Telemedicine is a way to provide remote medical care. Medicare covers some telemedicine services. These are healthcare services that people can access remotely.
During the coronavirus pandemic, people in many parts of the United States are unable to leave their homes. Many of these people may need to access essential medical care without attending a facility.
Medicare has expanded the coverage of telemedicine services, also known as telehealth, to account for this sudden change. This expansion will help more people access a wider range of services without leaving their homes during the public health crisis.
In this article, we discuss the vital role that telehealth may play during the pandemic. We also explain how telehealth works and which elements of the service Medicare covers.
People will continue to have other medical needs while they are staying at home to limit the spread of SARS-CoV-2.
However, individuals still need to stick to physical distancing (also called social distancing) guidelines while continuing to look after their physical and mental health.
Telehealth is an effective alternative to an in-person appointment that can help with many essential healthcare needs.
Although telehealth has been around in some form since the late 1950s, services have become even more important during the coronavirus pandemic.
With telemedicine, a person receives medical services, such as a doctor’s office visit, without having to leave their home.
This option may ease a person’s concerns if they need to seek consultation with their doctor while practicing physical distancing and staying at home.
Medicare Part B covers outpatient services and, in most cases, telehealth services.
A 20% coinsurance also applies to telehealth consultations. Therefore, while Medicare will pay 80% of the incurred costs, the individual will be responsible for the remaining 20%.
According to Medicare.gov, people with Medicare pay the same amount for telehealth services as they would for in-person services.
People with a Medicare Advantage Plan generally have similar coverage for telehealth services as those with Parts A and B of traditional Medicare. However, some Medicare Advantage Plans offer expanded telemedicine services.
Private insurers administer Medicare Advantage plans, so the exact telehealth services that a person’s plan includes may vary. It is best to determine coverage through the insurance provider directly.
Although a coinsurance for telehealth services usually applies, some providers are waiving the fees for telemedicine visits for coronavirus screening.
However, not all healthcare providers promote this policy. It is best to ask the healthcare provider whether they are waiving fees for coronavirus screening.
In the past, there were restrictions for Medicare telehealth coverage.
For example, Medicare only covered telehealth services in certain circumstances, including when a person lived in a rural area and was staying in a facility, such as a skilled nursing home or hospital-based dialysis facility.
However, Medicare has lifted many restrictions due to the Coronavirus Preparedness and Response Supplemental Appropriations Act, which the current White House administration signed into law in March 2020.
In the past, changes to the coverage of telehealth services were effective for a calendar year. For this emergency legislation and coverage expansion, though, it is not clear whether these changes are permanent.
The expansion of Medicare coverage helps reduce in-person medical visits.
Telehealth visits remain effective in managing many medical concerns. However, remote healthcare cannot attend to all medical problems, and some services may still require in-person visits.
Examples of the various telehealth services that Medicare covers include:
- occupational therapy evaluations
- physical therapy evaluations
- group psychotherapy
- speech therapy
- therapeutic exercises
- doctor’s office visits
Medicare also covers telehealth visits to evaluate coronavirus symptoms. A person connects with their healthcare provider through a telehealth visit.
After the visit, the healthcare professional assesses whether the individual requires further in-person evaluation, testing, or treatment.
Many Medicare enrollees are over the age of 65 years and have an increased risk of complications due to COVID-19. Telehealth services are one way for them to stay at home and decrease the risk of transmitting the virus.
Although it was the current public health emergency that led to expanded Medicare coverage for telehealth, this coverage also applies to other medically reasonable services.
Typical telehealth services may include preventive health screenings, routine office visits, and mental health services.
This expanded telemedicine coverage allows an individual to continue to receive regular medical services without having to travel to visit a practitioner in person.
Medicare put guidelines in place that outline who can receive reimbursement for telehealth services. The following types of healthcare professionals can offer these services:
- nurse practitioners
- clinical psychologists
- speech therapists
- occupational therapists
- licensed social workers
Professionals providing telemedicine services receive reimbursement through the Physician Fee Schedule. The telehealth consultation rate is the same as it would be for an in-person visit.
Telehealth includes a wide range of services, including doctor’s office visits.
Certain types of healthcare visits and services are easier to carry out through telehealth than others. However, technological improvements continue to emerge, making an increasing number of services available remotely.
People may use telephones, computers, and patient monitoring devices to facilitate telehealth services. Monitoring devices collect patient data and transmit them electronically to the treating healthcare professional for review.
Remote monitoring devices allow a healthcare provider to monitor various vital signs, such as heart rate, blood pressure, and oxygen level. Telehealth may also involve a consultation to review previous diagnostic tests.
Usually, an individual uses telehealth services at home. However, people can also use these services at a health facility, such as a dialysis center, when they require an evaluation with a healthcare practitioner.
The healthcare provider delivers services from a hub site or remote location, which may include an office, hospital, or clinic.
The technology allows for real time, two-way communication between people and their providers. Telehealth services may include preventive care, such as a routine office visit.
Telehealth provides medical services through a remote connection between an individual and their medical provider. Medicare covers various types of telemedicine services.
The Coronavirus Preparedness and Response Supplemental Appropriations Act expanded telehealth coverage during the COVID-19 pandemic.
It is best to talk with a healthcare provider directly to determine whether they offer telehealth services.
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