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Medicare Telehealth: Can I get Coverage for it?

Medicare telehealth

Medicare telehealth services are covered under Medicare. It covers telehealth and a wide range of medical and health-related services, allowing for long-distance healthcare visits and education through electronic communication technology. Please, continue reading to learn more about telehealth and the components of Medicare that it covers.

Medicare has several sections, each of which offers different types of coverage. The following are the main sections:

  • Hospital insurance or Medicare Part A
  • Medical insurance or Medicare Part B
  • Advantage plans or Medicare Part C
  • Prescription drug coverage or Medicare Part D

Parts B and C of Medicare cover telehealth, but we’ll go over this in more detail later.

What Medicare Part B covers?

Medicare Part B covers some telehealth services. Parts A and B of Medicare are called “Original Medicare.”

You will get the same treatment as an in-person outpatient appointment in a telehealth appointment. The following are examples of telehealth services that it covers:

  • Visits to the office.
  • Consultations.
  • Psychotherapy.

The following are some examples of healthcare professionals who can offer telehealth services:

  • Doctors.
  • Medical assistants.
  • Practicing nurses.
  • Psychologists who specialize in clinical issues.
  • Nurse anesthetists who are certified.
  • Dietitians who are registered.
  • Nutritionists who are licensed.
  • Social workers in clinical settings.

Telehealth services are available from the comfort of your own home in some cases, while in other cases, you’ll need to visit a medical facility.

What Medicare Part C covers?

Part C of Medicare is also known as Medicare Advantage, and private insurance companies sell part C plans. It provides coverage similar to original Medicare but with the possibility of additional benefits.

Part C will undergo changes in 2020, allowing it to provide more telehealth benefits than original Medicare. Increased access to telehealth benefits from home, rather than requiring a visit to a healthcare facility, is one of these changes.

Depending on your Part C plan, you may be eligible for additional benefits. Check your plan to see what kind of telehealth services are available.

What is the cost of a Medicare telehealth visit?

If you have Part B, you will be responsible for a 20% coinsurance payment for any telehealth services you receive but remember that you must first pay your Part B deductible, which in 2021 is $203.

Part C plans must cover the same essential benefits as original Medicare. However, before using telehealth services, check with your plan’s provider to see if it covers a specific service and estimate any out-of-pocket costs.

How do I know if I’m a telehealth candidate?

You’ll be eligible for telehealth services once enrolled in original Medicare.

If you’re 65 or older, have an end-stage renal disease (ESRD), amyotrophic lateral sclerosis (ALS), or cannot work due to a diagnosed disability, you may be eligible for Medicare.

Facilities with approval

People with Part B coverage frequently need to visit a healthcare facility for telehealth services. Check your plan to see if your visit requires you to visit an approved facility. The following are examples of these types of facilities:

  • Medical offices.
  • Hospitals.
  • Nursing homes with specialized care.
  • Mental health services in the community.
  • Health clinics in rural areas.
  • Hospitals with limited access.
  • Dialysis centers in hospitals.
  • Federally qualified health centers (FQHCs) are nonprofits that receive federal funding to provide medical services to those who cannot afford them.

Location.

The types of telehealth services you can get with original Medicare may vary depending on your geographic location which means you must live in a rural Health Professional Shortage Area or a county outside of the Metropolitan Statistical Area.

Government agencies are in charge of determining these areas. You can check if your location qualifies on the Health Resources and Services Administration website.

Please, note that it covers only certain types of healthcare providers and appointments. Before beginning telehealth services, check with your insurance provider to see if it covers something.

Medicare coverage for telehealth is being expanded.

Telehealth coverage for Medicare beneficiaries was expanded as part of the 2018 Bipartisan Budget Act. Certain circumstances may now qualify you for an exemption from the standard Medicare telehealth rules. Consider it more closely:

 

ESRD.

You can get telehealth services at home or your dialysis facility if you have ESRD and are on at-home dialysis. Telehealth location restrictions have also been removed.

After starting at-home dialysis, you must have periodic in-person visits with a healthcare professional. These visits should occur once a month, for the first three months, then every three months after that.

Stroke.

Telehealth services may make a stroke’s evaluation, diagnosis, and treatment go more quickly. As a result, you can use telehealth services for an acute stroke, regardless of where you are.

Organizations that are accountable for their care (ACOs).

ACOs are networks of healthcare providers who collaborate to coordinate care for Medicare beneficiaries. If you’re sick or have a chronic health condition, this coordinated care will ensure you get the help you need.

You can now receive telehealth services at home if you have Medicare and use an ACO. There are no restrictions based on your location.

E-visits and virtual check-ins with Medicare.

Medicare also covers additional services similar to telehealth visits, and regardless of their location within the United States, all Medicare beneficiaries are eligible for these services.

  • Check-ins via the internet. You can request brief audio or video communications from your healthcare provider to avoid unnecessary office visits.
  • E-visits. You can communicate with your healthcare provider in a new way through a patient portal.

You’ll only be responsible for 20% of the cost of a virtual check-in or an E-visit; just like with a telehealth visit to arrange virtual check-ins or E-visits, speak with your healthcare provider first.

Telehealth’s Advantages.

Telehealth has many potential advantages. For starters, it can aid in protecting Medicare beneficiaries in high-risk situations. This was especially true during the COVID-19 pandemic, but it could also be useful during flu season.

Telehealth also aids in the streamlining of healthcare services. Telehealth can be used to perform routine follow-ups and chronic condition monitoring, for example. In an already overburdened healthcare system, this could potentially reduce the number of in-person visits.

Telehealth can also be beneficial if you live in a rural, difficult-to-reach, or under-resourced area. It gives you instant access to a variety of healthcare professionals and specialists who may not be in your area.

Even though telehealth has several advantages, not everyone is aware of it. Only 37% of dialysis patients had heard of telehealth, according to a small 2020 study at a dialysis center. This demonstrates the need for increased awareness.

Takeaway.

The use of technology to provide long-distance medical services, such as videoconferencing, is also telehealth. Medicare covers some types of telehealth, and it appears that this coverage will be expanded in the future.

Medicare Part B covers telehealth for office visits, psychotherapy, or consultations. It only includes a few healthcare professionals and locations, while additional coverage under Medicare Part C may be available, but it depends on your specific plan.

There are usually restrictions on where they can be used for Medicare-covered telehealth services. However, the 2018 Bipartisan Budget Act and the COVID-19 pandemic have expanded.

If you want to get telehealth services, talk to your healthcare provider. They will let you know if they have any available and how to make an appointment.

Learn more about Medicare on our website NewMedicare.com.

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