22 Jun What is “Telehealth” & Does Your Insurance Cover it?
What is “Telehealth?”
As the pandemic forced everyone to adapt to social distancing restrictions, more and more Americans are taking advantage of new access to “telehealth” services. Telehealth refers to health care services ranging from check-ups to behavioral therapy delivered remotely, usually online or by phone. For patients especially at-risk for infection, this service is especially helpful.
To meet the increased need for “socially-distanced” care during the COVID-19 pandemic, some larger insurance companies have added coverage for these services. But, with the increased rollout of vaccines and relaxed safety rules, many of these companies are rolling back this coverage starting October 1, 2021.
However, your access to telehealth services depends on your health care providers and your specific insurance coverage. For example, if you’re covered by Medicare, Medicaid, or TRICARE you likely have access to expanded telehealth benefits because of the pandemic. If you need to access telehealth services, talk to your health care providers.
Does private (employer-sponsored and individual) health insurance cover telehealth appointments?
While it depends on your specific plan and insurance company, here are examples of how four or the largest insurance companies handle telehealth coverage.
- All appointments? UnitedHealthcare, Anthem, and Human cover telehealth appointments for all typically-covered medical services.
- UnitedHealthcare: Telehealth appointments with in-network providers are available, but coverage for in and out-of-network telehealth visits “is determined by your plan.” Until the end of the national public emergency period, there is a $0 cost-share for network and out-of-network COVID-19 testing-related telehealth appointments.
- Anthem: Anthem will stop waiving copays, coinsurance, and deductibles for virtual visits not related to Covid-19 on October 1, 2021. After that point, “member’s cost shares will be applied based on the terms of the plan they purchased,” according to an Anthem spokesperson (STAT, 2021). But, members can still use the Sydney Care mobile app to schedule virtual appointments, use text chat sessions, and utilize the COVID-19 symptom checker at home. Virtual sessions are $59 each for all appointments, but potentially less depending on the patient’s plan. Use of the symptom checker is free for all users.
- Aetna: In most cases, telehealth appointments, including behavioral health services, are covered at the same rate as in-person visits. All Medicare Advantage members can access in-network telehealth appointments for any medical service, as well as Teladoc® and MinuteClinic Video Visit and E-Clinic visits. Cost share waivers for specialist telehealth visits expired on January 31, 2021 for all Medicare Advantage and Aetna Student Health members. But, Aetna Group Medicare retiree members may have additional plan coverage.
- Humana: Offering telehealth services for all appointments wherein “it is medically appropriate to furnish the service via telecommunications-based technology, the service is coverable by the plan, and all applicable coding requirements are satisfied” (Humana 2020). Medicare Advantage (MA) member plans treat telehealth services as a basic benefit rather than a supplemental benefit as of January 2021.
Does Medicare cover telehealth appointments?
- All appointments? Yes. Medicare covers telehealth appointments including office visits, psychotherapy, consultations, and preventative health screenings. Click here for the Medicare webpage on telemedicine.
- Preventive services appointments? Yes.
- What Part of Medicare covers their services? Yes, Part B covers telehealth services.
- What are the co-payments for these appointments? The copayments and deductible for these services are the same as in-person services.
- Are there other out-of-pocket costs for these appointments? Standard Part B deductible applies, as well as any other costs associated with in-person appointments.
Does Medicaid cover telehealth appointments?
Yes, but the language surrounding these services depends on your state. States decide whether or not to cover telehealth, what forms of telehealth to cover, and where in the state to cover telehealth, as long as telehealth is delivered by a qualified provider. All states and DC provide coverage for some form of a live-video appointment. 26 Medicaid programs provide reimbursement for remote patient monitoring (RPM), 15 states allow audio-only service delivery, 26 states and DC reimburse services to the home, and 27 states and DC reimburse services in the school-based setting. Learn more here.
- All appointments? It depends on your state. In California, all appointments, including dental services, are covered by Medi-Cal if providing telehealth services is deemed medically appropriate. In Illinois, all appointments are covered if a licensed physician or health care professional is present with the patient throughout the telehealth service. All telepsychiatry appointments typically covered by Medicaid are also covered, except group psychotherapy.
- Preventive services appointments? Depends on the state. In Arizona, California, Illinois, and Georgia, for example, preventive services are covered.
- What are the co-payments for these appointments? Depends on the state. Some states, including Arkansas, Indiana and Massachusetts have laws prohibiting providers from imposing co-payments larger than those paid for in-person services.
- Are there other out-of-pocket costs for these appointments? Depends on the state. Hawaii requires insurers to disclose information on co-payments, deductibles, and co-insurance before issuing policies. States including Arkansas, Indiana, Massachusetts, Mississippi, and New Hampshire have laws restricting insurers from requiring costs exceeding those for similar services rendered in-person.
Do TRICARE & VA Health cover telehealth appointments?
Yes, for medically necessary services including certain office visits, preventative health screenings, telemental health services, and services for End Stage Renal Disease. Learn more here.
- All appointments? Medically necessary services including certain office visits, preventative health screenings, telemental health services, and services for End Stage Renal Disease. Due to the COVID-19 pandemic, audio-only telehealth services are also temporarily covered.
- What are the co-payments for these appointments? Throughout the national health emergency due to the pandemic, co-insurance and co-payments are waived for all covered telemedicine services provided by military or TRICARE providers.
These popular telemedicine apps offer virtual appointments (from office visits to telepsychiatry) for users with and without insurance. With insurance, your visit will likely cost the same as an in-person appointment. Without insurance, apps and websites often charge a flat rate per visit, potentially in addition to a membership fee.
- Sydney Care: Even for users without insurance, each video appointment through Sydney Care costs $59, and each text session costs $19. Depending on the user’s insurer, some portion of the cost may be covered.
- Zocdoc: This app/website has partnered with insurers including Blue Cross Blue Shield and Aetna to connect users to in and out-of-network providers. Booking an appointment through Zocdoc is free, but costs associated with care depend on each user’s insurance and the doctor they speak with.
- Amwell: Before insurance, virtual appointments for non-urgent care cost users $69 or less, and virtual psychiatry services cost up to $200.
- PlushCare: This app/website connects users to their personal team of doctors, charging normal copays and coinsurance for users with accepted health insurance or $99 + a monthly membership fee for other users.
- Teladoc: Teladoc visits vary in price, and can be as low as $0 with insurance for “Everyday Care,” or office visits. Without insurance, Everyday Care visits are $75 per visit.
- Doctor on Demand: Doctor on Demand offers users access to partnered Board Certified Clinicians, and pricing varies depending on the user’s insurance. Without insurance, 15-minute medical consultations cost $75, 25-minute psychology consultations cost $179, and psychiatry consultations cost $299 for an initial 45-minute consultation and $129 per 15-minute follow-up consultation.
For more information, see Triage Cancer Health Insurance Resources at https://TriageCancer.org/HealthInsurance.
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