Does Medicare Cover Telehealth?

As telehealth becomes a more common way to receive health care coverage for patients across the U.S., find out if Medicare will cover telehealth services.
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    Introduction

    A recent survey shows that seniors across the U.S. have embraced technology amidst the COVID-19 pandemic.  In particular, telehealth has been a popular approach for seniors to continue to receive healthcare services without unnecessarily having to visit healthcare facilities in person. So, does Medicare cover telehealth?   First, let’s find out what telehealth covers.

    What is Telehealth?

    Telehealth, also known as telemedicine, enables patients to get health care services remotely using electronic communication devices like computers, tablets, and mobile phones. This method makes health care accessible, particularly to those living in rural or isolated areas.  Plus, this service is beneficial for people who find it difficult to travel or move around.

    In response to COVID-19, telehealth has been the recommended approach where appropriate for patients to continue receiving care from doctors/physicians.

    A recent survey notes that the use of telemedicine services among seniors increased 300% during the COVID-19 pandemic, with around 40% of seniors having used telehealth services since the pandemic.

    Does Original Medicare Cover Telehealth?

    Traditionally Original Medicare, Medicare Part B (medical insurance) only covered telehealth services under specific circumstances.

    For example, the beneficiary receiving the services must have lived in a rural area and traveled to a local medical facility to get telehealth services from a doctor in a remote location. Also, the beneficiary would generally not be allowed to receive telehealth services in their home.

    However, with the COVID-19 pandemic, the federal government has introduced a waiver that broadens telehealth services covered under Medicare.

    Impact of COVID-19: Expansion of Medicare-covered Telehealth Services

    In March 2020, as a response to the COVID-19 public health emergency (PHE), the federal government expanded Medicare’s telehealth benefits through an emergency declaration under the Stafford Act and the National Emergencies Act.

    Under the expansion, a range of providers, such as doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, can now offer a specific set of telehealth services. The services include:

    • Evaluation and management visits (standard office visits)
    • Mental health counseling
    • Emergency department visits
    • Preventive health screenings

    As of October 2020, CMS added 144 telehealth services to the approved list previously not covered.

    Beneficiaries can get telehealth services in any health care facility, including a physician’s office, hospital, nursing home, or rural health clinic, as well as from their homes. This change broadens telehealth flexibility without regard to the beneficiary’s diagnosis.

    CMS estimates that between mid-March and mid-October 2020, over 24.5 million out of 63 million beneficiaries and enrollees have received a Medicare telemedicine service during the PHE.

    For Medicare Part A (hospital insurance), telehealth services include initial inpatient and nursing facility visits and select skilled nursing facilities (SNF) services.

    It is important to note that new flexibilities concerning coverage of telehealth services for all beneficiaries in traditional Medicare are only available on a time-limited basis. These services will continue to take effect until the Secretary of Health and Human Services (HHS) declares the PHE has ended.   As announced by CMS in December 2020, a permanent expansion of certain covered services for rural beneficiaries, such as telehealth services for non-rural beneficiaries, might be rolled back post-pandemic.

    If you’re considering telehealth services, call your provider before going to a routine office visit to see if a remote appointment is possible, as many healthcare providers are delaying or rescheduling unnecessary visits during the pandemic.

    Does Medicare Advantage Cover Telehealth?

    Traditionally, Medicare Advantage or Medicare Part C plans have the flexibility to offer more telehealth services as part of their supplemental benefits.  These are more than what Original Medicare could provide, such as allowing for telehealth services at home (traditionally not covered under Original Medicare pre-pandemic).

    While the federal government has temporarily expanded its coverage of telehealth services, Medicare Advantage plans have innovated and improved telehealth benefits.  In 2021, the vast majority (98%) of Medicare Advantage plans offer telehealth (up from 91% in 2020).

    Many Medicare Advantage plans provide telehealth visits for a $0 copay as part of their regular supplemental benefits.  For those wanting permanent telehealth services as part of their benefits, Medicare Advantage plans are a great way to access telehealth.

    Does Medicare Supplement (Medigap) Cover Telehealth?

    As Original Medicare already covers telehealth, Medicare Supplement (Medigap) will also cover telehealth costs and reduce your costs by paying for our Part B coinsurance.

    Does Medicare Cover Telehealth For Physical Therapy?

    Yes, temporarily to expanded allowable services during COVID-19. CMS recently added private-practice physical therapists (PT) and physical therapist assistants (PTA) to provide telehealth services under Medicare Part B. Previously, only limited e-visits and other select services were allowed. The same rates apply for in-person and telehealth consultations for physical therapy.

    Does Medicare Cover Telehealth For Mental Health?

    Yes – during the pandemic, Medicare will now cover mental health services provided by telephone, even if there is no video. Psychologists working from home can give psychological and neuropsychological testing, group psychotherapy, developmental screening, and adaptive behavior assessment and treatment.  Previously, only psychology sessions conducted in real-time, two-way interactive communication (audio and video) were reimbursable by Medicare.

    Does Medicare Cover Telehealth For Patients In Assisted Living And Nursing Homes?

    Yes, temporarily. Original Medicare and Medicare Advantage do not cover assisted living costs. However, as part of the temporary expansion of services, CMS has enabled Medicare to pay for office, hospital, and other visits furnished via telehealth across the country, including patients’ homes and assisted living and nursing home facilities.

    Final Words

    Does Medicare cover telehealth? Thankfully, yes. The federal government has temporarily expanded the services covered by Original Medicare during the COVID-19 pandemic.

    With telehealth services, Medicare enrollees have faster access to medical advice while reducing their exposure to COVID-19. Another advantage is that the cost of telehealth services is the same as in-person visits.

    However, it is essential to note that the expansion of covered services under Original Medicare may only be temporary during the COVID-19 emergency.  For those wanting more permanent access to telehealth services, a Medicare Advantage plan is the best solution.