Written on November 29, 2022 by Gillian (Gigi) Singer, MPH, Sexuality Educator & Certified Sexologist. To give you technically accurate, evidence-based information, content published on the Everlywell blog is reviewed by credentialed professionals with expertise in medical and bioscience fields.
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Navigating health insurance and figuring out your benefits can be a daunting task, but as a provider of at-home testing, Everlywell knows the importance of access to healthcare in your home. In 2021 alone, 37% of adults reported using telemedicine within the last year and has bridged gaps in healthcare coverage for aging and elderly folks, especially during the COVID-19 pandemic . Let us help you get the most out of telemedicine using your Medicare coverage.
The first step to answering the question, “Does medicare cover telehealth?” is to start understanding what Medicare is, is not, and what each part can do for you.
Medicare is an insurance program that serves mostly people ages 65 and over in addition to younger people who live with disabilities and/or are dialysis patients. Medicaid is an assistance program that serves low-income people of any age .
In this article, we will be focusing on Medicare coverage.
Part A of Medicare is your hospital insurance. It covers “inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care” .
Part B is your medical insurance that covers the following:
Part C includes your Medicare Advantage plan if you elect to have one. They are offered by preapproved private insurance companies and may give you extra coverage like “vision, hearing, dental, and/or health and wellness programs” . Medicare Advantage is described as follows:
Part D is your prescription drug coverage (including vaccines and shots). To receive this coverage, “you join a Medicare drug plan in addition to Original Medicare, or you get it by joining a Medicare Advantage Plan with drug coverage. Plans that offer Medicare drug coverage are run by private insurance companies that follow rules set by Medicare” .
You can buy Medicare Supplemental Insurance from a private insurance company to help share the costs of your Original Medicare insurance.
Telemedicine, sometimes called “telehealth” can include a variety of medical and health services that are offered via phone or video chat, whether that’s over the phone, computer, or tablet. It allows you to access healthcare without an in-person office visit. This is especially beneficial for people living in rural areas and also for folks with limited mobility due to age or disability .
Telehealth gained popularity during the COVID-19 pandemic—the AMA reports that “more than half of physicians used telehealth for the first time in the pandemic’s first few months” . It was hugely beneficial when many people couldn’t access their normal healthcare services because they couldn’t leave their homes or risk exposure to the virus.
The Medicare website states that the following healthcare providers can facilitate e-visits:
Regarding the cost of telehealth in general, “After you meet the Part B deductible, you pay 20% of the Medicare-Approved Amount for your doctor or other health care provider's services. For many telehealth services, you'll pay the same amount that you would if you got the services in person” .
One thing to note is that “Medicare Advantage Plans and providers who are part of certain Medicare Accountable Care Organizations (ACOs) may offer more telehealth benefits than Original Medicare,” so check with your plan to see what benefits you have if your provider participates in an ACO .
Medicare covers virtual check-ins and Medicare telehealth. Virtual check-ins (also called “brief communication technology-based services”)  can be conducted via phone, virtual delivery, secure messaging, email, or through your patient portal. In terms of cost, “After you meet the Part B deductible, you pay 20% of the Medicare-approved amount for your doctor or other provider's services” .
You qualify for virtual check-ins if you meet the following criteria:
Unfortunately, Everlywell cannot check your insurance for you. To check your coverage, try contacting the Centers for Medicare & Medicaid Services at 1-800-633-4227. We know you might have other questions regarding insurance coverage and Everlywell tests. For more information, visit our Insurance Coverage FAQ page.
You may also wish to book an appointment with Everlywell's telemedicine option, Virtual Care Visits.
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