Paying for Telemedicine

By Bryan D. Vargo

Telemedicine is having a moment. Thanks in a large part due to the novel coronavirus, its wide-scale acceptance and value are being realized by policy makers, health care providers and patients alike. Previously, telehealth services were used mostly by those living in rural areas and generally delivered from a health care provider’s clinic to a patient’s remote clinic via a proprietary video platform. Now the types of telehealth visits and services, and the platforms on which they’re delivered – many of which were not allowed in the past, such as audio-only (telephone) visits – are currently permitted, and in many cases, paid for in part or entirely by private and by Medicare and Medicaid health insurance.

“Since late March, we have implemented an aggressive strategy to help expand telehealth services and coverage to keep beneficiaries safe and prevent the spread of COVID-19 by getting rid of barriers to telehealth that have long existed in the Medicare program,” according to a spokesperson for the Centers for Medicare and Medicaid Services (CMS).

Your out-of-pocket cost for a telemedicine visit will vary based on your insurance type. However, during the pandemic many insurance providers both public and private are making exceptions by covering a portion or all costs for COVID-19-related telehealth visits. Some insurers are also covering a portion or all costs for visits unrelated to COVID-19.

Many private insurers, such as Aetna, Blue Cross Blue Shield and UnitedHealthcare, are waiving copays or cost sharing for many telemedicine visits, including COVID-19-related visits, until at least mid-June. Aetna, for example is offering free-copay telemedicine visits for any reason. Contact your insurer to see if and what telehealth visits are covered, or refer to America’s Health Insurance Plans (AHIP) to find out how insurance providers are responding during the pandemic.

For Medicare beneficiaries, coinsurance and deductibles for telemedicine visits may apply, typically at the same rate as in-person visits, although some health care providers are reducing or waiving the amount that patients pay. Telehealth is also available now for both new and established patients. The types of visits covered have also been expanded to include 80 additional services, including in-home and emergency department visits, inpatient rehabilitation, and hospice visits, among others. For infusions, CMS is allowing health care providers flexibility to arrange for home health agencies or infusion clinics to administer infusions in patients’ homes under the supervision of the health care provider via telemedicine.

In addition to telehealth services covered under Medicare, beneficiaries with Medicare Part C (Medicare Advantage (MA) plans) may also be covered for additional telehealth benefits.

Under Medicare, health care providers can also provide services to patients via audio-only.

To find out how much your telehealth service will cost, talk to your health care provider and ask them for the service’s billing code so you can look it up on the CMS’ physician fee lookup tool . The specific amount you’ll owe may depend on several factors, including other insurance you may have; how much your doctor charges and whether he or she accepts that plan; and the type of facility.

Coverage for telemedicine visits for people receiving Medicaid and CHIP benefits varies from state to state. CMS developed a telehealth toolkit to help states accelerate adoption of broader telehealth coverage policies during the COVID-19 pandemic. However, each state has authority to implement telehealth options in their programs, often without CMS approval. States also determine the amount of reimbursement for telehealth as well as for all other types of care. CMS must approve each state’s rate to ensure it promotes access to care. Information specific to each state’s program is available on the Medicaid and CHIP website.

When in doubt as to what your telehealth service will cost, check your policy, and call your health care provider to confirm before scheduling your visit.