These days, many Medicare beneficiaries are curious about telemedicine and telehealth.
The good news is that Medicare covers certain types of telemedicine and telehealth care. But not everything receives coverage. Certain telemedicine services might not be available (or be prohibitively expensive) depending on the type of care you need. Keep reading to learn more.
Does Medicare cover telehealth appointments?
As of March 6th, 2020, several telehealth services are now available for all Medicare recipients. This is especially relevant for services related to COVID-19 testing and treatment.
Medicare Part B covers the vast majority of these services, meaning you can expect to pay the same 20% coinsurance fees for the services you would with any other benefit available under Medicare Part B.
You may be a requirement to pay toward your Medicare Part B deductible. This will depend on the service and care you need.
Telehealth and Telemedicine Services Offered by Medicare
To qualify as a telehealth or telemedicine service, there must be live, two-way audio and visual interaction between the patient and the provider. There are some rare circumstances under which audio-only (i.e., a telephone visit) may be acceptable, but you’ll have to be sure and discuss that with your provider before you ask for those services.
In order to keep you and your loved ones safe, telehealth visits can reduce your exposure the pathogens like the COVID-19 virus and replace in-person services such as:
- Office visits
- Monthly End-Stage Renal Disease visits for home dialysis
- Substance abuse treatment
- Medical services designed to help with an acute stroke, including evaluation, diagnosis, and the ability to request a mobile stroke unit
- Virtual check-ins and E-visits
- Certain physical and occupational therapy services
- Urgent care consultations
How Medicare Advantage Covers Telemedicine Care
As the law requires, your Medicare Advantage plan must offer the same telehealth and telemedicine benefits as Original Medicare. The vast majority of Medicare Advantage plans will likely offer even more benefits at a lower cost.
You’ll have to talk with your Medicare Advantage insurance provider or insurance agent to go over your plan and ensure you have coverage before requesting certain services. But most beneficiaries with a Medicare Advantage plan might find it easier and less expensive to take advantage of telehealth services now.
Do Medicare Supplement Plans Cover Telemedicine?
If you supplement your Original Medicare coverage with a Medicare Supplement (Medigap) Plan, your Medicare Part B benefits will take care of your telehealth and telemedicine needs first. Beyond that, your Medigap plan will only help pay for costs if you have the type of plan which helps cover costs for Medicare Part B cost-sharing and/or your Medicare Part B deductible.
All 10 Medigap plans help cover the costs of Medicare Part B coinsurance and copayments. Remember that Plan K only covers 50% of those costs, and Plan L covers 75%. Medigap plans C and F will help cover the costs associated with your Medicare Part B deductible.
Telemedicine check-ins can allow you to communicate with your healthcare provider, such as a nurse practitioner, clinical nurse specialist, or physician assistant, by utilizing audio and video technology tools, like your phone or computer, without the need to visit the doctor’s office.
Your doctor can also assess your condition remotely by reviewing the photos or videos you sent to determine if an office visit is necessary.
Be Mindful of Telehealth/Telemedicine Fraud
Unfortunately, you have to be vigilant about scams and fraud for those with Medicare. The expansion of access to telehealth and telemedicine care is no exception. It’s not uncommon for these fraudulent scammers to contact you out of the blue. They’ll offer discounted telehealth services, cash payments, or free prescription drugs in exchange for taking advantage of their services.
But the scammers may end up billing Medicare for treatment, services, and drugs that you did not request or need — saddling you with potentially thousands of dollars in out-of-pocket costs that you knew nothing about.
If you suspect you’ve received contact or been taken advantage of by one of these fraudulent outfits, call 1-800-MEDICARE and report this criminal activity.
Is Medicare telehealth permanent?
While it’s hard to see it going anywhere, it would technically require an act of Congress to legally make Medicare telehealth permanent.
What if I need a telehealth visit but am a new patient?
Technically, the 2020 law which expands the availability of telehealth visits is for established patients only. The CMS office issued an announcement that auditing telehealth visits to determine their legitimacy will not be given top priority. So the final decision will be between you and your healthcare provider.
How much do telehealth medicine visits cost with Medicare Part B?
The average telehealth visit with Medicare Part B will cost $79. However, it may cost more for specialty services, especially those administered by a specialist. A 20% cost share is your responsibility.
But if you have a Medigap plan which helps cover cost-sharing expenses or a Medicare Advantage plan which provides similar benefits, the cost of your visit is greatly reduced cost or even free.
Medicare Supplemental Plans Can Cover Telemedicine
If you want to supplement your Medicare coverage, then a Medicare Supplemental plan might be just what you need.
We have licensed insurance agents who are experts at finding you the coverage you need at reasonable prices. You can ask them any question or get clarification on any issue — free of charge!
You can call us today or complete our quick online rate form to connect with your area’s best plans.