Does Medicare cover telehealth?
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 [1]. Let us help you get the most out of telemedicine using your Medicare coverage.
Understanding Medicare
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 v. Medicaid
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 [2].
In this article, we will be focusing on Medicare coverage.
Medicare parts
Part A of Medicare is your hospital insurance. It covers “inpatient care in hospitals, skilled nursing facility care, hospice care, and home health care” [3].
Part B is your medical insurance that covers the following:
- Services from doctors and other healthcare providers
- Outpatient care
- Home health care
- Durable medical equipment (like wheelchairs, walkers, hospital beds, and other equipment)
- Many preventive services (like screenings, shots or vaccines, and yearly “Wellness” visits) [3]
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” [4]. Medicare Advantage is described as follows:
- Plans may have lower out-of-pocket costs than Original Medicare.
- In most cases, you’ll need to use providers who are in the plan’s network.
- These “bundled” plans include Part A, Part B, and usually Part D. [3]
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” [3].
You can buy Medicare Supplemental Insurance from a private insurance company to help share the costs of your Original Medicare insurance.
What is telemedicine?
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 [5].
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” [6]. 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.
Who can provide e-visits?
The Medicare website states that the following healthcare providers can facilitate e-visits:
- Doctors
- Nurse practitioners
- Clinical nurse specialists
- Physician assistants
- Physical therapists
- Occupational therapists
- Speech-language pathologists
- Licensed clinical social workers (in specific circumstances)
- Clinical psychologists (in specific circumstances) [7]
Medicare coverage
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” [8].
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 [8].
Virtual check-ins
Medicare covers virtual check-ins and Medicare telehealth. Virtual check-ins (also called “brief communication technology-based services”) [9] 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” [9].
You qualify for virtual check-ins if you meet the following criteria:
- You've talked to your doctor or other providers about starting these types of visits.
- The virtual check-in doesn't relate to a medical visit you've had within the past 7 days and doesn't lead to a medical visit within the next 24 hours (or the soonest appointment available).
- You verbally consent to the virtual check-in, and your healthcare provider documents your consent in your medical record. Your healthcare provider may get one consent for a year’s worth of these services [9]
Checking your coverage
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.
Related content
Is telehealth covered by insurance?
Types of telehealth care and services
Can medication be prescribed via telehealth?
References
- Lucas JW, Villarroel MA. Telemedicine Use Among Adults: United States, 2021. National Center for Health Statistics. URL. Published October 12, 2022. Accessed November 28, 2022.
- Digital Communications Division (DCD). What is the difference between Medicare and Medicaid? U.S. Department of Health & Human Services. URL. Published October 2, 2015. Accessed November 28, 2022.
- Parts of Medicare. Medicare.gov. URL. Accessed November 28, 2022.
- Digital Communications Division (DCD). What is medicare part C? HHS. URL. Accessed November 28, 2022.
- Gajarawala SN, Pelkowski JN. Telehealth Benefits and Barriers. J Nurse Pract. 2021;17(2):218-221. doi:10.1016/j.nurpra.2020.09.013. URL
- Zarefsky M. In 2022, moving beyond telehealth to digitally enabled care. American Medical Association. URL. Published January 21, 2022. Accessed November 28, 2022.
- E-Visits. Medicare.gov. URL. Accessed November 28, 2022.
- Telehealth. Medicare.gov. URL. Accessed November 28, 2022.
- Virtual check-ins. Medicare.gov. URL. Accessed November 28, 2022.