Over the years, telehealth has expanded to cover a broad array of services, becoming a standard diagnostic and treatment tool in many parts of the world. It’s particularly useful in rural areas with minimal physician or primary caregiver access. Many people in these areas may only have Medicare-covered services, impacting their telehealth experience.
In this blog, we’ll examine telehealth as a concept, discuss its impact on Medicare services, and gauge just how much Medicare will cover for your treatments. We’ll also provide more context to recent COVID-inspired Medicare expansions in telehealth and track whether they’re still active. In this way, you can carefully plan your healthcare needs and avoid overpayment.
Let’s get started!
What is Telehealth?
Telehealth or telemedicine gives you access to a healthcare provider without you having to visit their office. Instead, you use your internet connection and video chat programs on a computer, phone, or tablet to talk with your doctor. During your chat, they’ll ask questions about your physical, emotional, and behavioral health.
Common topics covered during your call include:
- Chronic conditions, such as arthritis or bone-health issues
- Acute issues, such as colds, flu, or sinus infections
- Emotional concerns, including anxiety and depression
- Quality of life problems, i.e., if you’re suffering any excessive pain
- Medication usage and whether you want changes in prescriptions
However, telehealth goes beyond phone calls and includes many other service options. For example, you might also use secure messages, file exchanges, and emails to track healthcare information. This data may include your medical bills or prescription notifications, which you can print out and save for your files. Telehealth may also include remote monitoring support.
Remote monitoring lets a physician watch you check your vital signs to ensure you’re doing it properly. They can give you suggestions if you struggle and make sure that you get accurate results. Typically, you’ll receive these devices from your provider and training on how to use them. Furthermore, you can track your symptoms at home simply out of curiosity.
Typically, telehealth is a good option for people who live in hard-to-reach areas, such as rural towns far from a healthcare provider. Your doctor may also suggest it if you struggle with mobility issues or travel anxiety. Some people also prefer telehealth because it minimizes their time in a healthcare facility, which reduces their risks of getting diseases from other people.
Which Care Options Can You Receive With Telehealth?
Typically, telehealth provides a diverse array of services that can help you stay healthy. While you obviously can’t receive hands-on care with telehealth, you can still receive support in multiple ways to improve your overall health. Also, doctors may use telehealth to gauge whether you need an in-person visit.
Just a few options include:
- Sharing test results: Your physician can quickly share your lab or x-ray results with you to ensure you understand your health and can pick treatments with them.
- Prescription management: Telehealth meetings can also track your prescriptions, including tweaking your dosage or even prescribing new medications.
- Surgical follow-up: After surgery, you might not feel comfortable traveling. In this situation, telehealth can help your doctor check up on you without forcing you to travel.
- Fast diagnosis: If you develop severe symptoms and need a quick diagnosis, you can use telehealth to gauge what treatments you might need.
- Mental health support: Are you experiencing emotional problems that make life difficult? Telehealth can help you meet with a therapist regularly to improve your symptoms.
- Directed physical and occupational therapy: When dealing with an injury, a physical and occupational therapist may provide telehealth support with directed exercises.
During your visit, your physician might ask for your weight, blood sugar, blood pressure, vital statistics, and images of wounds or skin conditions. They may also ask you to read from your symptoms diary and share your current issues. Some even set up automatic reminders or notifications to help you plan your exercises and medications to stay healthy.
Is Medicare Set Up to Cover Telehealth?
Under current laws and regulations, Medicare does cover your telehealth services. This option was heavily expanded during the COVID-19 pandemic to protect people from spreading this condition. These changes were extended through December 31, 2024, at which point they will revert back to the pre-COVID rules and laws unless the law is further advanced.
These expansions were put in place to provide telehealth coverage for people in non-rural areas or those who otherwise didn’t qualify for this diagnostic option. As a result, if you have been denied telehealth coverage under Medicare in the past, you may qualify now.
Currently, Medicare will cover up to 80% of your treatment costs — you pay the rest out of your own pocket. But which Medicare insurance will cover telehealth? That’s an important question to answer, and here’s the answer: Medicare Part B. This policy type covers outpatient services and, in most cases, telehealth services.
While it doesn’t pay for every telehealth treatment, it will help pay for processes like:
- General doctor’s office visits, including regular checkups
- Group psychotherapy sessions that you can attend from your home
- Occupational and physical therapy evaluations before getting treatment
- Therapeutic exercises to walk you back from various long-term health issues
- Speech therapy after a stroke or general support if you struggle to talk
Note that Medicare Part B typically covers transportation costs if you need to go to a hospital or doctor’s office after a telehealth visit. It also usually covers follow-up care, including getting new prescriptions or treatments. In most cases, it covers emergency transportation and some limited non-emergency rides, specifically if you can’t get out of bed or need monitoring while in transit.
Do Any Other Medicare Options Cover Telehealth?
In 2019, the Centers for Medicare & Medicaid Services (CMS) expanded telehealth benefits to Medicare Advantage to improve overall coverage. Medicare Advantage (Part C) has coverage similar to Parts A and Parts B or original Medicare. Advantage may also offer expanded telehealth coverage, depending on your plan, your health, and other important factors.
This may include protection for monthly end-stage renal disease visits to receive dialysis at home, diagnosing, evaluating, and streaking acute strokes, managing substance abuse or co-occurring mental health disorders, and behavioral health services in your home. Availability might vary, so talk with your insurance team to learn more about your care.
Like with Plan B, Medicare pays for up to 80% of your covered costs, requiring you to cover the rest. So if your telehealth visit costs $1,000, Medicare will pay $800 while you pay $200. That greatly reduces your costs, which makes it important to verify your coverage. Make absolutely sure that your telehealth services are covered by Medicare before signing up for a session.
Who Does Telehealth Benefit?
Telehealth services are designed to help specific groups of people who might struggle to make it to a doctor’s office. Often, these individuals have one or more Medicare policies that may pay most of their costs. Typically, telehealth with Medicare can benefit:
- Anyone in rural areas: Telehealth was originally designed to help people in rural areas, though its popularity (and COVID-19) forced an expansion in Medicare coverage to urban regions.
- People with limited mobility: If you don’t own a car, struggle to drive, or have a hard time walking, telehealth helps you receive care in your home without stressing you out.
- Those with anxiety issues: Do you have social anxiety or feel uncomfortable in healthcare facilities? Telehealth treatment helps you receive care without causing excessive anxiety.
- Anyone with immune compromises: Diseases that compromise the immune system can make visiting healthcare facilities risky, but telehealth services can reduce your danger of infection.
- Individuals with COVID-19: To stop the spread of COVID-19 and its many mutations, physicians often approve telehealth for those with this condition.
Telehealth isn’t necessarily limited to people who fall under these headings. However, your telehealth services must be approved by your doctor before Medicare covers them. For example, they may believe that in-person physical therapy would help you recover from surgery or injury more effectively than doing exercises virtually.
Do You Qualify for Telehealth Services?
Are you uncertain if you qualify for telehealth services with your Medicare coverage? Contact me at Senior Insurance Solutions, and we’ll assess your situation in depth. With my help as a licensed Medicare insurance agent, you can figure out whether your Medicare coverage pays for your telehealth services or not. I’m more than ready to help you understand your coverage options and protect your overall health with hands-on support.
