See Your Doctor at Home: How Medicare Members Benefit from Telemedicine


March 19, 2020

Pandemic or not, seeing your doctor in person isn’t always a good option, especially if you’re in the 65+ crowd. From seasonal flu outbreaks to bad weather, there are lots of reasons why staying in is a safer route than going out — even when you’re sick.

Older adults tend to get sicker with bad viruses. What might be a run-of-the-mill cold to your grandkids could turn into a week-long hospital stay for you.

Fortunately, we live in a high-tech world. You’ve got options for seeing your doctor besides driving to the office and waiting in a crowded room with other sick people.

And thanks to recent government changes due to the coronavirus outbreak, Medicare members can use telehealth to avoid waiting rooms altogether. Whether you’ve got Original Medicare or Medicare Advantage, here’s what you need to know about access to telemedicine.

What is telehealth?

First, a refresher on telehealth services. “Telehealth” or “telemedicine” refers to virtual care that you get from a medical provider. It’s a broad term. Telehealth might mean using:

  • A video conferencing app or program
  • An online patient portal via your computer or phone
  • Text or a chat-based app
  • Any combination of these services either from your own home or in a medical setting

Telehealth services have become popular in recent years, well before a global pandemic made them necessary. From 2014 to 2016, use of telemedicine by Medicare enrollees jumped 57%. People with high blood pressure, diabetes and depression used telehealth services the most.

Many private and commerical plans cover telemedicine. But before the new regulations announced this month, Original Medicare didn’t cover the same level of telehealth services.

To combat the growing threat of COVID-19 for high-risk people, like America’s seniors, the Centers for Medicare and Medicaid Services (CMS) expanded coverage for telemedicine.

Pros and cons of telemedicine

Telemedicine comes with some handy benefits for everyone, specifically:

  • People with mobility issues
  • Those with chronic health problems
  • People living in rural areas without access to specialists

The new Medicare telehealth coverage expansion allows patients to chat with their own doctors via the internet, either through a patient portal (if one exists), a smartphone, a computer or some other platform that a provider agrees to use.

That’s where things get sticky.

Using telemedicine comes with tradeoffs, especially when it comes to security. In a perfect world, you could chat with your doctor via smartphone without any problems. Unfortunately, using a phone to talk about your medical problems invites a security risk.

Telehealth also comes with limits on treatment. Your doctor might be able to assess cold symptoms or tell you whether you need to come in for a COVID-19 test, but other problems require in-person visits.

Rule of thumb?

Telehealth works well for conditions and symptoms that a doctor doesn’t need to touch you for, like minor infections, UTIs, unexplained rashes and mild to moderate respiratory symptoms.

For other things — e.g. trouble breathing or deep wounds — you’ll still need to call your doctor and schedule a physical appointment.

Web-based medical care comes with risks, but it’s a good option if you can’t (or don’t want to) get out in public when you’re ill. And given the current climate, telemedicine could prove especially useful in keeping infection rates low among the most vulnerable groups.

New Medicare guidelines for telehealth

CMS released a fact sheet outlining these expanded telehealth benefits for Original Medicare on March 17.

As for cost, you’ll likely be charged the same for virtual visits as you would if you went to see your doctor in person. Part B services, which is what telehealth falls under, require 20% cost-sharing after you meet the annual deductible.

The new guidelines were created to encourage seniors to stay home as part of a nationwide effort to flatten the curve of the novel coronavirus outbreak.

Telehealth covers more than COVID-19 consults, too. You can use telehealth services for ongoing care, check-ins with your doctor and other reasons as needed. Virtual visits could help keep infection rates down for the most vulnerable groups in the country: adults over age 60 and/or people with compromised immune systems and certain underlying health conditions.

Medicare Advantage and telemedicine

If you have a private Medicare plan, also known as Medicare Advantage, then you may already have telemedicine coverage. In April 2019, CMS finalized a rule that allowed private Medicare plans to include additional telehealth benefits.

Medicare Advantage covers the same benefits as Parts A and B (Original Medicare) together, by law. Because the new guidelines introduced this month allow Part B to cover expanded telehealth benefits, private plans should follow. (Always check with your plan first for details on coverage and out-of-pocket costs.)

Private Medicare plans typically offer a variety of extra benefits, like dental and vision coverage, prescription drugs and more. That’s what separates these plans from Original Medicare.

How to use telehealth

Not sure how to start using telehealth? Check with your doctor, especially if you think you have symptoms of COVID-19. If you have a Medicare Advantage plan, check with your insurance company to learn more about telehealth coverage and cost-sharing.

(Note: Medicare Advantage plans cover testing and treatment for COVID-19 without cost-sharing.)

Health experts are urging people with coronavirus symptoms to call their doctors before coming into an office. Symptoms include cough, fever, fatigue and/or difficulty breathing.

Calling ahead will help keep spread low for your community. If you don’t have a primary care doctor, call your local hospital or emergency room and describe your symptoms. You’ll get instructions for testing from there.

Telemedicine can help you get the care you need without worrying about getting to a doctor’s office. The expanded benefits for Medicare telehealth services are temporary right now, designed to last through the coronavirus pandemic.

But if they work in helping more seniors gain access to care, then they may become a more permanent feature of Part B coverage. In the meantime, don’t hesitate to give telemedicine a try. It could help you — and the people around you — avoid getting sick.