, talk with your insurance company to see what benefits are covered.
Is Medicare Telehealth Coverage Temporary?
Medicare temporarily expanded its telehealth coverage to limit the spread of COVID-19 and extended those services through the end of 2024. In the past, Medicare provided telehealth coverage only under particular circumstances, such as for beneficiaries who lived in rural areas.
Many Medicare Advantage plans began offering expanded telehealth services as part of their standard benefits starting in 2021. To see which plans in your area offer telehealth coverage, give GoHealth a call. With a team of licensed insurance agents ready to discuss your telehealth needs, we have the know-how to find an option that works for you.
Sources
- Trump Administration Finalizes Permanent Expansion of Medicare Telehealth Services and Improved Payment for Time Doctors Spend with Patients. CMS.gov
- Direct-To-Consumer Telehealth May Increase Access To Care But Does Not Decrease Spending. Healthaffairs.com.
- List of Telehealth Services. CMS.gov.
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