Now that we’re all living in the COVID-19 era, seeing your healthcare providers isn’t as simple as it used to be.
Before the pandemic, Medicare only covered “telehealth” visits in certain situations, and coverage was limited mostly to people who live in rural areas. Now, though, the Centers for Medicare & Medicaid Services (CMS) has temporarily expanded this benefit. So anyone who receives Medicare benefits has access to telehealth services and coverage.1
The government made this change so that people who receive Medicare benefits, and especially those who are at high risk of complications from the coronavirus, can still access a wide range of medical services from the safety of their own home. Keeping more people at home during COVID-19 limits exposure to the virus and helps stem its spread.
Effective March 6, 2020, and for as long as the COVID-19 public health emergency continues, Medicare will continue to pay for telehealth services.
What You Need to Know
CMS, which oversees Medicare, has temporarily expanded the types of providers that can offer telehealth visits.
The cost for a telehealth appointment is the same as an in-person visit and may even be less.
It’s unclear whether expanded Medicare benefits for virtual appointments will continue after the COVID-19 pandemic ends.
What is Telehealth?
Telehealth is the exchange of medical information from one place to another place using technology and electronic communication, with the goal of improving a patient’s health.2
In practical terms, patients with mild symptoms or those seeking routine care meet with their doctor or other healthcare provider online via video or by phone instead of having to go into the office.
During a video appointment, patients can see and hear their providers on a computer screen or smartphone and receive health advice much as they would in person. Healthcare providers typically email or text patients a link they use to connect to a virtual appointment. In the case of a phone call, your provider will usually call you.
If you’re meeting with your provider by video, you may need to download software to your computer or add an app to your phone before the appointment. This enables you to access the appointment.
Someone from your provider’s office may be able to walk you through connecting to a telehealth appointment the first time.
Telehealth can also include monitoring devices that collect patient data and deliver it directly to providers to review, like devices that monitor heart rate and blood pressure.
What Part of Medicare Covers Telehealth?
Medicare Part B, which covers outpatient services, covers telehealth services.
For seniors who have Medicare Advantage (Medicare Part C), which you buy through a private insurance company, coverage for telehealth appointments is typically the same as for those who have Original Medicare, also known as Medicare Parts A and B.3
Depending on your Medicare Advantage plan provider, however, the telehealth services that are covered might vary. So be sure to check coverage with your insurance provider. Most plans will also require service providers to be in-network.
When Can You Use Telehealth?
Since March 6, 2020, Medicare has covered telehealth appointments for all Medicare beneficiaries for office, hospital visits and other services that typically take place in person.
It’s still unclear exactly what telehealth benefits will be covered once the COVID-19 pandemic is over. CMS has proposed a permanent expansion of telehealth coverage to make it easier and more convenient for people receiving Medicare to access care, especially those living in rural areas.4
Prior to the coronavirus pandemic, Medicare only covered and paid for telehealth services for seniors in rural areas who left their home to have a virtual appointment at a nearby clinic, hospital or other medical facility.
Many appointments were with specialists that patients otherwise would not have been able to meet with in person due to distance.
Medicare limited the eligible facilities where seniors could have their appointments to:5
- healthcare provider offices
- rural health clinics
- skilled nursing facilities
- critical access hospitals
- federally qualified health centers
- community mental health centers
- hospital-based or critical access hospital-based renal dialysis centers
Exceptions to this rule included patients who needed end-stage renal disease (ESRD) services, treatment of acute stroke, and treatment of substance use disorder and related mental health conditions.
Before the temporary expansion of telehealth benefits due to COVID-19, seniors in rural areas were also limited by the types of providers they could meet with by video and phone. These included:6
- nurse midwives
- physician assistants
- clinical nurse specialists
- certified registered nurse anesthetists
- registered dietitians or nutrition professionals
- clinical psychologists and clinical social workers
What Healthcare Providers Can You See Using Telehealth?
For as long as the coronavirus pandemic lasts, patients can meet virtually with any provider that’s eligible to bill Medicare for their professional services.
As a Medicare recipient, you can see your primary care provider or any specialist, and also receive mental health counseling via telehealth. Other providers that are covered include:7
- physical therapists
- occupational therapists
- speech language pathologists
While this public health emergency lasts, Medicare won’t check that patients have an established relationship with practitioners they’re connecting with via telehealth, which was previously a requirement for a telehealth visit.8
How Much Does Telehealth Cost?
Under Medicare, telehealth visits are considered the same as in-person visits.
So, for a telehealth visit, you’ll likely pay the same amount you would have paid if you saw your doctor in person. Those with Original Medicare are responsible for paying their Part B deductible as well as 20% of the Medicare-approved amount for that service.9
For Medicare Advantage plans, beneficiaries would be subject to paying the plan’s designated cost-sharing.
During the pandemic, though, some healthcare providers are reducing or waiving fees for telehealth visits, especially if you’re seeing your doctor for screening for COVID-like symptoms. Check with your provider for the exact costs.
Who Should Use Telehealth?
If you don’t need to see your provider in person, you should book a telehealth appointment. Virtual appointments are ideal if you have mild symptoms or you need only routine care, such as reviewing the results of recent lab tests, discussing whether or not to refill a medication or checking in with your doctor on management of a chronic condition.
Telehealth appointments also work well for treating many mental health issues and for screening patients with mild COVID-like symptoms to determine if they need further, in-person care.
What Are Pros and Cons of Using Telehealth?
The pros of using telehealth include:
- more convenient, accessible care
- less exposure to germs
- easier access to specialists for those in remote/rural areas
- fewer unnecessary ER visits10
The cons of telehealth include:
- no physical exams
- difficult to use for those without reliable technology
- possibly less in-depth communication with providers
If you have an upcoming telehealth appointment, be sure to prepare ahead of time. Here are some troubleshooting steps to ensure your visit with your provider goes as smoothly as possible:
- Make sure your computer, phone or other device is fully charged, working well and that your internet connection is strong.
- Gather your medications or compile a list of all the medications you take and note how often you take each.
- Take any vital signs you can, such as your temperature, blood pressure and, if you have a pulse oximeter at home, measure your oxygen saturation level.
- Document any symptoms you’re experiencing, ideally tracking these over time in advance of your visit.
- Write out any questions or concerns.
- Print out lab results to review with your doctor.
- Find a quiet spot where you can speak to your provider without being interrupted; this also helps to maintain confidentiality.
While CMS first made telehealth services available to more seniors on a temporary basis, the more flexible policy may stay; Congressional bills have proposed expanded access to telehealth services and making telehealth waivers for Medicare permanent through 2021.