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Telehealth & Telemedicine Services Covered by Medicare

Medicare continues to expand telemedicine and telehealth services. As virtual care becomes more necessary, doctors and patients look for Medicare to cover services. Part B includes more telehealth services than ever before. In the content below, we’ll discuss how and when Medicare works with telemedicine.

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What Telehealth is Covered by Medicare?

Telehealth is a remote clinical service. Doctors must use live, real-time audio, and video connections to interact with patients. Medicare only reimburses telemedicine that takes place via live videoconference. Current telemedicine has coverage through Medicare Part B.

Also, the location during the time of service must be in a patient’s home or an allowable facility. There are no location restrictions for doctors.

Medicare Telehealth Parity Act

The Medicare Telehealth Parity Act has expanded. Now, the federal healthcare program covers more virtual care services than before. The bill also increased the approved locations for both originating and distant sites. Also, the 2017 Act initiated remote patient-monitoring for those with chronic conditions. Two years earlier, Congress introduced The Medicare Telehealth Parity Act of 2015. The bill opened the doors of opportunity for better delivery of healthcare.

Further, the bill included in-home telehealth as a qualifying originating state. Qualifying beneficiaries may obtain medical care from home.

Trump Expands Telehealth Benefits to Beneficiaries in Rural Areas

While telehealth can’t fully replace in-person care, it does compliment care by increasing access. During the Pandemic, Trump began making telehealth available to those on Medicare. Well, he is making this access permanent. This rule would also reduce clinician burden while giving convenient doctor access to those in rural areas.

What is the Difference Between Telehealth vs. Telemedicine?

Telehealth is the broad scope of care that includes telemedicine. Telemedicine includes clinical services. Whereas telehealth consists of both clinical and non-clinical services.

For example, doctor training and administrative meetings would fall under telehealth. And, a virtual follow up doctor’s visit would be telemedicine. To make things more complicated, the World Health Organization uses the term “telematics” to describe health activities that take place via communication technology. Telematics is both telemedicine and telehealth.

So, all telemedicine is telehealth. But not all telehealth is telemedicine. And, telematics is both.

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How Much Does Medicare Pay for Telemedicine?

On average, telehealth costs about $79 per visit. Of course, costs depend on insurance carriers or plan types. Telemedicine costs are similar to standard copayment costs of healthcare.

Telemedicine that Accepts Medicare

  • Hospitals
  • Critical Access Hospitals
  • Home of a beneficiary with End-Stage Renal Disease getting home dialysis
  • Hospital-based Renal Dialysis Centers
  • Renal Dialysis Facilities
  • Doctor’s Offices
  • Community Mental Health Centers
  • Rural Health Clinics
  • Federally Qualified Health Centers
  • Skilled Nursing Facilities
  • Mobile stroke units
  • Community mental health centers

Do Medicare Advantage Plans Cover Telemedicine?

Medicare Advantage plans, as of recently, are full of telemedicine benefits, some more than Medicare. The Bipartisan Budget Act changed Medicare Advantage telemedicine benefits. Medicare allows and encourages plans to include telemedicine benefits.

Costs of telemedicine services and office visits are comparable under Advantage Plans. For example, if you’re video conferencing a primary care doctor, you’ll likely pay less than if you’re video-chatting with a specialist.

FAQs

What type of telemedicine does Medicare cover?
Reimbursement from Medicare is only for live telemedicine. You must have a real-time video chat with your doctor. The goal is to mirror an in-person visit as close as possible. Live telemedicine is like an office, except its not face-to-face. Two states within the U.S. have different guidelines. Only in Hawaii and Alaska, Medicare pays for store-and-forward telemedicine.
What is the originating site for telehealth?
The patient’s location during the time of service is the originating site. Generally, telehealth is available for people outside of metropolitan areas or in rural Health Professional Shortage areas. For example, if your doctor and you are both in a rural area, a visit can be difficult. If you need care and you’re a high-risk-patient, talk to your doctor about virtual services.
What qualifies as a distant site for Medicare in telemedicine?
A distant site for telemedicine refers to the location of the doctor. Doctors must participate and accept Medicare to qualify.
Does Medicare cover telephone visits?
Yes, Medicare will cover telephone visits. The visit would still be considered a telehealth visit.

How to Get Help with Telehealth & Telemedicine Coverage with Medicare

Telehealth and telemedicine give patients access to doctors from a remote location. In times of crisis, this kind of care can be life-saving. Our agents can help you find your best policy today! We have a team of experts ready to get you the benefits that you deserve. We compare rates and offer free quotes for plans in your area. Give us a call to find the best policies in your area. Can’t talk right now? We get it, and we’re here to help make things easier. Complete our online rate form to get the process started.

Kayla Hopkins

Kayla Hopkins

Content Editor
Kayla Hopkins is an accomplished writer and Medicare guru serving as the Editor of MedicareFAQ.com. Upon completing her Communications degree from Ohio University, Kayla dedicated her time to understanding the ever-evolving landscape of healthcare. With her extensive background as a Licensed Insurance Agent, she brings a wealth of knowledge and expertise to her writing.

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