Be Prepared to Discuss Medicare Telehealth Coverage This AEP

Today, technology use is becoming more and more prevalent in many industries and Medicare is one of them. While you’re meeting with clients, there’s a good chance at least one will ask you about telehealth. What is it and how does it work for Medicare beneficiaries?

Let’s explore some specific details of this trending health services practice so you’re ready to answer any telehealth questions that come up.

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What Is Telehealth?

Telehealth, also sometimes known as “telemedicine” and “telecare,” enables consumers to use technology to digitally connect with health care physicians for health care services. Both the policyholder and health care professional must have real-time communication, with both audio and video capabilities, for telehealth services. There are pros and cons of telehealth. Ultimately, it will be up to your client whether or not this type of health service will benefit their needs.

In 2020, telehealth is estimated to be a $36.2 billion dollar industry. This health practice could also save the U.S. up to $4.28 billion on health care spending per year. Considering that large chunk of change, it’s no wonder why telehealth’s popularity has increased. Not to mention, it makes advancements in the effort of value-based care by allowing flexibility in the location of health care.

Telehealth makes advancements in the effort of value-based care by allowing flexibility in the location of health care.

Which Carriers Offer Telehealth Benefits?

Carriers such as Cigna, Regence, Anthem, Humana, and UnitedHealthcare offer telehealth benefits to their beneficiaries. Some carriers refer to telehealth benefits as “virtual visits.” Keep this in mind when looking at the benefit packages of carriers’ Medicare Advantage (MA) plans. Also worth mentioning, Ritter Insurance Marketing is partnered with all of the carriers listed above and many more. If you haven’t already, complete your free registration with Ritter to gain access to competitive contracts and exclusive tools and resources to boost your business!

Does Original Medicare Cover Telehealth?

Telehealth coverage under Medicare Part B can depend on the circumstances and the type of medical service received by the beneficiary. Most telehealth services cost the beneficiary the same amount the health care service would cost in person. Typically, the beneficiary has to pay 20 percent of the Medicare-approved amount, in addition to the Part B deductible. The best way to find out the cost of a provider service is for the beneficiary to speak with their doctor.

Examples of Covered Telehealth Services

It’s essential to know exactly what your client will be able to accomplish using telehealth. The listing for telehealth services is quite extensive and can be viewed in a CMS booklet on Telehealth Services. To give you an idea, general covered health services that can use telehealth include:

  • Follow-up consultations
  • Individual psychotherapy
  • Pharmacologic management
  • Face-to-face counseling

The duration of the health care service and reason/ailment for the service are specified for each service. Again, it’s important to note that audio and video are required during all telehealth services.

Where Can Beneficiaries Be Treated Using Telehealth?

Originating sites are an important aspect of telehealth you need to make sure your clients know about. An originating site is the patient’s location where the telehealth encounter takes place. Right now, the site must be located in either a county outside of a Metropolitan Statistical Area or a rural Health Professional Shortage Area. In addition to being located in one of those areas, Medicare specifies that the originating site must be from within one of the following facilities:

  • Provider offices
  • Hospitals
  • Critical access hospitals
  • Rural health clinics
  • Federally qualified health centers
  • Skilled nursing facilities
  • Community mental health centers
  • Hospital-based or critical access hospital-based renal dialysis centers

Telehealth is currently not as simple as your Medicare client video-chatting their primary care physician from their living room couch, but it is still a worthwhile benefit, especially for those who live in rural areas. Your client may only have to travel five minutes to a rural health clinic, as opposed to traveling an hour to the doctor’s office. Make sure your clients understand that some travel is still required with this benefit.

What Is the Future of Telehealth?

In true Medicare-fashion, as health care evolves, rules and policies will change in the years to come. Since 2018, telehealth has made significant strides in the world of health care and services. In the years prior, Original Medicare was very strict regarding reimbursement for telehealth services. MA plans were also subject to strict rules regarding telehealth. Starting in 2019, Original Medicare began reimbursing for telehealth services used across the country, not just in certain rural areas. And in 2020, CMS is not only allowing additional telehealth services to be included in the benefits of MA plans, but it’s anticipated that MA plans may offer more leniency with telehealth location regulations than Original Medicare. This may mean your clients could be able to utilize telehealth from their homes, depending on the specific telehealth benefits outlined in their MA plans.

It’s anticipated that MA plans may offer more leniency with telehealth location regulations than Original Medicare.

These expected changes are great for both you and your clients. MA plans should be filled with great benefits, which will give them even more selling power. While you are meeting with your clients to sell 2020 plans, make sure to check for the plans’ telehealth benefits and see what is specified!

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Telehealth has become increasingly popular among beneficiaries and continues to expand and evolve each year. Whether your clients ask you about this benefit, or you notice it is within the benefit package of their new MA plan, it’s a wise decision to discuss the details so your clients can use the flexibility telehealth provides to their full advantage.

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