Does medicare cover telehealth? Certainly, the majority of Medicare Advantage plans cover telehealth services. Medicare itself covers some telehealth services. It depends on the coverage that you have with your plan. Medicare Advantage Plans (one type of Medicare) have a list of covered services. They do not always match up exactly with the list of services covered by traditional Medicare (CMS or medicare.gov). Private companies can regulate Medicare Advantage Plans, so it is possible that each company could cover different things than other companies. In general, though, traditional Medicare will cover some telehealth services, and many Advantage plans will cover additional telehealth services. It depends on what Medicare covers.
What does medicare cover?
The types of telehealth services covered by Medicare depend on your type of Medicare. There are three types:
- Traditional Medicare (Parts A and B)
- Medicare Advantage plans (Part C), Medicare Supplement plans (Parts D and F) – often called Medigap.
- Traditional Medicare, as well as some Medicare Advantage plans, cover telehealth services in some situations. The services they cover vary depending on the plan. Part C covers many more services than Part A or Part B. Depending on your coverage; it’s worth checking out what you are covered for in terms of telehealth services.
The types of things covered by traditional Medicare, as well as some Medicare Advantage plans, include:
- Websites that help you understand your options regarding medical treatment. Some telehealth services are not provided directly by your doctor or nurse but through a website or phone. Medicare may cover these services, and you can have them added to your Medicare coverage.
- Telephone calls with a doctor who is located far away from where you are (telemedicine). Emergency room follow-up visits to go over what happened with the ER visit. You can use telehealth for follow-up visits after an ER visit if you need more information or to help manage an issue uncovered during the ER visit. Home health services. You can use telehealth for an ongoing home health situation.
Telehealth services that are available through Medicare Advantage plans include:
- Tele-rehabilitation — using video technology to help someone rehabilitate from an illness or injury, avoid hospitalization, and improve their quality of life. Examples include Home-based health care (such as wound care, physical therapy, or occupational therapy) in which you work with a therapist through a webcam. You may need to be referred by your doctor for this service. Telerehabilitation for stroke rehabilitation. Telerehabilitation for rehabilitation from back or neck pain. Telerehabilitation for rehabilitation after hip, knee, or other joint replacement surgery.
- Electronic case management — using video technology to improve the quality of your care among various conditions, including. End-of-life issues such as making advance care planning decisions. Making appointments with specialists and other providers. Provide reminders about medications, appointments, and tests. Mental health issues (such as depression). Heart disease. Diabetes. Stroke. Aortic aneurysm (a bulge in a blood vessel that can burst). High blood pressure.
- Peer support groups — peer support groups are available by phone through a telehealth program such as On Call.
Examples of services not covered by Medicare Advantage plans include:
Telehealth services that are not covered by Medicare Advantage plans include:
- Tele-continuing care helps you maintain treatment after you’ve been released from the hospital or clinic. Medicare could provide these services in various settings, such as home health visits, day care centers, nursing centers, or assisted living facilities. The main goal of tele-continuing care is to help someone avoid readmission to the hospital or clinic.
- Telephone crisis counseling and telephone therapy. These services involve a telephone call from a therapist or counselor who assists you in managing a crisis.
If you are currently enrolled in a Medicare Advantage plan, you should check your list of covered services to see what is covered. Your Medicare Advantage plan may cover more than Medicare does. These plans also cover telehealth-related services that are not covered by traditional Medicare.
**Note: If your Medicare Advantage plan does not cover telehealth or if you have several Medicare Advantage plans, it is best to contact your state insurance department for information on where to find accredited telehealth providers. Some states may help you find an accredited provider in your area (which can be sponsored by the state).
Some telehealth services are covered by the many different Medicare Advantage plans that provide coverage for individuals who do not have access to traditional Medicare or a Medigap policy (i.e., Medicare Supplement policy). It is important for people with Medicare Advantage plans to check their coverage for telehealth services.
In conclusion, Medicare covers a variety of telehealth services depending on the type of Medicare you have. Medicare Advantage plans cover additional services.
Many patients receive reimbursement for portions of their telehealth visits through medicare or medicare advantage plans. It is important to check your coverage and contact the plan administrator to discuss coverage and reimbursement details.
Since each Medicare Advantage plan is different, it is best to contact your insurance official for information on what services are covered in your state.
If you are unsure if telehealth services are covered by your state or a Medicare Advantage plan, check with the helpline for your area of residence.
The Centers for Medicare and Medicaid Services (CMS) provide information about which services are covered for each plan. You can also find more detailed information on their website.
Note: If you do not have access to traditional Medicare or a Medigap policy that covers telehealth services, contact your state insurance department to find out what options are available in your area. Some states may sponsor programs that help patients find telehealth providers (and sometimes pay for these services).
