Does Medicare Cover Telemedicine?
This article was updated on: 09/12/2018
What is telemedicine?
Telemedicine is a general term that encompasses any medical activity involving an element of distance, according to the U.S. National Library of Medicine. Telemedicine includes “virtual” doctor-patient visits and physician consultations with other specialist physicians to assist in diagnosis and treatment. Telemedicine (also referred to as “e-health,” “online health,” or “telehealth”) allows health care professionals to evaluate, diagnose and treat patients in remote locations using telecommunications technology.
As a relatively new way to deliver health care, telemedicine is still being evaluated to determine its effectiveness and cost-efficiency in medical care. Telemedicine may offer some advantages to people who live in rural areas with limited access to medical care, according to the Centers for Medicare and Medicaid Services. While telemedicine isn’t a substitute for an in-person medical examination, it may be an effective and convenient means for patients with chronic health conditions to get medical advice when they have concerns about health symptoms. Some health professionals are using telemedicine as part of their addiction treatment programs, including treatment for opioid addiction, according to the Department of Health & Human Services (HSS).
What telemedicine services may Medicare cover?
Medicare Part B (medical insurance) may provide coverage for certain telemedicine services that are similar to existing Medicare-covered services delivered during in-person visits with a doctor or other qualified health professional. For example, professional consultations, office visits, and office psychiatric/behavioral health counseling may be covered telemedicine services when delivered using two-way communications. In almost all cases, Medicare covers only live telemedicine – in other words, a real-time video-chat between a doctor or other qualified health professional and a Medicare beneficiary.
Medicare coverage for telemedicine services is restricted to individuals who are enrolled in Medicare Part B and meet Medicare’s geographic requirements and who receive telemedicine services from eligible healthcare providers, as described below.
Patient location for telemedicine
Where you are located when you receive telemedicine services is called the “originating site” according to the Centers for Medicare and Medicaid Services. Medicare restricts coverage for telemedicine services to rural counties and geographic areas that are considered to be a Health Professional Shortage Area (HPSA) or areas outside of a Metropolitan Statistical Area (MSA).
Medicare may cover telemedicine services if you live in a rural area and only if you’re located at one of the following places when you receive telemedicine services:
- Critical Access Hospitals (CAH)
- Hospital-based or CAH-based Renal Dialysis Centers
- Skilled Nursing Facilities (SNF)
- Community Mental Health Centers (CMHC)
- Physician or practitioner offices
- Rural Health Clinics
- Federally Qualified Health Centers (FQHC)
Eligible health provider for telemedicine
Medicare limits the types of health care professionals who can provide covered telemedicine-delivered services. According to Medicare guidelines, the following healthcare providers are eligible to provide care to you via telemedicine:
- Nurse practitioners
- Physician assistants
- Nurse midwives
- Clinical nurse specialists
- Clinical psychologists and clinical social workers
- Registered dietitians or nutrition professionals.
As in the case of in-person health care services, telemedicine practitioners must participate in Medicare for Medicare coverage to apply.
What are my costs if I receive Medicare-covered telemedicine services?
You are responsible for your portion of the Medicare-approved fee for telemedicine services—just as you would be responsible for an in-person doctor visit or consultation. If you are enrolled in Medicare Part B, administered by the federal government, you would typically pay 20% of the Medicare-approved amount for telemedicine services after you have met your Part B annual deductible. If you are enrolled in a Medicare Advantage plan offered by a private insurance company contracted with Medicare, you will typically pay the same amount that you would if you received the services in person. Some Medicare Advantage plans may also offer additional benefits for other types of telemedicine—such as telephonic nurse consultations. However, you may have to pay a higher monthly premium or copay to receive added benefit.
If you have questions about Medicare’s telemedicine coverage or your Medicare coverage options, I’d be happy to answer your questions. To see a list of plans in your area, click the Compare Plans button on this page. You can request a phone call or an email with information by clicking the appropriate link below.