In response to the Covid-19 pandemic, the Department of Health and Human Services lowered telehealth restrictions, which led to a surge of online healthcare services.
Both private health insurance companies, Medicare, and Medicaid rapidly adopted more lenient and inclusive telehealth coverage. As the pandemic situation unfolds and millions of patients visit doctors online, telehealth will become more personalized and affordable for everyone.
In this article, I’ll help you determine whether your insurance provider covers or reimburses telehealth services and to what extent.
What is Telemedicine?
Telemedicine, under the umbrella of telehealth, allows virtual visits with a doctor or healthcare professional from the safety and convenience of your home or anywhere with an adequate internet connection, in real-time.
Rather than a hospital or office visit, you can consult with your healthcare provider through teleconferencing. Telemedicine mostly includes any of the following: doctor-patient consultations, counseling, therapy, and psychotherapy sessions. Due to telemedicine’s natural social distancing qualities, such services will likely continue to play a vital role in the pandemic response.
Primary care and behavioral health providers also provide telemedicine services where they once only provided face-to-face visits.
Telehealth has become a commonplace medical service in our post-Covid, shelter-in-place world, and people are online more than ever.
Will Telemedicine Survive Coronavirus?
According to one US federal agency (CMS), more than 10.1 million people received telehealth service between mid-March and early July. Beyond the pandemic, what else is driving this trend?
More than 20% of the US population lives in rural areas, where there are significant challenges to accessing healthcare. At the same time, older adults are the most at-risk of viral infection. For older people, the safety component of telemedicine is more vital than convenience.
Telemedicine is not only a good idea from a public health perspective; it’s actively encouraged by insurance providers. With the pandemic reshaping health systems, telehealth services, such as remote patient monitoring, are safer and more cost-effective for both patients and insurers. Telemedicine has set the trend – Virtual doctor’s visits will likely become more prevalent in the years to come.
Does My Insurance Cover Telemedicine?
Each healthcare provider sets unique limits to their customer’s telehealth benefits, while some cover it completely. A report by the American Occupational Therapy Association (AOTA) has compiled a list of the commercial healthcare companies that now provide telehealth coverage.
Rest easy if you’re unsure whether your provider’s telehealth coverage has changed due to the pandemic. America’s Health Insurance Plans Association (AHIP) keeps a database of insurer policy responses to Covid.
Private Health Insurance
All major carriers (Aetna, Blue Cross Blue Shield, Cigna, United Healthcare, and Humana) offer a form of telehealth coverage. Your coverage will be different depending on your specific plan.
Your healthcare provider may offer direct telehealth services or contract with a telehealth company. Follow the instructions by your insurance provider to confirm whether they will cover your chosen telehealth provider. You will typically find telehealth information in your insurance member portal, via the provider’s app or website.
Medicare Part B (Medical Insurance) covers some virtual care, but not everything. You will need to pay 20% of the Medicare-approved amount for your doctor or healthcare provider’s services.
Most telehealth services will cost nearly the same as in-person services. Since 2019, Medicare additionally covers virtual check-ins and E-visits.
The Centers for Medicare and Medicaid Services (CMS) published a list of telehealth services payable under Medicare. The list includes codes and short descriptors to identify services for reimbursement.
In general, telehealth services covered by Medicare include:
- Preventive health screenings
- Evaluation and management visits
- Mental health counseling
In 2020, Medicare Advantage Plans may include more notable telehealth benefits than Original Medicare. Medicare coinsurance and deductible also generally apply to telehealth services.
If a Medicare Advantage Plan covers you, you don’t need to pay out-of-pocket for COVID-19 tests. Some plans may have more telehealth coverage benefits than the approved 2020 benefits. You’ll need to check with your plan to see your carrier’s available services.
Many state-level governments have expanded their telehealth coverage into Medicaid programs. Beneficiaries can expect increased coverage of telehealth through FFS programs and managed care plans.
Each state will have specific limits on the level of coverage they provide for telehealth. Services offered will depend mainly on what is most cost-efficient for the provider.
The Covid-19 public health emergency created a temporary situation where online appointments are often much more safe and efficient than visiting a doctor’s office. The Kaiser Family Foundation (KFF) tracks all approved changes to Medicaid policies on a state-by-state basis.
Common Questions About Telehealth Insurance Coverage
Have questions about telehealth insurance coverage? We have answers.
Will My Coverage Change?
The primary healthcare insurance providers have published details on changes to telehealth coverage during the pandemic.
For example, Aetna’s “liberalized coverage” currently extends through December 31, 2020, which includes waiving member out-of-pocket costs for Medicare Advantage plans. Other providers have waived or reduced cost-sharing and copays for telehealth visits for the duration of the state of emergency.
How Can You Verify Your Coverage?
Insurance providers provide toll-free numbers to call and ask about telehealth coverage. State and federal governments also provide phone numbers to inquire about Medicare and Medicaid.
To verify your coverage, be ready when you call with important information. Some things you’ll need include your provider’s name, the name of the insurance plan and group number, and the reason for your appointment or treatment. To avoid being declined, be sure to confirm your insurance coverage before scheduling a telehealth appointment or treatment.
Will the Covid-19 Pandemic Affect My Coverage?
Telehealth policy related to Covid-19 is a rapidly developing subject. Thankfully, organizations exist which keep us informed.
The Center for Connected Health Policy (CCHP) provides current information on telehealth laws, regulations, and Medicaid changes. Through the CCHP’s interactive map, you can explore the telehealth policy developments for 50 states and the District of Columbia.
Health insurance companies and governments currently offer partial or full coverage for telemedicine. Some revised form of coverage will likely continue long after the pandemic. However, the benefits are likely to change uniquely to each provider and health plan.
Take advantage of any discounts or waivers provided to you for telehealth while those benefits still exist. No one is certain what the future holds for this nascent innovation in healthcare, so be sure to bookmark the regularly updated databases on telehealth policies found in this article.