In the ever-changing healthcare space, telehealth services under Medicare have seen changes in recent years, offering unprecedented access to medical services from the comfort of one’s home and other locations. Understanding how telehealth integrates with their coverage is crucial for Medicare beneficiaries in optimizing healthcare experiences.
In this comprehensive guide, we explore the intersection of telehealth and Medicare in 2024, shedding light on the benefits, challenges, and the evolving landscape of remote healthcare.
Medicare and Telehealth Services
Telehealth, encompassing virtual visits, remote monitoring, and digital communication with healthcare providers, has witnessed exponential growth in recent years. Accelerated by technological advancements and the global COVID-19 pandemic, telehealth has become an integral component of the healthcare ecosystem, providing a range of benefits to both patients and healthcare professionals.
This growth in telehealth services has also affected the Medicare program and how it approaches digital care. Medicare, the federal health insurance program primarily for individuals 65 and older, has adapted to the telehealth revolution. Understanding the current state of telehealth within the Medicare framework is essential for beneficiaries seeking to leverage these services and prepare their finances accordingly. You can learn more about Medicare costs at https://boomerbenefits.com/new-to-medicare/medicare-cost/.
In response to the public health emergency caused by the COVID-19 pandemic, Medicare expanded its coverage of telehealth services. While these changes were initially temporary, some will become permanent. In contrast, others will only continue through December 31st, 2024, allowing beneficiaries to access a broader range of telehealth services from various healthcare providers for a more extended period.
Current Medicare and Telehealth Services
Medicare currently covers various telehealth services, including virtual visits with doctors, mental health counseling, and preventive health screenings conducted remotely. Understanding which services are covered ensures beneficiaries can make the most of their telehealth benefits.
Telehealth coverage under Medicare can include services such as depression screenings, psychotherapy, ESRD (End-Stage Renal Disease) visits each month and more. There are also other general services beneficiaries can receive including e-visits, virtual check-ins, and more.
Medicare and E-visits
One of the telehealth benefits that Medicare covers is E-visits. Under the Medicare program, E-visits can be used for general inquiries like asking providers questions or scheduling visits. Several types of providers qualify under Medicare for these services, including doctors, nurses, physician assistants, and more.
Just know that the annual Part B deductible does apply first. Once you’ve met the deductible, you’re responsible for 20% of Medicare-approved services. Fortunately, a Medigap or Advantage plan will help cover your portion.
Virtual Check-Ins
Additionally, Part B helps cover certain virtual check-in visits via several digital mediums, including by phone, secure text message, patient portal, email, and more.
These virtual check-ins allow people to communicate with their providers without leaving their homes or other places of residence, such as a nursing home or assisted living facility. Virtual check-ins can be used via video and audio technology for assessments to determine if further care is needed in an in-person doctor’s office.
Substance Use Disorder
Medicare provides coverage for various types of treatment for those needing care for substance abuse. Medicare beneficiaries who have a substance use disorder or a dual disorder can receive telehealth services. This also includes the diagnosis, evaluation, or treatment of mental health disorders.
Permanent Medicare Telehealth Changes
Most of the services that will be permanent relate to behavioral versus non-behavioral mental care. Medicare beneficiaries who need behavioral mental health services will continue to have more flexibility in their care options.
For example, those receiving behavioral mental health care can continue to receive telehealth services in their home without geographical limitations to their originating site. CMS (Centers for Medicare & Medicaid Services) defines an originating site as the place a patient is located when they receive a telehealth service.
Audio-only communication for behavioral or mental health services will also continue to be covered by Medicare past 2024.
Temporary 2024 Medicare Telehealth Changes
After 2024, there will be more limitations for non-behavioral mental health care. For instance, Medicare beneficiaries can receive non-behavioral telehealth services in their own home through the end of 2024. However, after 2024, certain geographic and originating site requirements for non-behavioral or mental telehealth services may exist.
Another temporary change is that all providers that can bill Medicare can provide distant-site telehealth services. After 2024, not all providers can provide telehealth services and receive compensation for them.
Audio-only communications for non-behavioral mental health services may also be more limited after 2024.
Medicare Advantage Plans and Telehealth Services
Regarding Advantage plans and telehealth services, things may work differently. Medicare requires Advantage plans to provide at least the same coverage as Original Medicare (Part A and Part B). However, it is possible for them to offer additional benefits as well.
The exact benefits that are available depend on the specific plan. It’s best to refer to an Advantage plan’s SOB (Summary of Benefits) to learn more about a plan. An SOB is an outline of the benefits included in an Advantage plan.
Pros and Cons of Medicare and Telehealth Services
Accessibility and Convenience
Telehealth breaks down geographical barriers, enabling individuals, especially those in rural or underserved areas, to access medical consultations without the need for extensive travel. This newfound accessibility promotes timely interventions and preventive care.
Technology Literacy
Some older adults may face challenges related to technology literacy. Ensuring that beneficiaries have the necessary tools and support to engage in telehealth services is crucial for widespread adoption.
Communities often offer resources for older adults to become more familiar with today’s technology. Resources can include computer classes, digital literacy courses, digital training, and more.
Digital Disparities
Disparities in access to reliable internet connections and digital devices may hinder some individuals from fully benefiting from telehealth services. Addressing these disparities is an ongoing concern in the quest for equitable healthcare.
Conclusion
In 2024, the relationship between telehealth and Medicare offers a shift in healthcare delivery for older adults. Navigating this landscape requires an understanding of the evolving telehealth services, Medicare coverage, and the broader implications for the future of healthcare.
As beneficiaries embrace the opportunities telehealth presents, they embark on a journey toward a more accessible, convenient, and personalized healthcare experience.