Will Medicare Cover Telehealth?

Laura, age 72, suffers from Parkinson’s disease, arthritis, and diabetes. On a snowy afternoon, she sits on her bed watching her favorite court television programs. At 3:30 p.m., it’s time for her wellness appointment. Laura turns on her iPad (supplied by her doctor’s office), and sees her physician’s face smiling back at her. The doctor has already received information on Laura’s blood sugar levels, heart rate, and blood pressure via a remote monitoring system that sends the data directly to his office. After chatting for a bit, Laura shows the doctor a mild rash on her arm. Upon evaluating the condition—made possible by high-definition video conferencing equipment—her physician recommends a prescription lotion and transmits a prescription to the local pharmacy. Thirty minutes later, the appointment is over, and Laura hasn’t left her bed.

This scenario may sound like it’s from a futuristic film. But it isn’t –– it’s telehealth, and it’s gaining momentum in health care settings across the world. Telehealth is defined by the industry as “the use of medical information exchanged from one site to another via electronic communications to improve a patient’s clinical health status.” And, it’s more than just a trend — 52% of hospitals already use remote technologies to deliver clinical services.

Telehealth Impacts Seniors and Health Care as a Whole 

For aging adults with mobility and transportation challenges, telehealth can offer a welcome respite from in-person office visits. Frequent doctor’s appointments become less of a strain for seniors and their caregivers, who often must take time off work to accompany their loved one. The early intervention afforded by telehealth also helps prevent unnecessary emergency room visits and hospital readmissions. While this is good news for patients themselves, it also helps ease the burden on America’s health care system by improving efficiency and reducing costs. Additional advantages of telehealth are as follows:

Telehealth includes devices that seniors can wear that send an alert to a health care provider’s cell phone when the system detects a fall. These devices can also monitor heart rate, blood pressure, blood sugar and more, allowing a physician to keep close watch on a patient from a distance and send help if needed.

Even seniors with help from an in-home caregiver might find the whole process of getting to a physician’s office and having an appointment exhausting, especially if they have mobility issues and use walking aides. With telehealth, seniors can conduct an appointment in the comfort of home, no travel necessary.

Along with more time spent with a provider, seniors can avoid long wait times. The average person spends more than 20 minutes in a physician waiting room alone!

Telehealth has become a perfect tool to help physicians monitor chronic health conditions like COPD, heart failure, pacemaker monitoring, diabetes, obesity, and more. Along with remote video consultations for follow-up discussions, new systems allow for remote monitoring and transmission of important information like the patient’s weight, blood sugar and vital signs in real time.

Finally, telehealth has the potential to reduce the costs of senior healthcare, while increasing the quality of care. For example, a recent study indicated that hospital readmissions within one month of discharge cost more than $16 billion every year. Telehealth can reduce readmissions through the use of remote monitoring technology and follow-up video consultations.  

Does Medicare Cover Telehealth? 

At this time, sadly, Medicare does not cover most telehealth services, but it appears that this might be changing. 

Last year, the Centers for Medicare & Medicaid Services (CMS) added seven new payment codes covering additional telehealth services, such as annual wellness visits and psychotherapy. Since then, in an effort to help all Medicare recipients enjoy the benefits of telehealth, organizations such as the American Telemedicine Association continue to actively encourage CMS and Congress to eliminate the arbitrary restrictions that limit coverage.

And Congress is listening. Last week, House and Senate lawmakers introduced a bill that would lay the groundwork to expand Medicare reimbursement for telehealth services. 

The bipartisan Creating Opportunities Now for Necessary and Effective Care Technologies (CONNECT) for Health Act (S.2484) was recently introduced in the Senate. The bill would remove the requirement that to qualify for reimbursement, health services must be provided at a qualified site.

In the past, efforts to expand Medicare reimbursement for telehealth and remote patient monitoring services have failed partly because the Congressional Budget Office has reported that they’ll result in higher spending by facilitating enrollees’ access to health-care services. Supporters believe this legislation is likely to gain widespread support in Congress for its reported savings to the Medicare program. In fact, lawmakers are expected to claim that the major provisions of the bill will save the federal government $1.8 billion over 10 years. We will continue to keep you updated on the status of the bill.

When Aging in Place is no Longer the Best Option  

Most people want to stay in their home for as long as possible, and many are doing so by taking advantage of telehealth and other technologies. However, if you or a loved one cannot live independently and are showing signs that living alone is a strain, it may be time to consider other alternatives.

Whether the outcome is in-home care, assisted living, or nursing home care in the future, it is always wise to plan ahead. Life Care Planning and Medicaid Asset Protection is the process of protecting assets from having to be spent down in connection with entry into assisted living or nursing home care, while also helping ensure that you and your loved ones get the best possible care and maintain the highest possible quality of life. If you haven’t done your own planning yet, please contact us as soon as possible to make an appointment for your consultation: