Does Medicare Cover Telemedicine?

Fortunately, telemedicine was already in place before the pandemic, available to meet the needs of people in rural areas and in other complicated situations where an office visit didn’t work.

According to the Kaiser Family Foundation (KFF), however, telemedicine in the U.S. hadn’t taken off before COVID-19. The interest was minimal. But the pandemic changed everything, opening the healthcare community’s and patients’ eyes to the immense value of remote patient services.

Many patients and healthcare providers are now taking the time to learn more about what telemedicine means in terms of private insurance and Medicare coverage.

As your organization’s benefits manager, it might help to take a deeper look at the now fast-rising telemedicine trend and its vast potential benefits for the healthcare industry, patients, and employers.

TECHNOLOGY IS CHANGING THE FACE OF THE MEDICAL INDUSTRY

For decades, the medical industry has embraced emerging technologies to change the way it conducts business for everyone’s benefit. Technology provides the following opportunities for forward-thinking administrators and boards of directors for healthcare organizations:

• Ensures consistent, streamlined, and shareable information and record-keeping within a single hospital and among a healthcare system.
• Provides efficient and effective patient care.
• Facilitates the invention of critical medical equipment and devices, including insulin pumps, digital thermometers, smart inhalers, blood glucose monitors, pulse oximeters, wireless brain sensors, wearable patient technologies, and more.
• Offers unique communication strategies, such as telemedicine or telehealth and video conferencing, to streamline healthcare operations while also ensuring peak patient care at their convenience.

WHAT IS TELEMEDICINE?

According to the Centers for Disease Control and Prevention (CDC), and specific to the pandemic, “telemedicine is the use of electronic information and telecommunication technology to get the healthcare you need while practicing social distancing.” However, telehealth initially began with rural patients and potential epidemics and pandemics in mind.

Healthcare providers tap into the electronically collected, stored, processed, and shareable patient information to facilitate long-distance patient and practitioner contact, appointments, advice, care, intervention, reminders, and even remote hospital admissions when necessary.

Sometimes conducted as voice-only appointments or sessions, and sometimes done as video conference sessions, telehealth appointments offer providers and patients a wealth of benefits, including:

• Convenience for patients who live in rural areas and outside the line of public transportation.
• Makes it easier for busy professionals to get in touch with healthcare practitioners without leaving the office, missing important meetings, or having to choose between a crucial business trip and a long-awaited appointment. Telehealth is ideal for easing health providers’, employees’, and employers’ minds.
• Assurance for health professionals that they can keep up with and monitor conditions and the general well-being of patients, no matter where they live.
• Streamlines healthcare providers’ operations, allowing them and their staff to attend to more patients daily via telemedicine or in-person.
• Reduces costs for patients, regardless of insurance type, providing an alternative to expensive in-office visits or trips to the emergency room. The virtual nature saves everyone time, money, and other valuable resources.

SOME BACKGROUND ON TELEMEDICINE: HOW AND WHEN IT BEGAN

When you think about the history of medicine and medical practitioners, you’ll start to realize that health professionals have tried to bring care to patients for centuries. Think of the days when house calls were common, for example:

As far back as the 17th century, patients sent in urine samples for analysis and diagnosis, and the Union Army in the American Civil War sent telegraphed updates on casualties. Later, with the invention of the telephone, it became easier for doctors to communicate with patients and other one-site caregivers to ensure optimal patient treatment, regardless of either party’s location.

Telemedicine became its own specific healthcare strategy in the 1990s, emerging as the developmental years, with many state and system projects developing. Correctional facilities and Veterans’ hospitals were among the first large organizations to adopt and implement critical telehealth strategies to protect patients in their care.

During the 2000s, telemedicine has taken all of today’s technologies to create a real-time interactive experience for health providers and patients, regardless of where the parties are. Whether via voice or video calls, doctors or physician assistants can speak to patients who need to discuss a pressing health issue without either party interrupting their day.

