Medicare telehealth would be extended under a bill about to be voted on in the House
As many Medicare beneficiaries know, having a doctor’s appointment by video on a laptop or tablet became the norm when the pandemic hit.
This method of delivering care remotely – known as telehealth – to many retirees and most people over 65 may have some staying power, at least for now.
House lawmakers are due to vote Wednesday on a bill to extend, through the end of 2024, the pandemic-related rule flexibilities that allowed for the wide use of telehealth in Medicare. About 55.8 million of the 64.3 million beneficiaries of the program are aged 65 or over and the remaining 8 million are younger with permanent disabilities, according to government data.
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“I think going forward, there will be an ongoing need that will need to be met with continued flexibility,” said Juliette Cubanski, deputy director of the Medicare policy program for the Kaiser Family Foundation.
The extension will give experts “time to review usage data and learn more about appropriate uses of telehealth and perhaps less appropriate uses,” Cubanski said. “It gives everyone the opportunity to dig a little deeper.”
If the bill were to be approved by the House, it would also need Senate approval. Meanwhile, efforts to advance proposals that would make the telehealth changes permanent have stalled.
In March 2020, as communities worked to stem the spread of the coronavirus through temporary business closures and stay-at-home orders, lawmakers and regulators eased policies to make health care remote via Medicare more widely available during the pandemic.
Earlier trend accelerated amid 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 were allowed to offer such care.
During the pandemic-related public health emergency, beneficiaries can be at home, and the menu of eligible services and providers is significantly expanded, ranging from emergency department visits to group psychotherapy to radiation therapy management .
The temporarily looser guidelines, however, are set to expire five months after the public emergency ends. This declaration, which was last extended in July, will expire on October 14 unless the Biden administration extends it again.
“If it ends in October, those telehealth flexibilities will end in March,” Cubanski said.
The president is expected to provide a 60-day warning – by mid-August – if he plans to let the emergency expire.
It should also be noted that late last year, Congress approved some permanent changes to the use of telehealth for mental health services under Medicare, including removing geographic restrictions and possibility for beneficiaries to receive this care at home by video or, in some cases, by telephone, with certain limits.
A temporary stay tied to in-person visits for such care would be extended under the bill the House is due to vote on this week.
How much does a telehealth visit cost
In the first 12 months of the pandemic (March 2020 to February 2021), more than 28 million Medicare beneficiaries used telehealth services, according to research by the Kaiser Family Foundation. This included 38% of traditional Medicare beneficiaries (part A hospital insurance and part B outpatient coverage) and 49% of those enrolled in the Medicare Advantage plan (part C).
The cost of a remote appointment – whether video or audio – depends on the specifics of beneficiary coverage. Although providers and insurance plans may have waived or reduced cost sharing (i.e. copays or coinsurance) for these non-in-person sessions earlier in the pandemic, they may have started charging you again. as if it were an in-person visit.
Telehealth appointments are typically delivered through Part B. If you have traditional health insurance without additional insurance, Part B comes with a $233 deductible in 2022, then you typically cover 20% of the cost of services. And of course, that’s on top of a standard Part B monthly premium of $170.10 (for 2022).
If you have additional coverage through a so-called Medigap policy, the 20% coinsurance is fully or partially covered, although the Part B deductible probably is not, especially if it is a policy more recent.
For beneficiaries who choose to get their Part A and B benefits through a Medicare Advantage (Part C) plan, the cost of telehealth appointments depends on the specifics of your plan. This year, 95% of Advantage plans offer telehealth benefits, according to the Better Medicare Alliance.