telemedicine & telehealth medicare coverage

In the rapidly evolving healthcare landscape, telemedicine has become a lifeline for many, including Medicare beneficiaries. Did you know that as of March 6th, 2020, Medicare started covering various telehealth services? Imagine consulting with your healthcare provider from the comfort of your home.

Let’s venture into the world of Medicare telemedicine, uncovering the services it encompasses, how it integrates with your Medicare plan, and the crucial tips to ensure you harness the full potential of these convenient healthcare solutions. So, fasten your seatbelts as we explore how telemedicine transforms healthcare for Medicare beneficiaries like you.

Table of contents

Does Medicare cover telemedicine?

As of March 6, 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 most 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 required to pay toward your Medicare Part B deductible. This will depend on the service and care you need.

Exploring Medicare’s comprehensive telehealth services

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.

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:

Reviewing cost-efficient telemedicine with Medicare Advantage

As the law requires, your Medicare Advantage plan must offer the same telehealth and telemedicine benefits as Original Medicare. Most 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 review your plan and ensure coverage before requesting certain services. However, 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 plan that 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.

Medicare telemedicine coverage in rural areas: Bridging healthcare gaps

In the sprawling landscapes of rural America, access to quality healthcare has often been a challenge. Long distances, limited medical facilities, and healthcare professional shortages are just a few of the barriers that residents of rural areas face when seeking medical attention. However, there is a silver lining on the horizon, which comes in the form of telemedicine.

Overcoming geographic barriers

Telemedicine has emerged as a beacon of hope for residents of rural communities. These remote areas, which may be miles from the nearest healthcare facility, often struggle with healthcare access. In such regions, telemedicine can virtually bridge the geographic divide. With a reliable internet connection and a device with a camera, patients can consult with healthcare providers without the need for arduous journeys to distant medical offices.

Addressing healthcare provider shortages

One of the persistent challenges in rural healthcare is the scarcity of healthcare professionals. Physicians, specialists, and other medical experts tend to gravitate toward urban areas, leaving rural communities underserved. Telemedicine helps alleviate this issue by enabling rural residents to access healthcare professionals who may be located in urban centers. Through telehealth consultations, specialists can provide their expertise to patients in rural areas, ensuring that they receive the specialized care they need.

Emergency and urgent care

In rural regions, emergencies can become dire situations due to the time it takes to reach a healthcare facility. Telemedicine plays a vital role in delivering emergency and urgent care services. Patients experiencing sudden health crises can connect with healthcare providers remotely, allowing for immediate evaluation and guidance. This rapid response can make a critical difference in life-threatening situations, potentially saving lives.

Chronic disease management

Many residents of rural areas deal with chronic conditions like diabetes, heart disease, and respiratory illnesses. Telemedicine provides them with a lifeline for managing these conditions effectively. Regular virtual check-ins with healthcare providers ensure that chronic disease patients receive timely care, medication adjustments, and lifestyle guidance, helping them maintain their health and reduce hospitalizations.

Preventive care and health education

Telemedicine is not just about treating illness; it also emphasizes preventive care and health education. In rural areas where health literacy and awareness can be limited, telehealth platforms offer opportunities for healthcare providers to educate patients about disease prevention, healthy lifestyle choices, and early detection of health issues. This proactive approach can contribute to better overall health outcomes in rural communities.

Reducing healthcare costs

Telemedicine also has the potential to reduce healthcare costs for rural residents. By minimizing the need for lengthy trips to healthcare facilities and avoiding unnecessary hospitalizations, patients can save on transportation expenses and reduce the financial burden associated with healthcare access.

Eligibility criteria for Medicare telehealth services

Accessing telehealth services under Medicare involves specific eligibility criteria and conditions that ensure beneficiaries can take full advantage of this modern healthcare option. Understanding these requirements is essential to ensure that you or your loved ones can benefit from the convenience and accessibility of telehealth. Here, we break down the eligibility criteria to provide clarity for our readers.

Medicare enrollment

To be eligible for Medicare telehealth services, you must first be enrolled in Medicare. This includes enrolling in Original Medicare (Part A and/or Part B), Medicare Advantage (Part C), or a Medicare Cost Plan.

Established patient-patient relationship

In most cases, one of the crucial criteria for Medicare telehealth services is an established patient-provider relationship. This means that you must have had a face-to-face visit with your healthcare provider recently. This visit establishes the patient-provider relationship required for telehealth visits.

Designated healthcare providers

Medicare telehealth services are only available when provided by specific healthcare professionals, including doctors, nurse practitioners, clinical nurse specialists, and physician assistants. Make sure your telehealth service is offered by one of these qualified providers.

Eligible telehealth services

Not all medical services are eligible for telehealth coverage under Medicare. Verifying with your healthcare provider whether the service you require can be delivered via telehealth is essential. Medicare typically covers many services, but the specifics can vary.

Telehealth platforms and technology

Ensure you can access the necessary technology for telehealth consultations, such as a computer, tablet, or smartphone with a stable internet connection. Familiarity with telehealth platforms or apps may also be required.

