Wouldn’t it be great if you didn’t have to physically go to a doctor’s office every time you got sick?
In this day and age, that dream is now a reality for Medicare beneficiaries, thanks to Medicare’s telehealth coverage.
What Is Medicare’s Telehealth Coverage?
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Telehealth, which is a way to visit with your provider using a phone or video call, is a benefit available to all Medicare members. It’s recently gained traction in many health care circles.
“A lot of Medicare beneficiaries got their first taste of telehealth care during the COVID pandemic, and some came to really depend on it,” says Whitney Stidom, vice president of sales and operations with eHealth Inc., a health insurance broker and online resource provider headquartered in Santa Clara, California.
Rules were relaxed during the worst of the COVID-19 pandemic to allow for broader coverage of telehealth services under Medicare Part B, she adds, and that opened up telehealth access to many more people around the country. Both providers and beneficiaries appreciated this additional means of working together, and Medicare has since made telehealth coverage an ongoing benefit.
What’s more, Medicare beneficiaries enrolled in a Medicare Advantage plan may have additional telehealth benefits, such as urgent care visits, Stidom says, but these benefits can vary from one plan to another. If you’ve got Medicare Advantage, ask your insurer for more information about your telehealth coverage.
[Read: A Beginner’s Guide to a Virtual Doctor’s Visit.]
How to Access Telehealth
You can connect with your provider for a telehealth visit via a few clicks on an electronic device, such as a computer, smartphone or tablet, says Dr. Steven Arabo, medical director of Medicare programs for CalOptima Health, which provides health insurance coverage to low-income populations in Orange County, California.
Your provider will send a link to access your visit remotely via your computer or smartphone. At the appointed time, click the link, follow the instructions on the screen and you’ll be connected to your provider.
If your telehealth visit is provided as an audio-only call, connecting may be as simple as answering the phone when it rings.
Telehealth is a benefit available to all Medicare members.
“There are no geographic restrictions for patients or providers, therefore telehealth services are available in all 50 states,” Arabo says.
Just note that telehealth may not be appropriate for all visits and all situations, such as when you might need to undergo physical tests.
Before starting a telehealth call, make sure you have on hand a list of all the medications you’re taking or the bottles themselves. Come prepared with questions or talking points to ensure you make the most of your time on the call.
[Read: Medicare vs. Medicare Advantage: How to Choose.]
How Much Does Medicare’s Telehealth Cost?
After you meet the Part B deductible (which, in 2024, is $240), you’ll pay 20% of the Medicare-approved amount for telehealth visits, according to the Centers for Medicare and Medicaid Services. The Medicare-approved amount is the payment set by original Medicare (Parts A and B) for a covered service or item. When your provider accepts the assignment to treat you, Medicare pays its share and then you pay your share of that amount for the doctor or other health care provider’s services.
In most cases, telehealth services cost the same as if the care had been rendered in person. If price is a concern, ask your provider for details on what the services will cost. The specific amount you’ll owe depends on a variety of factors:
— How much the doctor charges for the services rendered
— Whether your doctor accepts Medicare payment
— Whether you have another insurance policy that might cover part of the cost
— In which part of the country services are rendered
[Read: What Medicare Doesn’t Cover and How to Manage Costs]
What Can Telehealth Be Used For?
Telehealth visits can be used for patients who don’t require a physical exam, Arabo says. As such, it can be a good option for many small issues, ranging from headaches and the common cold to an upset stomach.
“Telehealth visits can also be used for checking results from lab tests or X-rays, checking in with your provider after surgery and getting assistance with medication management,” Arabo adds.
It’s important to note that some of the expanded coverage that arose from the COVID-19 pandemic will expire after December 31, 2024. So, if you’ve used telehealth recently, be forewarned that some services you’ve accessed remotely before may not be covered next year. For example, Medicare Part B will no longer cover telehealth services for physical or occupational therapy or for speech therapy — unless you live in a rural area, Stidom notes.
Also after December 31, 2024, whether you live in a rural area or not, Medicare Part B will continue to cover telehealth for these services:
— Diabetes self-management training
— Substance abuse treatment
— Some mental health care services
— Some services related to treatment of a stroke
— Medicare nutrition therapy
— Monthly end-stage renal disease visits for home dialysis
If you’d like to use telehealth, ask your provider if it’s available for the care you need.
While telehealth can be a great option for many people and can address a wide range of health concerns, it can’t address all of your medical needs, Stidom notes.
“Sometimes you just need to be physically present with the doctor for proper diagnosis or treatment or for certain tests to be administered,” she says.
For example, no matter how advanced your smartphone technology, it won’t be able to draw blood from you remotely. And for other more complex diagnoses, your provider may insist on an in-person exam.
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How to Use Medicare?s Telehealth Coverage originally appeared on usnews.com
