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?

Listen to this article:

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

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, but one thing’s for sure, advancements in the effort of value-based care are possible due to flexibility telehealth provides. Ultimately, it will be up to your client whether or not this type of health service will benefit their needs.

Advancements in the effort of value-based care are possible due to the flexibility telehealth provides.

The COVID-19 pandemic caused a spike in telehealth use in 2020. Since regulation changes and vaccine availability, the usage of this service has evened out, but it’s still prevalent. A survey conducted at the beginning of 2021 reported 58 percent of providers offer telehealth services and 74 percent of people are open to using telehealth.

Which Carriers Offer Telehealth Benefits?

Carriers such as Cigna, Regence, Anthem, and Humana 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 offers contracting for 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, as you can see 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 all telehealth services require audio and video.

Where Can Beneficiaries Be Treated Using Telehealth?

Prior to the pandemic, originating sites — the patient’s location where the telehealth encounter takes place — were an important aspect of telehealth. The site had to be in either a county outside of a Metropolitan Statistical Area or a rural Health Professional Shortage Area. In addition, Medicare specified that the originating site had to 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

Thanks to the expansion of telehealth access under the 1135 waiver, which went into effect in March 2020, Medicare beneficiaries have had more access to telehealth services than ever before. In fact, by the end of 2020, CMS added 60 telehealth services to the list of those that Medicare will permanently cover for beneficiaries in rural areas who are in a medical facility, such as a nursing home. As a result of the changes, a wider range of providers, including doctors, nurse practitioners, clinical psychologists, and licensed clinical social workers, have been able to offer telehealth to their patients. The HHS Office of Inspector General (OIG) has also provided flexibility for health care providers to reduce or waive cost-sharing for telehealth visits paid by federal health care programs.

What Is the Future of Telehealth?

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

Telehealth has made significant strides in the world of health care and services. Original Medicare has been strict regarding reimbursement for telehealth services and MA plans were also subject to strict rules regarding telehealth. However, it’s anticipated that MA plans may offer more leniency with telehealth location regulations than Original Medicare in the future. While you are meeting with your clients to sell 2022 plans, make sure to check for plans’ telehealth benefits and see what they specify!

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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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