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Open Enrollment 2020: Make Sure Your Insurance Covers Telehealth

Check your plan before open enrollment ends

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The coronavirus pandemic has changed aspects of daily life for many Americans, including what their office looks like, how their children go to school and how patients see their doctors. Availability of and demand for “telehealth”  digital healthcare services have rapidly increased across the country in order to protect both patients and medical staff from COVID-19. 

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Though Medicare, Medicaid and many private health insurance providers have expanded their coverage of telehealth services in response to the pandemic, your current policy might not have the flexibility to meet your needs — or these provisions might be temporary. With open enrollment for 2020 approaching, now is the time to make sure your insurance plan covers telehealth services for you and your family.

One of the biggest components of telehealth is “telemedicine,” which means using technologies and telecommunication systems to administer healthcare to patients. Whether or not your insurance covers telemedicine is based on federal and state laws as well as insurance company policies.

In March 2020, the Centers for Medicare & Medicaid Services (CMS) broadened access to Medicare telehealth on a temporary and emergency basis. Medicare currently covers visits, virtual check-ins and e-visits over video or audio from all service providers that are eligible to bill Medicare regardless of geographic restrictions.

Every state Medicaid program offers some type of telemedicine coverage, including reimbursements for live video doctor’s appointments. However, only 23 state Medicaid programs provide reimbursement for remote patient monitoring (RPM), and just 16 states provide reimbursement for store-and-forward services, both potentially critical components of a patient’s telemedicine care.

If you have a private insurance plan, the “big five” insurance carriers — BCBS, United Healthcare, Signa, Aetna and Humana — all offer some form of coverage for telehealth services. However, telehealth coverage still depends on your particular plan. 

Ultimately, the best course of action is to call your insurance provider and ask if your policy covers telehealth services, how they define telehealth services and if there are any specific restrictions around reimbursements for telehealth services that you need to be aware of. For example, you may need special documentation from your doctor.

Related

Making sure your insurance covers your telemedicine needs is just the first step to having a successful virtual doctor’s appointment. Here’s what to expect once you’ve scheduled your first virtual doctor’s visit.