Telemedicine has become a popular form of healthcare that allows medical providers to diagnose and treat patients remotely. Whether or not your telemedicine appointments will be covered by health insurance is dependent upon two factors: your state and insurance provider. The five big providers— UnitedHealthcare, Cigna, Aetna, Blue Cross Blue Shield, and Humana— all have some form of coverage for telemedicine.
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What Telemedicine Is
Telemedicine is a new, modern type of medicine where medical providers can remotely diagnose and treat patients via telecommunications technology. For patients, this allows you to receive medical care in the comfort of your own home.
In doing so, you are able to protect yourself from going into medical facilities where you may be at higher risk of contracting certain illnesses, as well as protecting medical providers and other patients from any potential illness you may carry. Another benefit to telemedicine is that it can enable medical providers to reach more patients, as telemedicine operates seven days per week and patients save time by not having to come to the office.
Telemedicine cannot replace face-to-face consultations when it’s needed; however, it can act as a supplement for it. For example, telemedicine appointments are useful in conducting follow-up appointments and when providing prevention strategies to patients.
Telemedicine appointments can also be used for:
- Therapy sessions with mental health professionals
- Screenings for infections like COVID-19
- Nutrition counseling
- Check-ups with providers
- Providing care for individuals in rural areas
Health Insurance Coverage for Telemedicine
In general, each major health insurance carrier, including Blue Cross Blue Shield, United Healthcare, Cigna, Aetna, and Humana, offers some form of telemedicine coverage. However, each of these insurance providers will have different sets of limits to their telehealth plans. For example, some providers may cover the cost of a telemedicine visit completely, whereas others may only cover some of it. There are also different state law restrictions that compound the confusion with understanding whether telemedicine will be covered by health insurance.
Telemedicine and Major Health Insurance Providers
In general, private health insurance carriers have their own telemedicine reimbursement rules, which can be complicated. Overall, the five big providers— UnitedHealthcare, Cigna, Aetna, Blue Cross Blue Shield, and Humana— all have some form of coverage for telemedicine. Below are examples of how some of these providers provide coverage for telemedicine appointments:
- Anthem: As of October 1st, they have halted waiving copays, coinsurance, and deductibles for virtual appointments not correlated with COVID-19. Now, virtual sessions are $59 for all appointments; however, this cost could be less based on the patients’ plan.
- UnitedHealthcare: Telemedicine appointments for providers that are in-network are covered, but whether out-of-network providers are covered is determined by your plan. Until the national public health emergency period ends, there is no charge for both in and out-of-network COVID-19 testing-related appointments.
- Aetna: For most, telemedicine visits are at the same rate as an in-person visit. Cost-share waivers for specialist telemedicine appointments will end on January 31, 2021, for Aetna Student Health members and Medicare Advantage members.
- Humana: Humana covers telehealth services for all visits where it is medically appropriate to provide the service via telecommunications, the service can be covered by the plan, and coding requirements are meant.
However, to be completely certain of the amount of coverage you will receive with a telemedicine appointment, it would be best for you to reach out to your provider directly and also check your plan’s policies. This is because even though your insurance carrier may say they cover telemedicine visits, your specific plan may not.
Unfortunately, health maintenance organization (HMO) plans have yet to be covered by telemedicine appointments. This is because of the payment structure with the doctors, as it is at a capacitated rate and has no fee-for-service. It would cause your plan to clash with the telemedicine company, and so you could receive telehealth services through a company as opposed to your doctor.
How State Laws Impact Telemedicine Health Insurance Coverage
In addition to major insurance providers, the laws revolving around telemedicine and the state can be difficult to interpret and navigate. In general, all 50 states have some sort of health insurance for telemedicine with live video. However, only 21 states allow for reimbursement for remote patient monitoring, which is a form of telemedicine that enables patients and providers to communicate via the patients’ health data inputs throughout their day.
Additionally, a majority of the states require doctors to be licensed in the clinic site’s state, whereas other states may only require the doctor to have a license in the state in which the patient is located. Thus, even though you and your provider may want to schedule a telemedicine appointment, it may be difficult to do based on your state.
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Medicare and Telemedicine Coverage
Original Medicare does cover most telemedicine appointments, and they do have a detailed list of covered services which can be found here. Typically, Medicare telemedicine regulations tend to be more strict than other providers, and not all Medicare providers end up offering telemedicine services.
Despite this, if you are able to make a telemedicine appointment with a Medicare provider, you will be responsible for 20% of your co-payment. This is because Medicare views telemedicine appointments as regular appointments. Additionally, with a Medicare Advantage plan, you can have an expanded network of telemedicine benefits. The only catch here is that you would need to confirm with your individual plan that telemedicine is covered.
Medicaid and Telemedicine Coverage
Telemedicine appointments are covered by Medicaid. However, the verbiage around the coverage is dependent on the state you reside in.
For example, all states and DC will cover some type of live-video appointment. However, only 26 states and DC provide coverage for remote patient monitoring, 27 states and DC reimburse services in a school-based environment, and 15 states cover audio-only services. Preventative service appointments are also dependent on the state you live in.
If you have Medicaid, in order for your telemedicine appointment to be reimbursed, the reimbursement must comply with federal requirements of efficiency, economy, and quality of care. States have been encouraged to devise payment plans for services that use telecommunications technology. Thus, whether Medicaid covers your telemedicine appointments is again dependent on your state.
Out-of-Pocket Costs for Telemedicine
If you do not have access to health insurance or if your insurance does not cover a service that you want or need, the out-of-pocket cost for telemedicine will vary from company to company.
You may also have to pay for additional healthcare services, such as prescription medications and treatments.
Telemedicine Frequently Asked Questions (FAQs)
Understanding telemedicine and whether or not it is covered by health insurance can be confusing. Thus, in order to have a better understanding check out some of these frequently asked questions regarding telemedicine.
Virtual care for only $5 per visit
Virtual primary care or urgent care visits are only $5. Behavioral health visits are $15.
What is the difference between telemedicine and telehealth?
The terms telemedicine and telehealth are often used interchangeably. However, technically, telemedicine falls under the umbrella of telehealth. This is because telehealth includes all aspects, including non-clinical aspects, of telecommunications including medical records management and patient education programs.
Is the quality of telemedicine the same as an in-person visit?
Through years of research, telemedicine has been found to be as safe, advantageous, and cost-effective as an in-person visit. Sometimes there may be scenarios where a doctor or other medical provider may need to physically see you in person, such as for a gynecologist visit, but for the most part telemedicine visits can be as efficient and worthwhile as an in-person visit.
Does telemedicine have adequate privacy and security?
In short, the answer is yes. Telemedicine is most secure and private though when it is used in an encrypted platform that was specifically designed for that purpose. As long as measures such as these are kept up, telemedicine will be able to continue to thrive.
Between the vast amount of health insurance providers and state regulations, it can be very complicated to determine whether or not your telemedicine appointment will be covered by your health insurance plan. The best way to confirm this though is to check with your provider and your plan’s benefits.
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