Telehealth & related services
Medicare has temporarily expanded coverage of telehealth services
to respond to the current COVID-19 Public Health Emergency. These
services expand the current telehealth covered services to help you have
access from more places (including your home), with a wider range of
communication tools (including smartphones), to interact with a range of
providers (such as doctors, nurse practitioners, clinical
psychologists, and licensed clinical social worker).
As noted by Medicare: your cost with Original Medicare is "20% of the Medicare-approved amount for your doctor or other health care provider’s services, and the Part B Deductible applies. For most telehealth services, you'll pay the same amount that you would if you got the services in person."
During this time, you will be able to receive a specific set of services
through telehealth including evaluation and management visits (common
office visits), mental health counseling and preventive health
screenings. This will help ensure you are able to visit with your doctor
from your home, without having to go to a doctor's office or hospital,
which puts you and others at risk of exposure to COVID-19.
- You may be able to communicate with your doctors or certain
other practitioners without necessarily going to the doctor's office in
person for a full visit. Medicare pays for “virtual check-ins”—brief,
virtual services with your established physician or certain
practitioners where the communication isn't related to a medical visit
within the previous 7 days and doesn't lead to a medical visit within
the next 24 hours (or soonest appointment available).
- You need to consent verbally to using virtual check-ins and
your doctor must document that consent in your medical record before you
use this service. You pay your usual Medicare coinsurance and deductible for these services.
- Medicare also pays for you to communicate with your doctors using online patient portals without going to the doctor's office. Like the virtual check-ins, you must initiate these individual communications.
- If you live in a rural area, you may use communication
technology to have full visits with your doctors. The law requires that
these visits take place at specified sites of service, known as telehealth
originating sites, and get services using a real-time audio and video
communication system at the site to communicate with a remotely located
doctor or certain other types of practitioners. Medicare pays for many
medical visits through this telehealth benefit.
The Kaiser Family Foundation also added the following Medicare coverage points in March 2020:
- "CMS has given guidance that in the case of a national
disaster, emergency declaration, or public health declaration, CMS
expects Medicare Part D plans (PDPs and MAPDs)
to lift their "refill-too-soon" restrictions (edits) until the
termination of the emergency declaration. Therefore, during COVID-19,
Medicare Part D plans may, but are not required to relax their refill
rules. Contact your Medicare Part D plan's member services if you need a
prescription refill or an extended refill that would typically be
denied due to "refill-too-soon" restrictions. [And as noted by
Medicare, "Medicare Advantage Plans and Prescription Drug Plans may
waive or relax prior authorization
requirements."] [You can contact your plan's Member Services
department using the toll-free number found on your Member ID card.]
- During the period of the declared emergency, if you are affected by the emergency,
Medicare Advantage plans are required to cover services at
out-of-network facilities that participate in Medicare, and charge you
no more than you would pay if you had received care at an in-network
facility.
- Part D plans are required to ensure that you have adequate
access to covered Part D drugs at out-of-network pharmacies when you
cannot reasonably be expected to use in-network pharmacies. Part D plans
may also relax restrictions on various methods of delivery, such as
mail or home delivery, to ensure you have access to needed medications
if you unable to get to a retail pharmacy.
- In response to the national emergency declaration related to the coronavirus pandemic, if you need to be transferred to a skilled nursing facility
(SNF) as a result of the effect of a disaster or emergency, CMS is
waiving the requirement for a 3-day prior hospitalization prior to
coverage. If you have recently exhausted your SNF benefits, the waiver
from CMS authorizes renewed SNF coverage without first having to start a
new benefit period."
Sources include:
https://www.coronavirus.gov/
https://www.medicare.gov/medicare-coronavirus 03/23/2020, 09/23/2020, 05/25/2021
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://www.kff.org/medicare/issue-brief/faqs-on-medicare-coverage-and-costs-related-to-covid-19-testing-and-treatment/
03/19/2020 [with notes, links, and emphasis added]