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Does Medicare Cover Telehealth?

Telehealth is a way for Medicare beneficiaries to receive the healthcare they require remotely.

With many Americans unable to leave their homes during the Covid-19 pandemic, the need for telehealth services has been exasperated.

In response to the pandemic and a desire from vulnerable patients to receive remote healthcare, Medicare has expanded telehealth coverage (also known as telemedicine services).

The expansion will allow more Medicare beneficiaries to receive the care they need without leaving their home.

Wondering how telehealth works, how you can use it, and which elements are covered by Medicare? We’ve put together a complete guide for everything you need to know about Medicare and telehealth.

Medicare Covers Telehealth

What is TeleHealth or Telemedicine?

Telehealth (also known as telemedicine) is a way in which communication technology is used to facilitate remote healthcare. With telemedicine, a patient can receive medical services without even leaving their home.

Telehealth can be an effective alternative to an in-person appointment and can help with many essential healthcare needs.

Medicare telehealth services include office visits, psychotherapy, consultations, and other medical services provided by an eligible provider performed via a 2-way telecommunication system.

Who Provides Telehealth Services?

Medicare has outlined which health care providers can offer telehealth services. The following healthcare professionals can provide telehealth services (some can be from your home while others might be necessary from a healthcare facility):

  • Doctors
  • Nurse practitioners
  • Clinical psychologists
  • Speech therapists
  • Occupational therapists
  • Clinical social workers
  • Physician assistants
  • Registered dietitians

What is an Originating Site and a Distant Site?

Those who have been researching Medicare and telehealth benefits will have undoubtedly come across the terms “Originating Site” and “Distant Site.”

In essence, the two terms refer to the locations of the patients and the healthcare provider. The originating site is the location of the patient (the Medicare beneficiary), and the distant site is the location of the healthcare provider.

Authorized Originating Sites

The originating site is the location of the beneficiary at the time of the service. From March 2020, Medicare will cover telehealth services made in healthcare facilities and from home.

Qualifying healthcare facilities include:

  • Physicians or practitioner offices
  • Hospitals
  • Critical access hospitals
  • Rural health clinics
  • Federally qualified health centers
  • Hospital-based or CAH-based renal dialysis centers
  • Skilled nursing facilities
  • Community mental health centers

Eligible Distant Site Practitioners

The distant site is the location of the healthcare provider. Distant site practitioners who can perform Medicare telehealth services include:

  • Physicians
  • Nurse practitioners
  • Physician assistants
  • Nurse-midwives
  • Clinical nurse specialists
  • Certified nurse anesthetists
  • Clinical psychologists and social workers
  • Registered dietitians/nutrition professionals

Telemedicine During Covid-19

Although telehealth has been around for decades, the recent coronavirus pandemic has made it more important than ever. The remote service will ease many American’s concerns about in-house consultations while adhering to physical distancing measures.

As of March 6, 2020, doctors and other health providers can use telehealth services to treat Covid-19 and other medical needs from offices, hospitals, and places of residence. Coinsurance and deductibles will continue to apply; however, some insurance providers are reducing the amount for telehealth visits.

Medicare Advantage plan holders do not pay out-of-pocket costs for Covid-19 tests, and they may also have more telehealth services available than what was included in their 2020 benefits.

What Part of Medicare Covers Telemedicine?

Telemedicine/Telehealth is covered by Medicare Part B and Part C.

Medicare Part B covers some telehealth services, and it is treated the same as an in-person outpatient visit. Example telehealth services that Medicare Part B covers include:

  • Office visits
  • Consultations
  • Psychotherapy

In response to the Covid-19 pandemic, changes were made to Medicare Part C that allowed it to offer additional telehealth benefits. Some example telehealth services that your Medicare Part C plan might cover include (services vary from plan to plan):

  • Care planning for chronic conditions
  • Consultation with a specialist in a different area
  • Psychotherapy
  • Screenings for depression or alcohol use
  • Nutritional therapy
  • Support to quit smoking
  • Health risk assessment

Telemedicine/Telehealth is covered by Medicare Part B and Part C

Telehealth Services Covered by Medicare

Medicare beneficiaries can receive a wide range of services through telehealth. This includes everything from evaluation visits to mental health counseling.

The expansion of coverage will help reduce the number of in-person medical visits and allow those who are high-risk of Covid-19 to make a healthcare appointment from their home.

Telehealth services that Medicare covers include:

  • Doctor visits
  • Consultations
  • Occupational therapy evaluations
  • Physical therapy evaluations
  • Psychotherapy
  • Speech therapy
  • Therapeutic exercises

Although telehealth is an effective service for managing many health concerns, telehealth cannot be used for all medical problems – some still require in-person visits. If you are unsure if your required service is covered, speak to your healthcare provider.

Medicare Telehealth Restrictions

Before the Covid-19 pandemic ensued, there were several hurdles for medicare enrollees to meet in order to receive telehealth coverage. Perhaps the most limiting restriction was the service’s availability to only those living in rural areas or staying in a facility, such as a skilled nursing home.

Because of these restrictions, the majority of Medicare beneficiaries have long been unable to access telehealth services. However, in March 2020, Medicare lifted many of these restrictions and opened telehealth services to all enrollees.

Previously, changes to telehealth coverage restrictions have been effective for one calendar year. It remains unclear whether this change will be permanent or if it will revert to the old coverage.

Summary of Medicare Telemedicine Services

Summary of Medicare Telemedicine Services Infographics
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