This article was written in 2020. The facts and figures are current as of then. With the lifting of many COVID-19 restrictions, we will no longer be updating the article. While much of it remains true, we encourage our readers to check with CMS and the Medicare program to get the most updated information.
On March 17, 2020, the Centers for Medicare & Medicaid Services (CMS) and the Trump Administration announced that they would be expanding the Medicare program’s coverage of telehealth services to ensure that beneficiaries could receive care in the comfort and safety of their own homes during the COVID-19 outbreak. This is coupled with the announcement week before of the guidance issued by CMS of expanded benefits for Medicare Advantage and Part D prescription drug plans to help combat the growing coronavirus concern in the United States. The goal of the most recent expansion is to help seniors receive health care without having to leave their homes, potentially exposing themselves to COVID-19 infection.
These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries. — Seema Verma, CMS Administrator
What’s Been Changed?
According to the press release, CMS will temporarily be paying health care providers who complete telehealth services for Medicare insurance beneficiaries. This expansion of payment began on March 6, 2020, allowing doctors who provided these services to apply for payment. Previously, the Medicare program did cover telehealth services, but in a limited way, often based on your coverage area and the service provided. Many of the covered services fell under the category of telemedicine, which refers to more clinical care like virtual doctor appointments. As for the service area, telehealth was previously covered for beneficiaries in rural areas, but only if they were located in one of the following places:
- A doctor’s office
- A hospital
- A critical access hospital
- A rural health clinic
- A federally-qualified health center
- A hospital-based dialysis facility
- A skilled nursing facility
- A community mental health center
Now, the coverage locations have been expanded to include the beneficiary’s home. Telehealth services are still covered at the above locations, but seniors and other at-risk populations should seek to social distancing to prevent exposure, making at-home telehealth services preferable at this time. The type of devices allowed, as part of the two-way interactive telecommunications system, was also expanded to include telephones with video and audio capabilities.
What Services are Covered?
The services covered have also expanded beyond routine check-ups or even health concerns directly related to COVID-19, as other recent Medicare insurance coverage expansions have been. Beyond routine office visits, the Medicare program will now be covering telehealth mental health counseling services, preventative health screenings, or doctor visits to refill a prescription or as part of a diabetes management program, to name only a few examples. All these have been included to provide the freedom and flexibility for seniors to stay indoors.
Many states have expanded their own coverage of telehealth services, and some may already cover these services or more. If you have further questions about the specifics of what is covered, it may be worth checking with your State Health Insurance Assistance Program (SHIP) or your local Medicare ombudsman. You can also read the Telemedicine Fact Sheet released by CMS as part of this most recent announcement or download the list of Telehealth Services that is normally covered by the Medicare program to learn more.
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Many Americans are focused on stopping the spread of COVID-19 and flattening the curve, as has often been discussed. Limiting travel and time in public can greatly lessen the chances of exposure to the coronavirus, which is essential for the most at-risk populations like the elderly and the chronically ill. This expansion of telehealth services covered by Medicare insurance will greatly assist with the goal of helping seniors stay safe during the public health crisis.
Further Reading
The Shop & Enroll Blog — CMS & Insurers Announce Part C and D COVID-19 Coverage
The Shop & Enroll Blog — Ways to Avoid Getting Sick
