Does Medicare Cover E-Visits?

Medicare Benefits Solutions
Apr 20, 2021

Telehealth, often referred to as virtual healthcare or e-visits, is the marriage of technology and medicine that allows individuals and healthcare providers the ability to address medical concerns using the Internet, without the need for in-person care. As technology has evolved, the telehealth industry has grown to include virtual doctor visits.

Advantages of Telehealth

Telehealth has a number of advantages over traditional medicine in certain circumstances. Because virtual visits take place online and from the comfort of the patient’s home, scheduling tends to be more flexible. Patients who are in poor health or who have a health concern that may be contagious can also receive healthcare virtually without the risk of furthering an ongoing health issue or spreading a health concern to others.

Telehealth also tends to be less expensive compared to traditional healthcare. Care providers often can treat more patients per day and have less overhead when providing telehealth services, lowering the cost passed on to patients and insurance providers.

Does Medicare Cover Virtual E-visits?

In most cases, Medicare provides coverage for e-visits through Medicare Part B. This is the outpatient benefit and usually covers in-person care on an outpatient basis. Because e-visits are similar to traditional doctor visits, the same regulations apply to coverage, including the care specialist needs to be a Medicare-participating provider and the services rendered being covered under Medicare insurance.

Is There a Limit to Medicare’s E-visit Coverage?

Medicare coverage doesn’t place a limit on the amount of e-visits recipients can receive, but visits may be restricted based on Medicare’s rules regarding the amount of certain services recipients can receive annually. For example, your plan may place a limit on the number of counseling sessions available within a 12-month period. Even if these sessions take place virtually, the restrictions will likely still apply. To learn more, you will need to consult your plan materials or speak with your plan provider as each plan is unique.

Telehealth and Inpatient Care

Although you might not think about virtual care being used in an inpatient setting, many hospitals and skilled nursing facilities are turning to technology to provide inpatient care virtually. This allows specialists who may be located in another city or state to evaluate a patient based on medical records, test results and virtual consultations without the need for being physically present at the facility. This can also give patients access to a wider network of specialists and potentially deliver faster treatment without the need to wait for a physician or specialist to travel.

Does Medicare Advantage Cover E-visits?

Medicare Advantage plans have to provide the same minimum level of coverage as Original Medicare, and this means that e-visits should be covered under Medicare Advantage in the same way they are covered by Original Medicare coverage. The difference, however, is that Medicare Advantage plans often provide additional benefits outside of those required by Original Medicare. As such, Medicare Advantage recipients may be able to receive telehealth services from a wider range of providers for a wider range of medical concerns.

Recipients of Medicare Advantage plans may also be able to receive services, including virtual doctor visits with specialists, more frequently compared to Original Medicare, and it may be possible to receive discounts on non-covered telehealth services. Each plan is different, and each provider sets its own rules, so contact your plan manager to learn more details about what is available to you.