When the COVID-19 pandemic hit, a lot of things changed. Suddenly, even going grocery shopping or going to the office for work was dangerous, and for a while, medical settings like the doctor’s office became riskier for your health than skydiving. The free market responded with grocery delivery services, a transition to remote work, and telemedicine.
Things finally seem to have returned to normal, or at least settled into a new normal, but a lot of the solutions that sprung up during the pandemic are here to stay, including telemedicine. For those who aren’t familiar with the term, telemedicine is simply a way to get access to healthcare without leaving the home. The question is, does Medicare cover it? The short answer: yes and no.
Paying for Telemedicine with Medicare
Medicare has a tendency to be confusing, partly because of the bureaucracy that tends to come with any “government benefit” – even though you’ve spent your entire life paying into it. Trying to make sense of it can be more than a little difficult, especially when you run into the distinctions between Pars A, B, C, and D.
For clarity:
- Part A covers inpatient care. That includes hospital stays, skilled nursing facility care, hospice, and limited home health.
- Part B covers outpatient care. This would be services like doctor visits and durable medical equipment. The cost of the injection for vaccinations is covered under Part B, but the vaccine itself is usually covered under Part D, further confusing things.
- Part C, also known as Medicare Advantage, is an option for those on Medicare who don’t mind paying more every month for more comprehensive coverage. Companies like UnitedHealthCare (UHC) and Aetna offer Medicare Advantage plans, and in a lot of instances, what Medicare doesn’t cover, Medicare Advantage takes care of.
- Part D is Medicare’s prescription drug program.
Without paying extra – just on basic Medicare, or if you have a dual plan where Medicare and Medicaid benefits are bundled together – you do have some telemedicine coverage. Like most things in life, though, there are terms and limits. Like most other Medicare expenses, the patient is going to be responsible for 20% of the cost after meeting the annual deductible, which in 2023 is $226.
What Kind of Telemedicine Does Medicare Cover?
Before we dive into the specifics of Medicare telemedicine coverage, one caveat: medical necessity. Medicare, like private insurance companies but perhaps a bit more strict, requires that any services they pay for are 1) medically necessary and 2) meet certain criteria. Their approach to telemedicine is no different. That said, if those conditions are met, medicare will cover evaluation and management for illness or injury and mental health consultation and treatment.
Telemedicine Services You Can Always Get
Before COVID, Medicare had strict regulations and limitations on telemedicine coverage. Some laws were passed, including the Coronavirus Preparedness and Response Supplemental Appropriations Act and the CARES act, both of 2020, that relaxed though restrictions and also decreased the cost sharing for telehealth coverage to make safe, affordable care more accessible to seniors during a time when going to the doctor’s office in person would expose them to the risk of contracting the virus. That extension is slated to expire December 31, 2024 thanks to the Consolidated Appropriations Act of 2023.
Before the Extension Expires:
Until the extension expires or is renewed again, Medicare will cover routine check-ups, consultations with specialists, and some preventive screenings, all at reduced or completely waived cost shares. Now is definitely the time to schedule a telehealth appointment if you want it to be covered by Medicare.
After the Extension Expires:
Once the extension expires, Medicare coverage for telemedicine services goes back to pre-pandemic levels. This means much more limited coverage and at higher coinsurance. That’s not to say that another law won’t come along to extend the current coverage or even make the coverage permanent, but as it stands right now, you can’t count on Medicare to cover online doctor’s appointments forever.
The Specifics
That’s well and good, but the specific amounts matter. According to Medicare.gov, until the extension expires, anyone with Medicare can receive any medical service – from office visits to psychotherapy – with the same cost share as in-person at home through telehealth. To reiterate, right now, the cost is exactly the same to the Medicare beneficiary for telehealth as it is in-person.
After December 31, 2024, medicare beneficiaries will have to receive medical service in person except for the following services:
- End-Stage Renal Disease visits for Home Dialysis
- Services for Acute Stroke Symptoms
- Treatment of Substance Use Disorders or Mental Health Disorders
- Behavioral Health Services
You can learn more at Medicare’s official website.