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:

1. 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.
2. 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:

1. 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.
2. 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.
3. 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:

1. 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.
2. 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).

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1. How has technology enabled the healthcare industry to adapt during the pandemic in order to effectively treat patients?

The silver lining of the pandemic is that it has propelled the healthcare industry forward decades in terms of digital transformation. When the pandemic hit and it was necessary to quarantine and stay-at-home, telehealth had to be widely adopted in order to limit potential contamination.

New technology innovations, from biometric devices to IOT sensors, are enabling healthcare workers to effectively treat patients even from a distance. For example, Apple recently expanded its Apple Watch electrocardiogram capabilities with guidance from the FDA, to now enable EKG tests. These types of insights are key to understanding the patient’s health and their environment, making virtual visits comparable to in-person services.

2. How has the technology of telehealth services evolved, and what are some other areas that the technology can be improved to enable better services?

Telehealth has had to evolve rapidly in order to meet the needs of healthcare providers utilizing this technology at-scale. From virtual waiting rooms, to integrations with healthcare software, to mass communication abilities, these are all functions that are continuously being improved upon.

Technology to help with data security and management is more important than ever and a particular challenge. To manage, healthcare companies are prioritizing investments in two critical areas. The first is network security and access technologies to ensure that any system can be accessed remotely and securely. Companies like Okta are winning big in this area. The second area of investment is interoperability, technology that connects disparate systems reliably and securely. Skedulo has partnered with a leader in this space, Bridge Connector, which enables mobile healthcare workers to consistently and reliably access patient EHRs and hundreds of other systems from anywhere while maintaining HIPAA compliance.

3. How has the rise of telehealth services enabled care providers to “see” increased volumes of patients during a time when in-person visits have been limited?

Telehealth is making the scheduling of health appointments more convenient than ever before, expanding access to enable more frequent care. For mental health services, such as therapy or medication management, this is making a huge difference in terms of access. Virtual care also opens the door for underserved groups to receive more regular check-ins and preventative services. Think of rural parts of the United States, where it may be a several-hour drive to access a specialist, or low-income communities where blue-collar workers can’t afford to take the day off to go physically see a doctor. These types of individuals are able to receive preventative care more easily, helping improve their long-term health and preventing more costly issues down the line.

4. Have health providers fully embraced telehealth? What will telehealth be used for once in-person appointments are deemed safe?

Telehealth has it’s pros and cons, but the majority providers have embraced practicing telehealth in some capacity. For example, some providers are still offering predominantly virtual services or will leave it up to the discretion of the patient. Both physicians and patients are seeing the value of permanent telehealth practices. A recent study showed that 72% of individuals had their first virtual care visit ever during the pandemic, with over 75% saying they were very satisfied with their experience.

Skedulo customers’, Catalight and Solace Pediatrics Home Healthcare, both switched from 100% in-person services to 100% virtual services at the beginning of the COVID-19 outbreak in the United States. They are both home healthcare agencies that deliver autism therapy services. Solace Pediatric Home Healthcare were able to complete 85% of the “normal” level of appointments in their first week of operations. By week two, they completed all of their typical appointments, and in week three, they set a new record, exceeding their pre-pandemic level of operations.

It’s clear that there’s a demand for telehealth services and that we’ll continue to see demand once the pandemic passes. Providers are now beginning to think about how they want to incorporate telehealth into their regular model of care. While it won’t replace in-person care, it certainly will stick around once the pandemic passes and be incorporated into how healthcare systems practice their business of care. Moving forward, healthcare providers will need to embrace telehealth and the necessary digital transformation that comes with it to meet patient’s needs and remain competitive.

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