What You Should Know About Medicare Coverage of Telehealth

Telehealth has grown in popularity as a way to communicate with doctors. Rather than discussing your current health situation in person, you can log onto a computer or your phone and talk to your doctor virtually. This can be a great benefit for those who live in rural areas and would need to travel far to a doctor’s office, are homebound, or have a difficult time with transportation.

As we age, getting to and from in-person appointments is not always easy, so understanding your other appointment options is important and could save you time and energy!

What is telehealth?

According to the Health Resources and Services Administration, “Telehealth is defined as the use of electronic information and telecommunication technologies to support long-distance clinical health care.” You can think of it as a doctor’s visit, just virtually. It could include a video chat or voice chat with a doctor.

What does Medicare cover?

When you’re 65 and older, you will likely enroll in Medicare insurance. The Medicare insurance program works differently from private insurance, which you may have from Marketplace or an employer. Instead of having a specific plan from an insurance carrier, you receive two parts from the federal government: Part A and Part B. Although these two parts are from the government, there are two other parts you can enroll in. To make it even more confusing, you can also choose from Medicare Supplement plans. You can learn more on Medicare and plans by working with a reputable broker.

What does Part A cover?

You can think of Part A as your inpatient hospital coverage. It helps cover your semi-private room when you’re admitted, three daily meals, home health care, skilled nursing facility care, and hospice. You are responsible for the Part A deductible before it helps kick in to cover costs.

What does Part B cover?

Medicare Part B covers your outpatient medical services such as doctor visits, physical therapy, durable medical equipment, and more. However, like Part A, there is a Part B deductible and you’ll pay 20% coinsurance of the cost of your services. An important thing to remember is there is no limit on your out-of-pocket costs with Original Medicare.

Part C and Part D

The other parts of Medicare are Part C, also known as Medicare Advantage, and Part D, which is your drug coverage. Private insurance carriers offer these plans. Advantage plans are an alternative to Original Medicare, so instead of receiving your Medicare benefits from the federal government, you would get them from the insurance company. However, the insurance company sets your cost-sharing, so it won’t be the same as if you had Original Medicare.

Part D plans are standalone drug plans. They help cover drugs that you pick up from the pharmacy.

How does Medicare cover telehealth?

Since telehealth is a type of doctor’s office visit, it falls under Medicare Part B. However, you’ll want to ensure the doctor accepts Medicare. Doctor on Demand is an example of telehealth that includes Medicare-accepted doctors.

How much does telehealth cost with Medicare?

The Part B deductible will likely need to be met first. In 2024, the Part B deductible is $240. Once that deductible is met, Medicare will cover 80% of approved telehealth appointments. This leaves you responsible for the remaining 20% with no limit.

It’s essential to understand that Medicare has approved rates for each service. If the doctor accepts Medicare Assignment, they must take what Medicare will pay them for the service. For example, the doctor could charge Medicare $200 for a service, but Medicare might only approve it for $150. This means Medicare will pay 80% of that $150, and you would pay 20% of $150.

If you purchase a Medigap plan to help supplement your Medicare benefits, that plan can help cover the remaining 20%. Medigap plans help lower your out-of-pocket costs with Medicare.

Additionally, if you enroll in an Advantage plan and receive your benefits, your cost-sharing will look different. Instead of being responsible for the 20% coinsurance, your plan might have a set copay for telehealth visits. For example, a $40 copay could be for an approved telehealth visit.

What are the 2025 changes for telehealth?

After December 31, 2024, Medicare beneficiaries’ telehealth coverage will change. For most services, you will need to go to a doctor’s office or facility rather than make an appointment via telehealth.

There are a few services that will continue to offer a telehealth option:

• If you have End-Stage Renal Disease and need monthly home dialysis visits.
• Services for diagnosis, evaluation, or treatment of symptoms of an acute stroke wherever you are, including in a mobile stroke unit.
• Services to treat a substance use disorder or a co-occurring mental health disorder (sometimes called a “dual disorder”) or for the diagnosis, evaluation, or treatment of a mental health disorder, including in your home.
• Behavioral health services, including in your home.
• Diabetes self-management training.
• Medicare nutrition therapy.

Keeping up with the changes

Medicare coverage is always changing, whether improving or reducing benefits. Telehealth is one part of Medicare’s coverage that will change in the future. It’s essential to keep up with coverage updates and changes so you won’t be blindsided when the changes are effective.