Medicare already covers a number of telehealth services, and now provides significantly expanded telehealth benefits for the duration of the coronavirus crisis. | Image: JCP-PROD / stock.adobe.com
- Medicare is expanding telehealth benefits during the coronavirus crisis.
- Not all beneficiaries will be able to use video for telehealth.
- Beneficiaries will generally owe cost sharing for telehealth in both Original Medicare and Medicare Advantage.
- You’ll owe 20 percent of the Medicare-approved rate for a phone consultation if you have Original Medicare.
- You can set up a telehealth visit by calling your provider.
- Original Medicare now pays for over 80 services when provided using telehealth.
- Original Medicare is covering office visits via telehealth for both new and established patients.
- Although you’ll be able to talk with your doctor about symptoms during a telehealth visit, not all care can take place virtually.
- Be sure you have a stable internet connection for your video call and install necessary software before your session.
- Some providers can offer remote patient monitoring.
Q: How can Medicare beneficiaries utilize telehealth during the coronavirus crisis?
Before the public health emergency, Original Medicare covered telehealth visits only if they took place through a video-based teleconference. (Telehealth also had to be delivered using HIPAA-compliant software.) Beneficiaries needed to live in a rural area to be eligible, and had to travel to a facility-based “originating site” to have their visit.
Due to the emergency, telehealth is temporarily available to all Original Medicare beneficiaries – not just those in rural areas – and you can now connect through software platforms such as FaceTime and Skype. Check with your healthcare provider to see whether they have a preferred platform for telehealth.
Can Medicare beneficiaries use video when connecting?
Due to technology and time constraints, not everyone is easily able to have a video-based visit. This is why the Centers for Medicare and Medicaid Services (CMS) is also temporarily reimbursing providers for audio-only phone calls at the same rate as in-person care. (Visits using video-based telecommunications will also be paid at the in-person rate).
Depending on your health care provider’s preference and your own comfort with technology, you may prefer the flexibility of an audio-only visit.
Will I be charged for using telehealth to communicate with my doctor?
Medicare Advantage plans cover the same telehealth care Original Medicare covers, and some plans cover additional telehealth services. However, we do not know whether any Advantage insurers are offering higher telehealth reimbursements. (Until recently, access to telehealth has been more limited in Original Medicare than Medicare Advantage. The new regulations should hopefully change this dynamic – at least until the end of the public health emergency.)
You’ll generally owe cost sharing for telehealth in both Medicare Advantage (which typically requires a co-pay) and Original Medicare (which requires the beneficiary to pay the Part B deductible and coinsurance) – unless the encounter is for Medicare preventive services or a screening visit for COVID-19, which would be covered in-full. Medigap can cover your coinsurance if you have Original Medicare (and if you have Medigap Plan C or F, it will also cover your Part B deductible). CMS has encouraged Advantage plans to waive co-pays for telehealth during the emergency, and many have said they’ll also do this for services beyond just screening or treatment for COVID-19. (Advantage plans are required to waive co-pays for coronavirus screening visits, but not for treatment.)
What costs should I anticipate for a phone consultation?
As mentioned above, under its new policy Original Medicare will pay the same amount for a telephone visit as it would pay if you saw your doctor in-person, meaning you’ll owe 20 percent of the Medicare-approved rate if you have Original Medicare. (Costs will vary in Advantage plans.)
Because Medicare is paying higher rates for phone-based care, more people can expect their providers to bill for telephone interactions – something that was previously free of charge. This means you may for first time owe cost sharing for “routine” provider calls that had been complementary. CMS is allowing providers to waive co-pays for telehealth visits during the coronavirus emergency. If you’re concerned about your costs, talk with your provider.
Do I have to get an appointment to set up a session?
Telehealth visits with your primary doctor can be set up the same way you’d establish any other appointment – by calling your provider or contacting their office through its online portal. As with other healthcare visits, it helps to make a list of the topics you wish to discuss in your session.
What types of care can I receive via telehealth?
Original Medicare now pays for over 80 services when provided using telehealth. In addition to primary care and other office visits, that coverage includes:
- Emergency room visits – Patients can have non-COVID-19 illnesses managed remotely to avoid exposure to coronavirus, for example.
- Observation and inpatient hospital care – Doctors can visit remotely with hospitalized patients if they’re potentially infectious.
- Physical and occupational therapy – Your therapist can work with you via videoconference.
- Licensed clinical social worker and clinical psychologist services – You can continue mental health or addiction counseling from home.
Home healthcare and hospice providers can also provide some services using telehealth, as long as they don’t replace necessary in-person care specified in the patient’s plan of care. CMS has also made clear that telehealth visits can fulfill “face-to-face” visit requirements for obtaining Medicare coverage for hospice or home health. Furthermore, CMS has implemented the provision in the CARES Act allowing nurse practitioners, certified nurse specialists, and physician’s assistants to certify and oversee a home healthcare plan of care, meaning more types of practitioners can now help you recover from injuries at home.
On April 30, CMS said it was further expanding the types of providers that can offer services over telehealth to include all providers (this was previously restricted to only a few types of providers specified in the law). This means physical, occupational, and speech-language therapists can safely care for more patients during the emergency.
CMS is also temporarily allowing Medicare patients enrolled in partial hospitalization programs to receive the individual and group therapy and educational counseling components of those programs from home, either by phone or telehealth. Similarly, patients enrolled in an opioid treatment program (methadone clinic) can participate in therapy sessions and periodic assessments while at home.
Some providers may still prefer to meet with you in-person or prefer video-based teleconferencing to a phone call. This will be up to you and your provider.
Are only established patients eligible for telehealth?
Original Medicare is covering office visits via telehealth for both new and established patients during the public health emergency; until now only established patients were eligible. (Specifically, CMS said it would not check for compliance with the requirement that telehealth be provided only to established patients treated within the past three years. The requirement itself is unchanged.) Medicare Advantage plans are allowed to cover additional telehealth services beyond their approved 2020 benefits. It is best to check with your insurer if you have Medicare Advantage.
Will my doctor be able to examine me visually by computer?
Many types of healthcare can be provided using telehealth. Because of its promise during the coronavirus pandemic, organizations like Aledade are working with medical providers to help them scale their telehealth capabilities.
Although your doctor will be able to see you and you’ll be able to communicate about your symptoms during a telehealth visit, not all care can take place virtually. Your doctor will be unable to do things like physically examine you or check your temperature and blood pressure. (You may be asked to monitor these things yourself.)
Do I need to have complicated equipment, software, and a strong internet connection?
You’ll want to make sure you have a stable internet connection for your video call and give yourself time to install any software needed to communicate with your provider. The provider may send a link before your visit to download the teleconference software.
Are there other types of remote care available?
Providers can offer remote patient monitoring, where technology is used to keep tabs on health conditions, to more types of patients – including those with a single health condition. (This was previously limited to patients with multiple chronic needs.) If you’re being treated for COVID-19 and are at home, your provider will be able to remotely monitor your oxygen saturation using a pulse oximeter (a device that fits on your finger to measure the amount of oxygen in your blood). This could be an important way to check that your lungs and breathing are recovering.
Virtual check-ins (communication by phone or other device) and e-visits (communications with your doctor using an online patient portal) are also temporarily available to both new and established patients. These services had previously been limited to established patients only.
Josh Schultz has a strong background in Medicare and the Affordable Care Act. He coordinated a Medicare ombudsman contract at the Medicare Rights Center in New York City, and represented clients in extensive Medicare claims and appeals. In addition to advocacy work, Josh helped implement federal and state health insurance exchanges at the technology firm hCentive.