Many things changed in the medical world with the onset of the Covid epidemic, which really kicked off in early 2020. One of those things was a great leap in the use of telehealth as a way to receive medical care. It allows the patient to avoid exposure to covid or even other contagious diseases all while getting the care they need. For those with Medicare, telehealth is available, but there are specific situations, rules and guidelines for the appointments to be covered. This is your guide to understanding telehealth and understanding how your Medicare policies may cover telehealth visits.
What Is Telehealth?
You may hear it called telemedicine or e-visits. Telehealth is simply a way to visit with your healthcare provider without having to go to an office in person. Telehealth appointments can take place over the phone, but the most common option is through virtual video visits on a smartphone, computer or tablet. Telehealth also refers to a doctor using remote monitoring to maintain records of vital statistics like pulse, blood oxygen and blood pressure as well as messaging systems for speaking with a provider without an actual visit.
There are limitations to the types of care and conditions that can be managed through telehealth. Of course, lab results, bloodwork and x-ray results can all be provided virtually. But the actual labs and x-rays would require an in-person visit. Telehealth can often also cover psychotherapy, ongoing or recurrent conditions, common colds and skin conditions, prescription management, goal tracking, and follow ups.
Telehealth has been around for a while, but with the onset of the pandemic, use of it grew by leaps and bounds. But, is it covered for Medicare patients? The short answer is yes, but it is important to know the long answer as well.
Is It Covered and When?
Medicare Part B, also referred to as “Original Medicare” and Medicare Advantage by default cover certain types of telehealth appointments. Because of Covid, many restrictions were lifted on the use of telehealth for care through Medicare, and some of those restrictions may be eventually put back into place.
While there are approximately 100 different types of medical services that Medicare will cover through telehealth, the most common include: psychotherapy, basic office visits, preventative care, occupational therapy, physical therapy, patient education and some emergency department visits (within limits).
What Are the Costs?
If you have Medicare Part B, then telehealth visits will cost the same as an in-office visit, you can learn more about Part B here. There are some rules you must follow: the visit must be with a Medicare approved provider, the visit must be on the list of approved telehealth visit types, and you must pay any co-pays and deductibles.
As with standard in-person visits, you can expect to pay 20% of the cost of the telehealth visit up to the out of pocket maximum. If you have Medigap insurance, be sure to check with the insurer to determine if they will cover the co-pays and deductibles for telehealth specifically. The government has put into place an act during the Covid emergency for providers to waive cost-sharing for telehealth visits. However, this option is not required and providers may or may not offer it. You would need to speak with your own healthcare providers to determine if they have chosen to offer this waiver.
Changes in 2024
As mentioned, some of the restrictions on telehealth offerings through Medicare may change as the Covid health crisis slowly comes to an end. This is yet to be seen. However, one change is set to take place at the end of 2024.
At this time, anyone with Medicare can use telehealth for approved visits from anywhere, such as their home. In December of 2024, many telehealth services will no longer be available from your home. If you live in a rural area and you do not have access to certain providers or specialists, you will need to go in-person to certain Medicare approved facilities and the telehealth appointment will take place from there. However, according to this new rule, certain conditions will always stay available for telemedicine from the home. These conditions include the following: behavioral health, dual diagnosis mental health and substance abuse disorders, monthly visits for the management of end stage renal disease, and evaluation and treatment of acute stroke.
Because restrictions may change in the future, it is vital that you speak with your provider and review Medicare rules regularly to ensure your telehealth visits will remain covered.
Telehealth has become all the more popular with the onset of the pandemic, and people with Medicare Part B can make use of these virtual visits. Just make sure that you know the rules, what visits are covered, what your cost will be, and what changes could come in the future. That way, you can ensure you are getting your appointments covered whether they can remain telehealth or need to be in-person.