Telehealth vs. in-person care: A comparative analysis

As healthcare continues to evolve, choosing between telehealth and traditional in-person care has become critical for patients, including Medicare beneficiaries. Each approach offers unique advantages and limitations, and understanding the differences can help individuals make informed choices about their healthcare. Here, we compare these two healthcare modalities:

Advantages of telehealth

  • Convenience: One of the most significant advantages of telehealth is its unparalleled convenience. Patients can access healthcare services from the comfort of their homes, eliminating the need for travel, waiting rooms, and associated time constraints. This convenience is particularly beneficial for individuals with mobility issues or those residing in rural areas, where access to in-person care can be challenging.
  • Reduced exposure to pathogens: Telehealth has gained prominence, especially during health crises like the COVID-19 pandemic. It significantly reduces the risk of exposure to contagious diseases by minimizing physical contact between patients and healthcare providers.
  • Access to specialists: Telehealth enables patients to consult with specialists far away, expanding access to expertise that may not be available locally. This is especially valuable for Medicare beneficiaries requiring specialized care.
  • Timely consultations: Telehealth often offers shorter appointment wait times, facilitating quicker access to medical advice and treatment options. This can be crucial for addressing acute health issues or obtaining timely prescription refills.
  • Cost savings: For some patients, telehealth can be more cost-effective, eliminating transportation expenses and potential work hours lost due to travel to medical facilities.

Limitations of telehealth

  • Physical examinations: Telehealth has limitations when it comes to physical examinations. Some medical conditions require in-person assessments, such as palpations, auscultations, or specific diagnostic tests that can’t be performed remotely.
  • Technological barriers: Not all patients have access to the necessary technology (e.g., smartphones, internet connection) or the digital literacy required for successful telehealth appointments. This can create disparities in healthcare access.
  • Lack of hands-on procedures: Certain medical procedures, like vaccinations, sutures, or casting for broken bones, necessitate hands-on care that cannot be provided through telehealth.
  • Complex diagnoses: Complex medical conditions may require multiple diagnostic tests and consultations with various specialists, making in-person care more practical for comprehensive evaluation.
  • Personal connection: For some patients, the personal connection and reassurance provided by face-to-face interactions with healthcare providers are essential for their well-being.

Virtual check-ins

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.

Tips for preparing for a telehealth visit

Preparing for a telehealth visit is crucial to ensure a smooth and successful healthcare experience. Here are some practical tips for Medicare beneficiaries to help you get ready for your telehealth appointment:

#1 Test your technology in advance

Ensure you have a reliable internet connection and a compatible computer, tablet, or smartphone. Test your camera, microphone, and speakers to ensure they function correctly.

#2 Download the necessary apps or software

If your telehealth provider requires specific apps or software for the appointment, download and install them in advance. Familiarize yourself with how to use these tools.

#3 Create a quiet, well-lit space

Find a quiet, well-lit area in your home where you can have a telehealth appointment without interruptions. Good lighting will help the provider see you clearly.

#4 Gather important information

Have your Medicare card, ID, and relevant medical documents ready. This might include a list of current medications, your medical history, and any questions or concerns you want to discuss.

#5 Make a list of questions

Write down questions or issues you want to address during the telehealth visit. This ensures that you don’t forget any important topics.

#6 Check your medications

If you have questions about your medications, have them on hand so you can discuss them with your healthcare provider. Ensure you know the names, dosages, and potential side effects.

#7 Prepare for the physical exam

If your telehealth appointment involves a physical examination, be ready to follow your provider’s instructions. This might include taking your blood pressure, temperature, or other vital signs.

#8 Plan for follow-up care

Discuss with your healthcare provider how any necessary follow-up care or prescriptions will be handled. Ensure you understand the process for receiving any prescribed medications.

#9 Be on time

Log in to the telehealth platform a few minutes before your appointment. This ensures you’re ready when your healthcare provider joins the virtual session.

#10 Understand billing and costs

Before the appointment, confirm how billing and costs will be handled, including copayments or additional fees. Clarify if your Medicare plan covers telehealth services.

#11 Practice patience

Technical issues or delays occasionally occur during telehealth visits. Be patient and understanding if there are any hiccups, and work with your provider to resolve them.

Be mindful of telehealth 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.

FAQs

Does Medicare cover telehealth visits for physical therapy?

Absolutely, Medicare currently provides coverage for certain telehealth services related to physical therapy. If your healthcare provider prescribes physical therapy as part of your treatment, Medicare Part B will assist in covering a substantial portion of the associated expenses. The process typically involves you initially meeting your deductible and assuming responsibility for 20 percent of the Medicare-approved cost.

Is Medicare Telehealth Here to Stay?

While it’s hard to see it going anywhere, it would technically require an act of Congress to make Medicare telehealth permanent legally.

Is telehealth effective for physical therapy?

Thorough research studies have consistently demonstrated that Telehealth is just as effective as in-person care, and in some instances, it has shown superior outcomes. Telehealth empowers you with greater autonomy in managing your healthcare while providing physical therapists with unique advantages.

Can you use Teladoc if you are on Medicare?

Teladoc partners with numerous Medicare Advantage and Medicaid managed care plans, allowing beneficiaries to access their services seamlessly. However, it’s important to note that Teladoc is not a participating provider for Medicare or Medicaid fee-for-service plans.

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 announced 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 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.

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Written By:
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Lindsay Malzone, Lindsay Malzone is the Medicare editor for Medigap.com. She's been contributing to many well-known publications since 2017. Her passion is educating Medicare beneficiaries on all their supplemental Medicare options so they can make an informed decision on their healthcare coverage.
Reviewed By:
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Rodolfo Marrero, Rodolfo Marrero is one of the co-founders at Medigap.com. He has been helping consumers find the right coverage since the site was founded in 2013. Rodolfo is a licensed insurance agent that works hand-in-hand with the team to ensure the accuracy of the content.