THE STATE OF TELEMEDICINE BEFORE COVID-19

Telehealth had become a vital part of the health industry long before COVID-19 changed the world as everyone knew it before. However, thanks to existing infrastructure and processes, doctors and patients were able to run with this innovation.

Healthcare organizations have long been investing in digital healthcare. Patients were also stepping up, especially as broadband and wireless communications have become increasingly available, even in remote locations.

The stage was set to fully embrace telemedicine as a critical solution, although no one could have imagined what was ahead with the onset and ongoing issues associated with COVID-19. For better or worse, the coronavirus brought many technological innovations to the forefront, including telehealth services, instantly making it a mainstream service.

HOW HAS TELEHEALTH CHANGED AS A RESULT OF

COVID-19?

When COVID-19 became a stark reality, sparking lockdowns, restrictions, and social distancing requirements, there was a ready-made solution to comply with it all. Telehealth was already an option available to everyone. At this point, even the most technology-averse patients became open to embracing essential technologies for everything from grocery orders to at-home telehealth visits.

It wasn’t only a practical measure but one encouraged by policymakers, health systems, and insurers to help prevent the spread of the coronavirus and protect everyone at the same time.

Further, the demand has rapidly and broadly increased for the use of telemedicine, which has inspired changes in telehealth policy and coverage for many different health coverage providers, including Medicare. In addition, it has eased the minds of the health community and patients, making telehealth widely available during a state of emergency and ongoing health concerns.

WHICH BENEFITS COVER TELEMEDICINE SERVICES?

In many cases, an organization’s health insurance policy determines whether it covers telehealth. Therefore, it is important for benefits leaders to research an insurance carrier’s position on providing telemedicine benefits. However, since it has become more widely used in the wake of COVID-19 and offers a more affordable solution for everyone, it is likely to become an increasingly included part of a benefits package.

DOES MEDICARE COVER TELEMEDICINE?

While private insurance carriers are hit-and-miss on covering telemedicine, Medicare readily covers this convenient health service to help ensure the good health of recipients and avoid further costs for unchecked health issues when patients can’t visit provider sites.

According to the National Institute on Aging (NIH), patients enrolled in Medicare Part B, certain telehealth services are sometimes included, such as:

• Doctor’s visits
• Outpatient care
• Medical supplies
• Preventive services

The specific amount patients might pay depends on some variables, including:

• Additional insurance the patient has
• The type of facility
• The amount the provider charges
• Where a patient visits for a test, service, or item

Medicare does fully cover e-visits and virtual check-ins.

Another aspect of Medicare to consider is its Advantage plans, which are offered by a private company that enters into a contract with Medicare to provide Part A and Part B benefits more effectively and efficiently. Such plans offer more benefits than the Original Medicare plans.

Since Medicare plans change frequently, it is best to check the Medicare website regularly for updates. Right now, patients pay 20% of the Medicare-Approved Amount for their doctor or other healthcare services. Additionally, the Part B deductible applies here. In most cases, patients pay the same for telehealth services that they would pay if they received services, treatments, and advice in person.

Medicare telehealth coverage includes services for primary care visits, psychotherapy, consultations, and certain other health services suited to communications between two parties in different locations using audio and video communication technology.

Here are some telehealth services available to those who do not live in rural communities:

• Treatments for a substance abuse or use disorder co-occurring with a mental health disorder. These instances are called “dual disorders,” and make it more challenging for patients to visit the provider’s site, even if not a rural location.
• Monthly home dialysis treatments for End-Stage-Renal Disease (ESRD).
• Diagnosis, evaluation, and treatment for symptoms that suggest acute stroke.
• Certain at-home emergency services.
• Physical and occupational therapy sessions.
• Some audio-only services make it easier for those without video capabilities.

Would you like to help your benefits team learn more about telemedicine? Our KBI Benefits team can help your staff preparing for retirement know more about what’s ahead for them in terms of Medicare benefits.