Are Telehealth Visits Covered By Insurance?

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Most health insurance companies — including both public and private options — cover at least some form of telemedicine.[1]

During the COVID-19 lockdown, many providers turned to telehealth visits to stay connected with their patients. As the benefits became clearer and clearer, some states took action and mandated that insurance companies cover this form of care. Some of these new rules expanding telehealth coverage have remained in place even after the pandemic, and telemedicine is being used much more widely and regularly as a means of facilitating access to care.

Insurance coverage is complicated, and often, coverage isn’t straightforward. The best way to understand if your insurance company covers telehealth is to call them directly. Find your insurance coverage card, and call the number on the back to speak with a representative. 

Are Telehealth Appointments Covered by Insurance?

Every policy is a little different, and it's hard to make sweeping statements about how each one works. But in general, most insurance plans include at least some type of coverage for telehealth. 

Will Medicare Cover Telehealth Appointments? 

Medicare coverage is sheared into parts, and some are tied to enrollment fees. One such option, Medicare Part B, will cover some telehealth services. Meet your Part B deductible, and you'll pay 20% of the Medicare-approved amount for the services.[2]

Some people buy plans from private companies (Medicare Advantage plans) to get even more coverage. Beginning in 2020, insurance companies can include telehealth in their benefits packages, but not all of them do.[3] 

Will Medicaid Cover Telehealth Appointments?

Medicaid is a state based program. Every state has a Medicaid program but the plans and what they cover vary by each state. Per federal rules, each state can determine whether or not to cover telehealth for members.

They can also determine how providers are reimbursed, and they can set limits on what types of telemedicine care are recognized.[4] While some states cover telehealth, others don’t. 

Will Private Healthcare Companies Cover Telehealth Appointments?

More than 40 states require private insurance companies to cover telemedicine services.[1] If you live in one of these states, your telehealth appointments will likely be covered by your plan. Some companies that provide services across many states also cover telemedicine, whether the state requires it or not. 

How to Find Out if Your Insurance Company Covers Telehealth 

Insurance companies provide paperwork, identification cards, and other documents when you enroll. That paperwork should include a phone number for member services.

Call that number, provide your identification information, and ask about telehealth. This is the quickest and most efficient way to get an answer about whether the company will cover your visits.

You can also use this state checker to see if your state requires telehealth coverage.[5] But remember that your insurance company may cover telehealth even if the state doesn’t require it. Calling is the best way to get a clear answer to your question.

How to Prepare for a Virtual Visit 

Have you used your computer for a work-related Zoom call? Have you talked to your friends on your phone via FaceTime? You're prepared to talk with your provider in a telemedicine appointment.

Don't be intimidated by technology. It’s easier than you think.

Take these steps to prepare:

  1. Check your equipment. During your appointment, your provider wants to both see and hear you. Ensure that your computer or phone has a working microphone and camera. Charge your equipment before your appointment too.

  2. Enable access. Strong security settings could impair your telehealth appointment. Ensure that your provider's telemedicine portal has access to your camera and microphone.

  3. Get a strong signal. Telemedicine portals require a lot of processing power, and you need a crisp connection to ensure the call isn't dropped while you're talking. Set up where your device has the strongest signal, and close all other applications you don't need.

  4. Protect your privacy. Your doctor needs honest answers to questions, and you may talk about very private issues. Set up in a space where you can talk freely.

If you're computer savvy, all of these steps are easy to understand and finish. But if you're confused or unsure, ask for help from a friend and practice before your appointment starts. 

Is Telehealth Effective for Opioid Use Disorder? 

In the past, people with an opioid use disorder (OUD) had to visit a provider in person. Telemedicine techniques changed everything, and many researchers say the new model is remarkably effective. People have better access to the care they need.

In one study, researchers found that telehealth was as effective as in-person treatment for OUD.[6] And other researchers said telemedicine could reduce barriers to treatment, such as limited access to quality care.[7]

In a small study of people with OUD experiencing houselessness, more than half had never used OUD medications. Almost 88% stayed in treatment, and none required emergency care or experienced an overdose.[8] To these vulnerable people who may have struggled in traditional care, telemedicine can be a lifesaver.

If you are interested in telehealth services for medication for an OUD, reach out to your provider, or to us here at Bicycle health for more information.

Sources

  1. Private Insurance Coverage for Telehealth. Health Resources and Services Administration. https://telehealth.hhs.gov/providers/billing-and-reimbursement/private-insurance-coverage-for-telehealth/. October 2021. Accessed August 2022.
  2. Telehealth. U.S. Centers for Medicare and Medicaid Services. https://www.medicare.gov/coverage/telehealth. Accessed August 2022.
  3. Advances in Telehealth. U.S. Department of Health and Human Services. https://aspe.hhs.gov/topics/health-health-care/advances-telehealth. Accessed August 2022.
  4. Telemedicine. U.S. Centers for Medicare and Medicaid Services. https://www.medicaid.gov/medicaid/benefits/telemedicine/index.html. Accessed August 2022.
  5. Policy Finder. Center for Connected Health Policy. https://www.cchpca.org/all-telehealth-policies/. Accessed August 2022.
  6. Addiction Treatment and Telehealth: Review of Efficacy and Provider Insights During the COVID-19 Pandemic. Psychiatric Services. https://ps.psychiatryonline.org/doi/full/10.1176/appi.ps.202100088. October 2021. Accessed August 2022.
  7. The Provision of Counseling to Patients Receiving Medications for Opioid Use Disorder: Telehealth Innovations and Challenges in the Age of COVID-19. Journal of Substance Abuse Treatment. https://www.sciencedirect.com/science/article/pii/S0740547220304207. January 2021. Accessed August 2022. 
  8. COVID-19: A Catalyst for Change in Telehealth Service Delivery for Opioid Use Disorder Management. Substance Abuse. https://www.tandfonline.com/doi/full/10.1080/08897077.2021.1890676?src=recsys. March 2021. Accessed August 2022.

Medically Reviewed By Elena Hill, MD, MPH

Elena Hill, MD; MPH received her MD and Masters of Public Health degrees at Tufts Medical School and completed her family medicine residency at Boston Medical Center. She is currently an attending physician at Bronxcare Health Systems in the Bronx, NY where she works as a primary care physician as well as part time in pain management and integrated health. Her clinical interests include underserved health care, chronic pain and integrated/alternative health.

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