Today, many businesses and service providers offer contactless consultations and services through digital or virtual platforms. Medicare Telehealth services are part of this evolving trend. Medicare follows the same trend. Every day, more health care providers add telehealth services.

Telehealth refers to health care services such as virtual consultations and visits using a smartphone, tablet, or computer. Your telehealth session may include both audio and video. Quality audio helps you communicate clearly, while video allows your provider to better understand your questions, symptoms, and concerns. Since telehealth remains a relatively new option, you need to understand how Medicare covers it.

COVID-19 and Telehealth

During the Coronavirus (COVID-19) Public Health Emergency, doctors and other providers began using telehealth to treat COVID-19 and other medically reasonable conditions. They can deliver these services from offices, hospitals, homes, nursing homes, and assisted living facilities. Coinsurance and deductibles still apply, but some providers reduce or waive your out-of-pocket costs for telehealth visits.

If you have coverage through a Medicare Advantage Plan, you don’t pay out-of-pocket costs (called cost-sharing) for COVID-19 tests.

Costs for Tests, Items, and Services

To learn how much a test, item, or service will cost, ask your doctor or health care provider. The specific amount you owe depends on factors such as:

• Other insurance you have

• How much your doctor charges

• Whether your doctor accepts assignment

• The type of facility

• Where you receive care

Medicare and Telehealth Services

Medicare Part B covers various telehealth services such as office visits, psychotherapy, and consultations. Your coverage depends on your provider’s eligibility and location.

Medicare Part B also covers telehealth services that support rapid diagnosis and treatment of acute stroke symptoms. It also covers telehealth from home for individuals facing substance abuse or co-occurring mental health disorders. Always check with your provider before using telehealth to confirm coverage.

For most telehealth services, you’ll pay the same amount you would for in-person care.

As of 2020, many Medicare Advantage Plans also include extra telehealth benefits that Medicare Part B does not cover.

Geographic Impact on Telehealth Coverage

Your location can affect Medicare coverage for telehealth. If you live in a rural area, you may qualify for additional telehealth services under specific conditions. Medicare covers telehealth in these locations:

• Doctor’s office

• Hospital

• Critical access hospital (CAH)

• Rural health clinic

• Federally qualified health center

• Hospital-based dialysis facility

• Skilled nursing facility

• Community mental health center

• Renal dialysis facility

Virtual Check-Ins and E-Visits

Medicare also pays for virtual check-ins and e-visits. Although they don’t fall under true telehealth, Medicare Part B still covers them.

Virtual check-ins let you talk with your doctor or another qualified practitioner, such as a nurse practitioner or physician assistant. You can use your phone, an audio/video system, or even a captured video image—without visiting the office.

Your doctor or practitioner may respond using:

• Phone

• Audio/video

• Secure text messages

• Email

• A patient portal

To qualify, you must talk with your provider to start the check-in. The communication cannot relate to a medical visit in the past seven days and cannot lead to one in the next 24 hours. You must give verbal consent, and your provider must document it in your medical record.

E-visits use an online patient portal that allows you to communicate with your provider. Talk to your provider to start an e-visit. These providers can offer e-visits:

• Doctors

• Physical therapists

• Occupational therapists

• Speech-language pathologists

• Nurse practitioners

• Physician assistants

• Clinical psychologists

• Licensed clinical social workers (under special circumstances)

Why Telehealth Matters

Telehealth services give you a convenient way to care for your health from home. Learn what your plan covers and how much you’ll pay. Contact your provider for details specific to your coverage.

Need More Information?

We are Independent Insurance Brokers appointed by many major insurance carriers. Our team helps clients find the policy that best fits their situation. We serve clients in Winchester, VA, Martinsburg, WV, and Charles Town, WV.

Contact us today at (540) 662-4432 to schedule a FREE consultation with one of our insurance agents. Or visit medicaretrustedagents.com to learn more.