The pandemic increased the need for virtual health services, but even before COVID-19, Medicare offered telehealth visits to some of its members. Medicare Telehealth services traditionally included virtual office visits and a small list of other medical or health services provided by a doctor or certain other types of health care providers through two-way audio/video technology to its remote and rural customers. In 2018, only about 21.5% of Original Medicare beneficiaries were living in rural areas, leaving a lot of beneficiaries out of qualifying for telehealth.
Medicare offers telehealth coverage through Medicare Part B insurance. Kupunas on Original Medicare pay 20% of the Medicare-Approved Amount for telehealth services, and the Part B deductible applies*. For most telehealth services, patients pay the same amount as they would for an in-person visit. Kupuna on Medicare Advantage plans may have additional coverage for telehealth services. Speak to a local Medicare agent to discuss plan options.
*While coinsurance and deductibles normally do apply for telehealth services, healthcare providers have the option of reducing or waiving the amount their patients pay for telehealth visits during the pandemic. Be careful not to accept telehealth appointments from providers that you have never worked with before. In some cases, they call and offer perks for setting up the appointment and then start billing Medicare for items or services you don’t need. If you suspect Medicare fraud, call 1-800-MEDICARE.
Medicare Telehealth Expanded in 2021 Because of Covid-19
With the need for social distance during the COVID-19 public health emergency, Medicare expanded its virtual health care services in several ways. While 144 services were added on a temporary basis, several have now become permanent additions.
Permanent changes include the addition of:
Some home visits for established patients
Group psychotherapy services
Care planning services
CMS has also approved a temporary expansion of service coverage through the calendar year that the COVID-19 public health emergency ends, including:
High-intensity home visits
Emergency department visits
Nursing facility discharge day management
Specialized therapy visits
Monthly End-Stage Renal Disease (ESRD) visits and transplant evaluation visits for patients on home dialysis
Substance abuse services to treat substance use disorder or mental health services to treat a co-occurring mental health disorder
Services for diagnosis, evaluation, or the treatment of symptoms of an acute stroke
Other temporary changes through 2021 allow more flexibility in how virtual health care is provided through communications technology-based services (CTBS). Changes include:
Expanded the types of health professionals that can provide CTBS services
Flexibility for follow-up nursing home visits delivered through remote connection
Geographic and location type restrictions lifted
Removed frequency limitations on follow up hospital care and nursing facility care services
Allowed direct supervision via telemedicine
No restrictions on practitioners providing telehealth services from their home
Allowed Qualified Medical Professionals to perform Medical Screening Examinations
Patients no longer have to be established with a provider prior to receiving telehealth services
Patients no longer have to travel to the originating site (such as a hospital or doctor’s office) to receive services
Technology is no longer required to be HIPAA compliant, which means that apps like FaceTime, WhatsApp, and Facebook Messenger are now viable options.
The idea is for the 2021 Medicare reimbursement expansions to be an incentive for providers to offer more services in their telehealth programs; at least until the expansions expire. Click here for a complete list of services now offered through telehealth and audio-only.
Our independent insurance agents are dedicated to assisting people on Medicare and those who are ready to transition from employer coverage to personal retirement coverage. We help kupuna understand their benefits options and apply for additional coverage, as needed. Because we represent all the major Medicare Advantage and supplement plans in Hawaii, we are able to offer unbiased advice; all at no cost to our clients.
At PBC, our clients are our number one priority and we look forward to getting to know you and your needs. Call us today at (808) 738-4500 to see how we may be of assistance.