Telemedicine, the use of technology to provide healthcare remotely, has revolutionized the way patients access medical care. Both Original Medicare and Medicare Advantage plans have embraced telemedicine, making it easier for beneficiaries to consult with healthcare providers without the need for in-person visits. Here’s a closer look at how telemedicine works within these two types of Medicare coverage.
Telemedicine and Original Medicare
Original Medicare, which includes Part A (hospital insurance) and Part B (medical insurance), covers telemedicine services under specific conditions. These services are primarily included under Part B and are available to beneficiaries who meet certain criteria.
Medicare covers telemedicine for beneficiaries who:
- Are located in rural or underserved areas.
- Receive services at approved locations, such as a healthcare facility or a community health center.
During the COVID-19 public health emergency, Medicare temporarily expanded telehealth coverage to include all beneficiaries, regardless of location. This expansion allowed beneficiaries to access telemedicine services from their homes, a significant improvement in accessibility and convenience. Although some of these expanded benefits have been made permanent or extended, it is essential to verify the current coverage rules, as policies may evolve.
Covered telemedicine services under Original Medicare include:
- Virtual consultations with physicians, nurse practitioners, and other healthcare providers.
- Mental health counseling and therapy sessions.
- Remote monitoring of chronic conditions, such as diabetes or heart disease.
Original Medicare typically pays 80% of the approved amount for telehealth services after the Part B deductible is met, leaving beneficiaries responsible for the remaining 20% unless they have supplemental insurance.
Telemedicine and Medicare Advantage Plans
Medicare Advantage (MA) plans, also known as Medicare Part C, are offered by private insurance companies and must provide at least the same level of coverage as Original Medicare. However, these plans often include additional benefits, such as expanded telemedicine services.
Many Medicare Advantage plans go beyond Original Medicare’s requirements by offering:
- Telemedicine access for a broader range of services, including routine care, dermatology, and prescription management.
- The flexibility to access telehealth services from any location, including the beneficiary’s home, without geographic restrictions.
- Integration with mobile apps and patient portals, enabling seamless communication with healthcare providers.
Additionally, some MA plans include telemedicine as part of wellness programs, chronic care management, and preventive care initiatives. For example, beneficiaries with chronic conditions may receive devices for remote monitoring, such as blood pressure cuffs or glucose meters, which automatically transmit data to their healthcare providers.
Another advantage of Medicare Advantage plans is the potential for lower out-of-pocket costs for telemedicine services, as many plans offer $0 copays for virtual visits.
Choosing the Right Telemedicine Option
Beneficiaries should carefully review their Medicare coverage to understand how telemedicine services are covered and whether additional benefits are available. Original Medicare provides a solid foundation for telehealth services, particularly for those in rural areas, while Medicare Advantage plans often offer enhanced telemedicine options with fewer restrictions.
If you need additional help understanding how telemedicine works with Medicare or if you have any other questions about Medicare, please connect with one of our Member Agents. There are never any fees for their educational or enrollment services!
