Getting Your Telehealth Appointments Covered by Medicare

Wondering if your insurance will cover a virtual visit? Here's what you need to know

Deborah Pike Olsen

More than 10.1 million Medicare beneficiaries have received medical care via telemedicine since the coronavirus hit, thanks to an expansion of services and coverage during the pandemic. In recent months, the Centers for Medicare & Medicaid Services (CMS) has more than doubled the number of health care services beneficiaries can receive via telemedicine. The agency has allowed an additional 135 services, including home visits, eye exams and physical, occupational and speech therapy. In early August, CMS proposed covering some of these new services on a permanent basis. According to CMS Administrator Seema Verma, telemedicine has proven to be a boon for patients and physicians.

It's clear that telemedicine will continue to play a key role in health care for Medicare beneficiaries. “Telemedicine is more integrated into our lives now, so some of the changes in coverage are likely to stay,” says Mei Kwong, executive director of the Center for Connected Health Policy.

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What's included in the expanded/emergency coverage

Under the Coronavirus Preparedness and Response Supplemental Appropriations Act, which was signed into law in March, the secretary of the Department of Health and Human Services was allowed to waive certain Medicare telemedicine payment requirements during the public health emergency. This resulted in the following changes that affect coverage:

During the public health emergency, CMS is paying for telehealth services at the same rate as in-person visits. Original Medicare beneficiaries pay 20 percent of the Medicare-approved amount for a doctor's services, and the Part B deductible applies. However, the Families First Coronavirus Response Act waives cost sharing (coinsurance and deductibles) under Medicare Part B for COVID-19 testing-related services. In addition, the Office of the Inspector General is allowing doctors to waive the 20 percent copay for telemedicine visits.