A telehealth service is a full visit with a provider that requires real-time communication through audio and video technology.
During COVID, people with Medicare could access telehealth in any geographic area, both at home and in health care settings.
Original Medicare covers telehealth services under Part B.
Before the pandemic, Original Medicare Part B covered telehealth in limited situations. Medicare has since expanded coverage and access to telehealth to ensure older adults have access to health care services. These flexibilities have allowed more people with Medicare to use telehealth and may be helpful for meeting your health care needs.
What is telehealth?
Telehealth includes certain services that you receive from a health care provider outside of an in-person office visit. A telehealth service is a full visit with a provider using telephone or video technology that allows for both audio and video communication.
Does Medicare cover telehealth?
Original Medicare covers telehealth services under Part B. Some examples of Medicare-covered telehealth benefits include:
- Lab test or x-ray result consultations
- Post-surgical follow-up
- Prescription management
- Preventive health screenings
- Urgent care issues like colds, coughs, and stomach aches
- Mental health treatment, including online therapy and counseling
- Treatment of recurring conditions, like migraines or urinary tract infections
- Treatment of skin conditions
What does telehealth cost under Medicare?
After you meet the Medicare Part B deductible ($233 in 2022), you will pay 20% of the Medicare-approved amount for the service from providers who accept Medicare assignment. If you are enrolled in a Medicare Advantage Plan, contact your plan to learn about their telehealth costs.
Cost-sharing for telehealth has not changed during COVID. However, your provider may choose to reduce or waive cost-sharing for telehealth visits. Providers usually cannot routinely waive cost-sharing, but this flexibility is available during the pandemic.
How is Medicare covering telehealth during the pandemic?
Original Medicare has expanded the list of covered telehealth services during the pandemic, including emergency department visits, physical and occupational therapy, and certain other services. For example, a doctor can use telehealth in place of the face-to-face visits required to prescribe Medicare-covered home health care. Ask your doctor about telehealth options and whether it would be suitable for your health care needs.
Previously, only Medicare beneficiaries in rural areas could access telehealth, and they were required to travel to an authorized health care setting such as a physician’s office or hospital. During the pandemic, telehealth services are covered for all beneficiaries in any geographic area, and you can receive these services at home in addition to health care settings.
You must generally use an interactive audio and video system that allows for real-time communication with the provider. Providers are temporarily allowed to use any non-public facing remote technology (such as FaceTime, Zoom, or Skype) to communicate with their patients.
During the pandemic, limited telehealth services can be delivered using audio only, via audio-only telephone or a smartphone without video. These services include counseling and therapy provided by an opioid treatment program, behavioral health care services, and patient evaluation and management.
Previously, Medicare only covered telehealth services provided by eligible practitioners, such as physicians and nurse practitioners. During the pandemic, any health care professional that is eligible to bill Medicare for professional services can provide and bill for telehealth services. This means you can access telehealth from more providers, including physical therapists, occupational therapists, and speech language pathologists.
Medicare Advantage Plans must cover all of the telehealth benefits included in Original Medicare. In response to COVID, Medicare Advantage Plans also have the flexibility to expand coverage and reduce or waive cost-sharing for telehealth services.
Will the expanded coverage of telehealth end after COVID?
Congress passed legislation in March 2022 that extends telehealth flexibilities for 151 days beginning on the first day after the end of the pandemic. As of July 15, 2022, the pandemic was extended until mid-October. The Centers for Medicare & Medicaid Services (CMS) will be evaluating all of the pandemic-related flexibilities to determine whether some should be retained as rule changes long-term.
Should I be wary of potential fraud related to telehealth?
Yes. With the expansion of telehealth services, you should be aware of people using telehealth for fraudulent purposes. The following scenarios are examples of potential telehealth fraud:
|You are contacted by a provider you do not know or have not met before to set up a telehealth appointment. The caller offers cash payments or free prescription drugs to get your personal information.||The caller will likely start billing Medicare for items and services you do not need or do not receive, like lab tests, braces, or orthotics.|
|You receive an unsolicited phone call from someone wanting to verify your pain symptoms.||The caller is likely a telehealth doctor trying to approve you for durable medical equipment (DME) that you do not need or did not request.|
|You receive an unsolicited phone call from someone wanting to verify your family history of cancer.||The caller is likely a telehealth doctor trying to approve you for a genetic testing kit that actually needs to be ordered by your treating physician.|
If you suspect fraud, you should call 1-800-MEDICARE. You can report potential telehealth fraud, errors, or abuse to your local Senior Medicare Patrol.
In summary, Medicare has expanded coverage of telehealth services during COVID. You can access telehealth in any geographic region, whether from your home or in health care settings. You can receive telehealth services from any health care professional who is eligible to bill Medicare, and providers have more flexibility to reduce or waive cost-sharing. Make sure to ask your doctor if you have questions about your telehealth options. Medicare’s flexibilities may change after the pandemic ends, but that is still to be determined.