Medicare and Telehealth Services

As conditions have made virtual care more necessary, Medicare has expanded coverage for telemedicine and telehealth services, with Part B including more telehealth services than ever. This is especially important in rural areas, where it may otherwise be very difficult to receive adequate services.

Is there a difference between Telehealth and Telemedicine?

Telehealth is the broad term that includes both clinical and non-clinical services. Telemedicine consists of clinical services only.

For example, a virtual follow up doctor’s visit would be telemedicine; doctor training and administrative meetings would be telehealth, but not telemedicine. So, all telemedicine is telehealth. But not all telehealth is telemedicine.

(To make things more complicated, the World Health Organization uses the term “telematics” to describe all health activities that take place via communication technology; the term includes both telemedicine and telehealth).

What Telehealth does Medicare cover?

Medicare will only reimburse for telemedicine that takes place via live videoconference. It is considered to be a remote clinical service, and doctors must use live, real-time audio, and video connections to interact with patients in order to have coverage through Part B.

While there are no restrictions regarding the doctor’s location, the location of the patient at the time of service is considered the “Originating Site,” and must be at their home or an allowable facility.

  Medicare Telehealth Parity Act

In 2015, Congress passed The Medicare Telehealth Parity Act, which expanded opportunity for better delivery of healthcare. This was expanded in 2017, covering more services and locations, as well as monitoring for patients with chronic conditions. Also, the bill included in-home telehealth as a qualifying originating state. Qualifying beneficiaries may obtain medical care from home.

How much Medicare pays for Telehealth

Telemedicine costs are comparable to standard copayment costs of healthcare, and depend on insurance plan types, with telehealth costs averaging about $79 per visit.

Telemedicine providers that accept Medicare

HospitalsCritical Access Hospitals
Hospital-based Renal Dialysis CentersHome of a beneficiary with End-Stage Renal Disease getting home dialysis
Renal Dialysis FacilitiesDoctor’s Offices
Community Mental Health CentersRural Health Clinics
Federally Qualified Health CentersSkilled Nursing Facilities
Mobile stroke unitsCommunity mental health centers

Do Medicare Advantage Plans Cover Telemedicine?

CMS allows and encourages plans to include telemedicine benefits, and some plans offer more coverage than Original Medicare does. The Bipartisan Budget Act changed Medicare Advantage telemedicine benefits, so that costs of telemedicine services and office visits are comparable under Advantage Plans. That means that, much like in-person visits, if you’re video conferencing a primary care doctor, you’ll likely pay less than if you’re video-chatting with a specialist.

Click here to download a PDF of this Guide.

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