Does Medicare Cover Telemedicine?

Medicare coverage for telemedicine visits is relatively new. Traditionally Medicare has paid for such visits in a limited way. But the coronavirus, or COVID-19 pandemic, has changed all of that. Why? Many primary care physicians are using telemedicine appointments in lieu of traditional in-office visits to keep patients, doctors and their staffs safe during this time. This has been valuable to patients 65 and older who are considered to be at higher risk, especially if they have an underlying condition such as COPD (chronic obstructive pulmonary disease), heart disease or diabetes.  

Many seniors, likewise eager to reduce their risk, have begun to embrace telemedicine. From mid-March to mid-June alone nine million Medicare beneficiaries used some type of telemedicine service. Over three million received telehealth services by phone, and 26 percent received care at nursing homes. Approximately 60 percent have had virtual visits with a psychologist or psychiatrist. 

What is telemedicine? 

Telemedicine, sometimes called telehealth, makes it possible for you to have a virtual doctor’s visit using telecommunications technology. All you need is a computer, tablet or mobile phone and an Internet connection. A live video chat, where you and your primary care physician can see each other, is the most common way to have a telehealth visit. Your doctor may provide you with a link to a secure website like doxy.me, or you may connect with Zoom, Skype or some other video chat application. Patients unfamiliar or uncomfortable with video chat technology can simply talk to their doctor on the phone. 

Another important aspect of telemedicine — remote patient monitoring — makes it possible for your primary care doctor to track, in real-time, vital statistics related to certain health conditions that you may have. If, for instance, you have hypertension, occasional blood pressure checks during office visits may not be enough. Your doctor may ask you to use a device such as a digital blood pressure cuff (or wrist monitor), which sends your pulse rate and blood pressure readings to your doctor each time you measure it. A record of readings over time enables your doctor to give you feedback on how you’re doing in your efforts to lower your blood pressure and to make him aware of any sudden changes, such as a spike or an irregular heartbeat. Partnering with your primary care doctor with this technology is an excellent way to track ongoing problems and take steps to manage them.  

When to Use a Telehealth Visit  

Before the coronavirus pandemic, there was limited interest among doctors to deliver health care and for patients to receive it through virtual visits. While your primary care doctor can’t do everything from afar, the Centers for Disease Control and Prevention (CDC) notes that these services work well for virtual visits: 

• Screening for COVID-19, testing recommendations and guidance on isolation or quarantine 
• General health care. Some patients have been less vigilant about their health since the pandemic spread. But it’s important to contact your primary care physician if you’re sick or even have a minor injury. Self-care may not do the trick, and self-diagnosis can endanger your health. It’s also important to maintain general wellness visits. Your doctor will want to keep tabs on any stress, anxiety or depression you may experience – three conditions exacerbated by the coronavirus that can wreak havoc on your health. 
• Management of chronic conditions, such as high blood pressure, high cholesterol and diabetes. A report out in late April showed that diagnostic tests like lipid panels and blood sugar screenings were down by as much as 68 percent nationwide—posing potential health risks to patients. 
• Maintain regimen for medication prescriptions
• Start or continue mental health counseling

How to Schedule a Telemedicine Appointment 

Start with a few questions for your primary care physician:

• Are you offering telemedicine visits? 
• If so, is a video chat a good option for my health concern?
• How will we connect? 

Your doctor may not provide telemedicine visits — for instance, he may not have the technology for it. In that case, visit medicare.gov to find a doctor who provides virtual healthcare and accepts Medicare. If you have an Advantage plan or supplemental insurance (called Medigap), check with your health insurer, who may be able to help you find an in-network provider.

Medicare and Telemedicine

Medicare is a federal program, and as such federal regulations oversee health services that qualify for reimbursement, and at what rate. 

Telemedicine isn’t entirely new to Medicare. For those with Original Medicare, Part B covers telehealth services such as doctor’s visits, consultations and mental health services. Patients are responsible for the Part B deductible and 20 percent of the Medicare-approved amount for the doctor’s visit.

Medicare Advantage plans, called Part C, offer similar coverage. Since patients buy Advantage plans from private insurance companies, services vary. Likewise, copayments, coinsurance and deductibles differ, based on the plan. According to the AARP, over half of Medicare Advantage plans now offer telemedicine services as part of the basic package. 

Medicare telehealth coverage has had a number of restrictions. But in early March, in response to the public health emergency, the government made significant, though temporary policy changes to encourage telemedicine visits.  Over 135 additional services were added to the Medicare telehealth list, including home visits and physical, occupational and speech therapy. Healthcare providers such as primary care physicians have been allowed to reduce or waive coinsurance and deductibles. At the same time doctors have been reimbursed the same amount as they would for in-person visits.   

The number of Medicare beneficiaries using telemedicine continues to surge. The question is, what happens when the pandemic is no longer considered a public health emergency? Congress would need to pass legislation to make any policy changes permanent. Bills have already been introduced in Congress to continue Medicare payment for telemedicine visits, although healthcare providers have voiced concerns about how reimbursement rates might change. Overall, however, there is a groundswell of interest for expanded coverage to continue. 

MDVIP-affiliated physicians have been using telehealth for 20 years to stay in touch with patients, answering calls after hours and on weekends. Some have adopted new telemedicine technology during the recent pandemic in order to see patients remotely; others prefer to see with you in person at the office, where they have more time than most primary care doctors. Because your MDVIP-affiliated physician has the time to really get to know you, they can use all their tools to help diagnose and treat medical issues as they come up, to answer your questions and help design a wellness plan for you.