Telehealth describes the provision of remote healthcare through the use of communication technology, such as a phone or computer. Medicare covers some telemedicine services.
Telemedicine, also known as telehealth, gives people access to essential medical care without asking them to travel to a healthcare facility. A person can communicate with a doctor on the phone or computer.
Telehealth first evolved in the late 1950s. More recently, during the height of the COVID-19 pandemic, many people developed a need for telehealth because they could not or preferred not to leave their homes to go to a healthcare facility.
Because of this, Medicare expanded its coverage for telehealth. Currently, a person can still take advantage of many of these telehealth services under Medicare. This article discusses how telehealth works under Medicare and which elements of the service Medicare covers.
People with Medicare pay the same amount for telehealth services as they would for in-person services. For standard services, Medicare covers 80% of the cost, while the person covers the remaining 20%, according to the Centers for Medicare & Medicaid Services (CMS).
Typical telehealth services may include preventive health screenings, routine office visits, and mental health services. Per CMS, examples of the various telehealth services that Medicare covers include:
- occupational therapy evaluations
- physical therapy evaluations
- group psychotherapy
- speech therapy
- therapeutic exercises
- doctor’s office visits
However, remote healthcare does not work for all medical concerns, and some services may still require in-person visits. A healthcare professional will assess whether the individual requires further in-person evaluation, testing, or treatment after the initial visit.
If a person needs transportation to a medical facility for follow-up care, Medicare Part B may cover the cost, according to Medicare Interactive.
Part B covers both emergency (ambulance) transportation and limited nonemergency rides. A person can receive nonemergency transportation if they cannot get out of bed or need monitoring in transit to another facility.
A person should check with their policy or doctor to see if Medicare can cover their transportation needs.
However, while telehealth services are currently available at any location in the U.S., they may only be available until the end of 2024. Those in an office or medical facility in a rural area may still receive telehealth services. Some exceptions will also apply, such as :
- monthly end-stage renal disease (ESRD) visits for home dialysis
- services for diagnosis, evaluation, or treatment of symptoms of an acute
stroke - services to treat a substance use disorder or a co-occurring mental health disorder, or for the diagnosis,
evaluation, or treatment of a mental health condition - behavioral health services
- diabetes self-management training
- medical nutrition therapy
People with a Medicare Advantage, also known as MedicarePart C, plan generally have similar coverage for telehealth services as those with parts A and B (original Medicare), according to the National Council on Aging. However, some Medicare Advantage plans may offer expanded telemedicine services.
Private insurers administer Medicare Advantage plans, so the exact telehealth services that a person’s plan includes may vary. An individual should determine coverage through their insurance provider directly.
In some cases, a person may need transportation to a healthcare facility. Some plans offer nonemergency transportation to a healthcare facility or doctor’s office. A person should check with their provider to find out what transportation needs their plan covers.
If a person’s provider participates in an Accountable Care Organization (ACO) they may offer expanded telehealth services. An ACO is a group of doctors, hospitals, and other healthcare progessionals that teamed up to coordinate healthcare services.
In the past, Medicare has placed some restrictions on telehealth coverage.
For example, Medicare formerly covered telehealth services in only certain circumstances, including when a person lived in a rural area and was staying in a facility such as a skilled nursing home or hospital-based dialysis facility. In 2020, Medicare lifted many restrictions due to the Coronavirus Preparedness and Response Supplemental Appropriations Act.
However, these restrictions will again be effective come the end of 2024. Some exceptions will still apply, depending on the exact health service a person requires and their location. As a result, a person may want to check with their healthcare professional’s office if they are able to continue using telehealth services from 2025 onwards.
Telehealth provides medical services via a remote connection between an individual and their medical provider. Medicare covers various types of telemedicine services.
Currently, many services are available through telemedicine. However, come 2025, restrictions may apply to a number of services. Certain exclusions will apply depending on the service and a person’s location. A person’s best option involves consulting a healthcare professional directly to determine whether they offer telehealth services and their costs.