Telemedicine Coverage Through Medicare


how to get medicare telemedicine coverage infographic

Being able to get to and from doctor visits can become challenging the older we get, especially if it’s a specialist visit out of town. This is unfortunate since as we age, we may require visits more often. Thankfully, Medicare has made strides to help seniors get the doctor visits they need, even if they can’t physically get to them…using telemedicine and telehealth.

Telemedicine is a way for a doctor to provide health care from a remote location to a patient via video chat. Medicare covering telemedicine is the perfect solution to helping seniors get to and from their appointments.

Here’s what you need to know to make sure your telemedicine services are covered and what you’ll pay for them.

Telemedicine Requirements for Coverage

For Medicare to cover a telemedicine consultation, certain guidelines must be followed. First, you must be at an Originating Site at the time you receive your telemedicine consultation. The Originating Site must also be located in either a county outside of a Metropolitan area or a Health Professional Shortage Area (HPSA). In other words, a rural area.

Some common acceptable Originating Sites are:

  • A doctor’s office
  • A hospital
  • A rural health clinic
  • A skilled nursing facility

In addition to these sites, critical access hospitals, federally qualified health centers, some dialysis centers, and mental health center are also considered Originating Sites.

The next guideline is that an accepted practitioner must provide you with your services and receive payment. Some practitioners that can furnish your consultation are medical physicians, physician assistants, nurse practitioners, and clinical nurse specialists.

Another requirement is that a telecommunications system with audio and video components must be used for the consultation. The consultation is usually with a specialist or medical expert and their location is called the Distant Site.

How Medicare Pays for Telemedicine Consultations

Medicare will cover medically necessary telemedicine consultations under Part B. Like most everything covered under Part B, you will be subject to your annual deductible. In 2019, the Part B annual deductible is $185.

Once you have met this deductible, Part B pays 80% of the cost for medically necessary outpatient services, while you pay for 20% of the cost. If you have already met your deductible prior to receiving your telemedicine consultation, then you will just pay 20% of the cost. Medicare Part B will also help cover a fee for the doctor at the Originating Site.

Several factors that could affect what you pay for your telemedicine consultation are 1you’re your doctor doesn’t accept Medicare assignment and 2) which type of Originating Site you are using and 3) whether you have secondary insurance, such as a Medigap plan.

Medicare also now covers telehealth services for patients with more than 1 chronic health condition. This benefit will allow for better chronic care management where patients can get a non-face-to-face consultation of at least 20 minutes per month for managing chronic conditions. For example, a patient with diabetes could get help with monitoring glucose, blood pressure, and medications. This may also include coverage of remote monitoring equipment.

Coverage for Telemedicine Consultations Under Medicare Plans

Private insurance carriers sell plans that help lower Medicare beneficiaries’ out-of-pocket costs. One type of plan sold is Medigap. Medigap plans help cover cost-sharing expenses that you would normally be responsible for such as deductibles, copays, and coinsurance.

If you were enrolled in a Medigap plan such as Plan G, you would only be subject to the Part B deductible for your telemedicine consultation. Plan G covers your Part B copays and coinsurance for you so you wouldn’t have to pay that 20% of the appointment.

Another type of plan sold by private insurance carriers is Medicare Advantage. Medicare Advantage plans, also called Part C, offer the same coverage as Original Medicare and usually, plus some.

Medicare Advantage plans can provide their beneficiaries with extra benefits such as drug, dental, vision, and hearing. Because Original Medicare now covers telemedicine services, Medicare Advantage plans will also cover them, but they may have their own rules about how you access them and what you pay for them.

These two types of coverages work very differently so be sure you understand how a plan will cover you before you enroll.

People Who Will Benefit from This Added Coverage

This newly added coverage will benefit many people including patients, doctors, and medical facilities. Patients will obviously benefit from being able to see specialists that would normally be out of reach for them. However, by having access to telemedicine, patients will also have better chances to stay out of the hospital once discharged.

This, in turn, helps the hospital have more beds available to new patients. This new coverage also helps specialists have access to more patients since more beneficiaries can schedule a consultation without driving hours for an appointment.

Medicare beneficiaries living in an assisted living facility will also be able to get the care they need without having to be taken to doctor appointments that they wouldn’t be able to travel to alone. As you can see, telemedicine and telehealth coverage is a great addition to Medicare.

About Our Guest Author

Danielle Medicare headshotDanielle Kunkle Roberts is the co-owner of Boomer Benefits and a Contributor. Her licensed insurance agency specializes in Medicare-insurance related products, with tens of thousands of clients across 47 states. 

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