As many Medicare beneficiaries know, having a doctor’s appointment via video on a laptop or tablet became standard when the pandemic hit.
That method of providing remote care, known as telehealth, to many retirees and most people over 65 may have some staying power, at least for now.
House lawmakers are scheduled to vote on a bill this week, possibly Wednesday, aimed at extending, through the end of 2024, pandemic-related rule flexibilities that allowed widespread use of telehealth in Medicare. About 55.8 million of the program’s 64.3 million beneficiaries are 65 or older, and the remaining 8 million are younger with permanent disabilities, according to government data.
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“I think in the future there will be a continuing need that will need to be met with continued flexibility,” said Juliette Cubanski, deputy director of the Kaiser Family Foundation’s Medicare policy program.
The extension will give experts “time to review the data on utilization and learn more about the appropriate uses of telehealth and the perhaps not-so-appropriate uses,” Cubanski said. “It gives everyone a chance to dig a little deeper.”
If the bill were to pass the House, it would also need Senate approval. Meanwhile, efforts to advance proposals that would make telehealth changes permanent have stalled.
It gives everyone a chance to dig a little deeper.
Juliette Cubanski
Deputy Director of the Medicare Policy Program for the Kaiser Family Foundation
In March 2020, as communities worked to stop the spread of the coronavirus through temporary business closures and stay-at-home orders, lawmakers and regulators relaxed policies to make remote health care through Medicare more available during the pandemic.
The above trend gained strength in the midst of a pandemic
Before that, telehealth was already on a slow path to wider use within Medicare. However, it was generally limited to rural areas, with restrictions on where remote visiting could take place and which providers could offer such care.
During the public health emergency related to the pandemic, beneficiaries can be in their own homes, and the menu of qualifying providers and services is greatly expanded, from emergency room visits to group psychotherapy and radiation treatment administration.
However, the temporarily more flexible guidelines will expire five months after the public emergency ends. That declaration, which was last extended in July, will expire on October 14 unless the Biden administration extends it again.
“If it ends in October, these telehealth flexibilities would end in March,” Cubanski said.
The president is expected to provide a 60-day warning in mid-August if he plans to allow the emergency to lapse.
It is also worth noting that at the end of last year, Congress approved some permanent changes to the use of telehealth for mental health services under Medicare, including removing geographic restrictions and allowing beneficiaries to receive such care at home via video or, in certain cases, by telephone, with certain limitations.
A temporary postponement related to in-person visits for such care would be extended under the bill the House is scheduled to vote on this week.
How much does a telehealth visit cost?
During the first 12 months of the pandemic (March 2020 to February 2021), more than 28 million Medicare beneficiaries used telehealth services, according to research of the Kaiser Family Foundation. This included 38% of traditional Medicare beneficiaries (Part A hospital insurance and Part B outpatient care coverage) and 49% of those enrolled in the Medicare Advantage Plan (Part C).
The cost of a remote appointment, either by video or audio, depends on the beneficiaries’ coverage details. While providers and insurance plans may have waived or reduced cost-sharing (i.e., copays or coinsurance) for those non-face-to-face sessions early in the pandemic, they may have gone back to charging you as for an in-person visit .
Telehealth appointments are usually provided through Part B. If you have traditional Medicare with no additional insurance, Part B comes with a $233 deductible in 2022 and then typically covers 20% of the cost of services. And of course, that’s on top of a standard monthly Part B premium of $170.10 (for 2022).
If you have supplemental coverage through a policy called Medigap, the 20% coinsurance is covered in whole or in part, though the Part B deductible probably isn’t, especially if it’s a newer policy.
For beneficiaries who choose to get their Part A and Part B benefits through a Medicare Advantage Plan (Part C), the cost of telehealth appointments depends on the details of your plan. This year, 95% of Advantage plans offer telehealth benefits, according to the Better Medicare Alliance.