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Mobile phone with telehealth screen for Everlywell Virtual Care Visits covered by insurance

Is telehealth covered by insurance?

Written on November 29, 2022 by Theresa Vuskovich, DMD. 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.


Table of contents


During the COVID-19 pandemic, telehealth claims increased by 4,347% between March 2019 and March 2020 [1]. Due to telehealth's popularity during the pandemic, public and private health insurance companies now cover telehealth services. However, coverage (i.e., payment) varies across plans.

This article explains the basics of telehealth, telehealth insurance, and coverage for Everlywell's virtual visits.

What is a telehealth appointment?

Telehealth is "the use of electronic information and telecommunications technologies to support long-distance clinical health care, patient and professional health-related education, public health and health administration" [2]. On the other hand, telemedicine involves interaction between a patient and a clinician who are physically separated [9]. Although these definitions seem similar, there are subtle differences, such as telehealth encompassing a greater range of services [9]. Telehealth appointments offer patients remote clinical services through a variety of technologies. These include video platforms, text messaging, telephone calls, or a healthcare provider's online portal.

The concept of telehealth originated in the 1970s with the "Fathers of Telemedicine," Dr. Rashid Bashshur and Dr. Jay Sanders [4]. After the 2008 recession, the American Recovery and Reinvestment Act directed over $25 billion to advance digital healthcare and technology [4]. Even though office visits have increased following the COVID-19 pandemic, telehealth appointments are still popular due to their convenience and the variety of services available [4,9].

Services

Telehealth appointments can help you access a wide range of healthcare services: [3, 7, 8, 11,12]

  • nutritional counseling
  • sleep disorder screening
  • skin assessments
  • speech therapy
  • prescription management
  • post-surgical follow-ups
  • remote patient monitoring

Before making an appointment, check with your healthcare provider or insurance company to determine if your insurance covers the services.

Prescriptions

Telehealth appointments are ideal for managing prescriptions since many chronically ill patients need to schedule regular appointments with their healthcare providers [2]. Telehealth appointments make it easier for patients to access medication and adhere to medication schedules. Since state prescribing laws vary, you should also ask your healthcare provider's office what medication they can prescribe during a telehealth appointment [2,5].

Advantages

Aside from offering convenient access to care, telehealth appointments lessen the burden on the medical system by reducing staffing and facility needs [2,12]. Additionally, telehealth appointments can protect you from infectious diseases and prevent others from getting sick if you are ill [2,12].

Does insurance cover telehealth appointments?

Now that you understand the basics of telehealth appointments, let's look at health insurance coverage for telehealth visits. Telehealth coverage increased thanks to COVID-19, which prompted more public and private health plans to cover virtual visits.

Telehealth and Medicaid

Medicaid coverage for telehealth services is based on your state. You can contact your local Medicaid program to see if telehealth services are covered.

Telehealth and Medicare

Before COVID, Medicare covered about 100 telehealth services, such as office visits, psychotherapy, and preventive health screenings [6]. As a result of COVID, Medicare now covers a wider range of telehealth services. Behavioral health and patient education are covered through video platforms or by audio-only telephone [6].

Telehealth coverage by private insurance

Similar to Medicaid, private health insurance coverage varies widely. For more information about your telehealth coverage, you can visit your insurer's website, which frequently provides an overview of your benefits. You can also determine your eligibility by contacting your healthcare insurance company or healthcare provider.

Telehealth without health insurance

You can still use telehealth services even if you don't have health insurance. However, you will have to pay out-of-pocket for your services.

Everlywell's telehealth appointments: what to know about coverage

Everlywell offers virtual visits to assess the symptoms you are experiencing and provide you with the proper tests, prescriptions, and lifestyle recommendations. You will meet with a licensed nurse practitioner for 20 to 30 minutes through a virtual platform. Before you schedule your virtual care visit with Everlywell, here's what you need to know about insurance coverage:

  • Medicare Part B and Medicaid fee-for-service plans are not accepted.
  • Medicare Advantage and Medicaid managed care plans are accepted
  • CareCredit is accepted
  • FSA/HSAs are accepted

You can confirm coverage by scheduling your visit and entering your insurance information if you have private health insurance. Once you have scheduled an appointment, Everlywell's partner, OpenLoop, will send you an email with a summary of your eligibility and costs.

It's important to understand your insurance as well as situations where Everlywell telehealth is not right for you. These situations include being 18 years or younger and seeking any of the following:

  • prescriptions for antidepressants or antianxiety medication
  • weight management/weight loss programs
  • mental healthcare and therapy
  • erectile dysfunction prescriptions
  • birth control
  • preconception support
  • hormone replacement therapy
  • PrEP
  • management of chronic illnesses such as diabetes, celiac disease, and HIV

Everlywell's telehealth program offers convenient, equitable healthcare options to individuals with and without insurance. Visit Everlywell's online booking service to schedule your first appointment and determine your coverage eligibility.

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References

  1. Chang JE, Lai AY, Gupta A, Nguyen AM, Berry CA, Shelley DR. Rapid transition to telehealth and the digital divide: implications for primary care access and equity in a postā€COVID era. The Milbank Quarterly. 2021;99(2):340-368. doi:10.1111/1468-0009.12509. URL
  2. 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
  3. Health Resources and Services Administration. Office for the Advancement of Telehealth. Published July 2022. Accessed November 23, 2022. URL.
  4. Javidan A. History of telehealth. National Consortium of Telehealth Resource Centers. Published November 30, 2021. Accessed November 23, 2022. URL
  5. Javidan A. State telehealth laws & reimbursement policies - state summary chart. National Consortium of Telehealth Resource Centers. Published October 26, 2022. Accessed November 23, 2022. URL
  6. Koma W, Cubanski J, Neuman T. FAQs on Medicare coverage of telehealth. KFF. Published May 23, 2022. Accessed November 23, 2022. URL
  7. Mauldin K, Gieng J, Saarony D, Hu C. Performing nutrition assessment remotely via telehealth. Nutrition in Clinical Practice. 2021;36(4):751-768. doi:10.1002/ncp.10682. URL
  8. Shamim-Uzzaman QA, Bae CJ, Ehsan Z, et al. The use of telemedicine for the diagnosis and treatment of sleep disorders: an American Academy of Sleep Medicine update. J Clin Sleep Med. 2021;17(5):1103-1107. doi:10.5664/jcsm.9194. URL
  9. Shaver J. The state of telehealth before and after the COVID-19 pandemic. Prim Care. 2022;49(4):517-530. doi:10.1016/j.pop.2022.04.002. URL
  10. Telehealth. Eatrightpro.org. Accessed November 23, 2022. URL
  11. Voulgaris A, Ferini-Strambi L, Economou NT, Nena E, Steiropoulos P. Sleep telemedicine practices: checkpoint list and practical considerations in the COVID-19 era. Front Neurol. 2021;12:664274. doi:10.3389/fneur.2021.664274. URL
  12. What is telehealth? Hhs.gov. Accessed November 23, 2022. URL
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