Is Telehealth Covered by Insurance?

Telehealth or telemedicine, in synonymous terms, is a branch under the larger umbrella of digital health. NASA was one of the first organizations to utilize telehealth during the 1960s to monitor astronauts’ health in orbit. Recently, telehealth’s utilization expanded exponentially during the COVID-19 pandemic when the government allowed insurers increased flexibility to offer telehealth. Today, insurance covers many telehealth services. This article explores insurance coverage of telehealth, types of healthcare services provided via telehealth, and future considerations of insurance-covered telehealth.

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Telehealth overview

The World Health Organization (WHO) defines telemedicine as “The use of information and communication technologies to improve patient outcomes by increasing access to care and medical information.” The American Telemedicine Association uses the terms telemedicine and telehealth interchangeably. For this article, we will utilize the term 'telehealth.'

A telehealth visit typically involves remotely communicating with a healthcare provider, whether in your house or a rural medical facility. Many times, a smartphone or computer and an internet connection are all the technology needed for the visit. However, telehealth can also involve activities such as multidisciplinary communication among healthcare providers to coordinate care, at-home monitoring for chronic care management, patient education, and web access to data. Physicians in radiology, psychiatry, and cardiology reported frequently using telemedicine.

Not only can telehealth be more convenient for the user and healthcare provider, but it can also play a part in improving overall patient health and care coordination. For example, patients with congestive heart failure were provided in-home daily monitoring of their blood pressure, weight, heart rate, and pulse. These data points were transmitted securely via the internet to a decision support software monitored by nurses who could then initiate direct communication with patients who might require intervention. The Partners HealthCare 2013 study found a 51% decrease in hospital readmissions over six years utilizing this in-home monitoring program.

Telehealth providers can include physicians, nurses, therapists, dietitians, and other healthcare professionals.

Is telehealth covered by insurance?

Many telehealth services are covered by insurance. However, coverage largely depends on your insurance and state requirements and laws. The Center for Connected Health Policy, The National Telehealth Policy Resource Center, provides telehealth policy updates where you can find current, state-specific information. Their chart breaks down the information regarding Medicaid telehealth reimbursement, private payer law, and professional telehealth requirements per state.

Typically, telehealth visits are charged in the same manner as a face-to-face visit.

Private insurance

Most private insurance companies offer telehealth coverage options. The cost depends on the service type and the healthcare provider you see. For example, an initial consultation might be more expensive than a follow-up, and a visit with a cardiac specialist might be more costly than a primary care consult.

Some insurance companies offer a smartphone app to facilitate telehealth visits, or they may contract with a third-party company to provide them to their members.

Before scheduling a telehealth appointment, check with your insurance plan to determine what is covered and how much you can expect to pay. Telehealth visits are often charged copays or coinsurance like an in-person visit would.

Medicare

Some telehealth services are covered by Medicare Part B. After you’ve met the Part B deductible, you’ll pay 20% of the cost. However, starting in 2025, Medicare will no longer cover telehealth at-home visits. It will cover telehealth visits if you are in an office or a rural area medical facility.

Nonetheless, at-home telehealth will still be covered in 2025 for these conditions:

• Monthly end-stage renal disease
• Treatment for an acute stroke
• Mental health disorder or substance use disorder
• Behavioral health services

It’s important to note that many Medicare Advantage Plans offer more coverage options for telehealth services than Original Medicare. Also, some Medicare-certified providers are members of Accountable Care Organizations (ACO) that provide telehealth coverage for Medicare patients at no additional cost to the patient. The best way to find out is to ask your healthcare provider if they participate in an ACO.

Medicaid

Each state determines Medicaid coverage of telehealth services independently because federal Medicaid law does not specifically address telehealth implementation criteria or delivery methods. Medicaid considers telehealth a delivery method and not a benefit type.

According to Medicaid.gov, states have the flexibility to decide:

• Whether to cover telehealth
• What types of telehealth to cover
• Where in the state it can be covered
• How it is provided/covered
• What types of telehealth practitioners/providers may be covered/reimbursed
• How much to reimburse for telehealth services

Check with your local Medicaid office to find out if telehealth is covered in your area.

What types of healthcare services are available via telehealth?

Telehealth visits can replace office visits, therapy sessions, and common sick visits. The visits can occur via video chat or audio only using your phone.

The Health Resources and Services Administration (HRSA) suggests six uses for telehealth visits:

1. Check-ups and wellness visits for reviewing lab work and managing medications
2. Prenatal and postpartum care for lactation services and birth control counseling
3. Urgent care consult for common illnesses like sinus infection, back pain, and rashes
4. Chronic care disease management for ongoing diseases like diabetes, asthma, or kidney disease and nutritional counseling
5. Mental and behavioral healthcare for substance use treatment services and managing stress and anxiety; receiving counseling
6. Follow-up visits for check-in after a procedure, surgery, or treatment

In-person appointments may be more appropriate for conditions requiring a physical exam or testing. Deciding whether a telehealth appointment vs. in-person care is more appropriate can depend on accessibility, the kind of care needed, and personal preference.

What kinds of virtual therapy are covered by insurance?

Telehealth increases access to all types of therapy, including mental health and counseling or rehabilitation therapy like physical, occupational, or speech therapy. Research suggests virtual therapy can have equivalent or better outcomes than in-person treatment. Telehealth and its impact on therapy have been very positive.

Teletherapy typically refers to mental health therapy. Virtual therapy visits can include consultations, counseling, and sessions. Many insurance plans offer mental health benefits, which can be applied to most teletherapy costs. According to a KFF survey, over half of all therapy visits conducted in 2021 were via telehealth.

Contact your insurance company to learn about specifics on teletherapy coverage. One of the best ways to find an online therapist covered by your insurance is to utilize your company’s online provider locator. Psychology Today also offers a search feature to locate an online therapist who may be in network with your insurance plan.

Rehabilitation therapies like physical therapy, occupational, and speech can also occur virtually and may be covered by insurance.

Tips for maximizing insurance-covered telehealth visits

Preparing for your telehealth appointment can help you maximize your time. Write down your questions beforehand, take a photo or video of anything you’d like to share with the provider to send before the visit, find a quiet spot, and test your audio and video before the visit.

What is the future of telehealth visits?

With daily technological advancements, we can expect to see continued growth and usage of telehealth. It is a frequent legislative topic. The Health Resources and Services Administration established the Office for the Advancement of Telehealth with the goal of providing telehealth access for all. As more laws are passed standardizing telehealth usage and reimbursement, we can expect to see adoption grow by users, healthcare providers, and insurance models.

Many broadband programs continue to support individuals in underserved communities who need broadband internet access. The goal of these programs is to enable low-income households to pay for internet access so they can utilize telehealth services. An example is the Lifeline program, which offers discounted internet services.

However, Medicare’s telehealth expansion coverage ends at the end of 2024 with the conclusion of The Consolidated Appropriations Act. In 2025, Medicare will require most individuals to receive telehealth coverage in an office or rural area medical facility instead of their home. The Centers for Medicare and Medicaid Services states that there is no impact on private insurance companies regarding their coverage of telehealth. Each company can determine telehealth coverage independently.