Frequently Asked Questions About Medicare & Telehealth

October 24, 2022

Frequently Asked Questions About Medicare & Telehealth

As it is becoming increasingly popular in recent years, telehealth refers to healthcare services provided to patients by providers remotely. Before the COVID-19 pandemic, telehealth utilization in Medicare beneficiaries was low but increased 63-fold throughout the pandemic. During the first 12 months of the pandemic, over 28 million Medicare beneficiaries utilized telehealth services, including almost half of Medicare Advantage (Part C) enrollees and nearly 40% of those enrolled in Original Medicare.

With the emerging utilization of telehealth, we wanted to provide some answers to questions you may have regarding telehealth & Medicare.

What services can I get through telehealth?

Pre-pandemic Medicare covered approximately 100 services via telehealth, such as office visits, psychotherapy, and preventative health screenings. This has expanded to include emergency visits, physical and occupational therapy, and other services during the pandemic. Some services can be provided by audio-only telephone, including behavioral health, evaluation and management services, and patient education.

The Centers for Medicare and Medicaid Services (CMS) extended coverage for a subset of these expanded services under telehealth until December 21. 2023 (or the end of the year when the public health emergency ends. Whichever is later). This final rule was introduced to give both CMS and stakeholders time to decide if these services should be included permanently as telehealth services covered by Medicare.

Are mental health services available for Medicare beneficiaries via telehealth?

Telehealth was hugely important in ensuring that older adults received access to mental health care in 2020. Through the first year of the pandemic, many of the Medicare beneficiaries’ appointments were conducted through telehealth.

Policymakers have permanently expanded telehealth coverage for diagnosis in the Consolidated Appropriations Act of 2021, evaluation, or treatment of mental health disorders after the COVID-19 public health emergency. Medicare beneficiaries can use telehealth for mental health services in their homes; those who cannot use real-time two-way audio and video for telehealth mental health services can use audio-only devices to access their services. Beneficiaries are, however, required to have an in-person service within six months of their first telehealth service.

What are the costs of telehealth under Medicare?

Cost sharing for telehealth services has not changed during the pandemic. Telehealth services are covered under Original Medicare Part B, so those with Original Medicare are subject to the Part B deductible and 20% coinsurance. Many beneficiaries enrolled in Original Medicare also have a Medicare Supplement (Medigap) plan that covers some of the cost-sharing associated with telehealth. As long as it meets the standards of actuarial equivalence set by CMS, Medicare Advantage (Part C) plans have the flexibility to change their cost-sharing requirements.

What devices can be used for telehealth services?

Interactive audio-video systems and smartphones can conduct telehealth services with real-time audio-video capabilities. Some services can be provided on a telephone or smartphone via audio only.

Does my Medicare Advantage (Part C) plan cover telehealth services?

It is required that all Medicare Advantage (Part C) plans to cover all of the benefits covered by Original Medicare Parts A & B. Medicare Advantage (Part C) plans have also been able to offer telehealth services not usually covered under Original Medicare since 2020. Medicare Advantage (Part C) plans are now allowed to include costs associated with additional telehealth benefits in their bids for basic benefits.

If you have any questions about Medicare or telehealth benefits, don’t hesitate to get in touch with a licensed insurance agent at SEniorstar Insurance Group today. Click here to schedule an appointment.

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