Telehealth expansion for Medicare enrollees would be extended under a bill poised for possible House vote

As many Medicare beneficiaries know, having a doctor’s appointment via video on a laptop or tablet became standard when the pandemic hit.

That method of delivering remote care — known as telehealth — to many retirees and most people in the over-65 crowd may have some staying power, at least for now.

House lawmakers are scheduled to vote on a bill this week — possibly as early as Wednesday — aimed at extending, until the end of 2024, pandemic-related rule flexibilities that enabled broad use of telehealth in Medicare. Roughly 55.8 million of the program’s 64.3 million beneficiaries are age 65 or older and the remaining 8 million are younger with permanent disabilities, according to government data. 

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“I think moving forward there is going to be an ongoing need that will need to be met by ongoing flexibility,” said Juliette Cubanski, deputy director of the Medicare policy program for the Kaiser Family Foundation.

The extension will give experts “time to review data on utilization and learn more about the appropriate uses of telehealth and the maybe not-so-appropriate uses,” Cubanski said. “It gives everybody an opportunity to dig a little deeper.”

If the bill were to clear the House, it would still need approval from the Senate, as well. Meanwhile, efforts to advance proposals that would make the telehealth changes permanent have stalled.

In March 2020, as communities worked to stem the spread of the coronavirus through temporary business shutdowns and stay-at-home orders, lawmakers and regulators loosened policies to make remote health care through Medicare more broadly available during the pandemic. 

Prior to that, telehealth already was on a slow path toward broader usage within Medicare. However, it was generally limited to rural areas, with restrictions on where the remote visit could take place and which providers were allowed to offer such care.

During the pandemic-related public health emergency, beneficiaries can be in their own home, and the menu of services and providers that qualify is greatly expanded, ranging from emergency department visits to group psychotherapy to radiation treatment management.

The temporarily more loose guidelines, however, are scheduled to expire five months after the public emergency ends. That declaration, which was last extended in July, will expire Oct. 14 unless the Biden administration extends it again. 

“If it ends in October, these telehealth flexibilities would come to an end in March,” Cubanski said.

The president is expected to provide a 60-day warning — by mid-August — if he plans to allow the emergency to lapse.

It’s also worth noting that late last year, Congress approved some permanent changes to telehealth usage for mental health services under Medicare, including removing geographical restrictions and allowing beneficiaries to receive that care at home via video or, in certain cases, on the phone, with certain limitations.

A temporary reprieve related to in-person visits for such care would be extended under the bill that the House is scheduled to vote on this week.

During the first 12 months of the pandemic (March 2020 through February 2021), more than 28 million Medicare beneficiaries used telehealth services, according to research from the Kaiser Family Foundation. This included 38% of beneficiaries in traditional Medicare (Part A hospital insurance and Part B outpatient care coverage) and 49% of Medicare Advantage Plan (Part C) enrollees.

The cost for a remote appointment — whether video or audio — depends on the specifics of beneficiaries’ coverage. While providers and insurance plans may have waived or reduced cost-sharing (i.e., copays or coinsurance) for those not-in-person sessions earlier in the pandemic, they might have resumed charging you as if it were an in-person visit. 

Telehealth appointments generally are delivered through Part B. If you are on traditional Medicare with no additional insurance, Part B comes with a $233 deductible in 2022 and then you generally cover 20% of the cost of services. And of course, that’s on top of a standard monthly Part B premium of $170.10 (for 2022).

If you have supplemental coverage through a so-called Medigap policy, the 20% coinsurance is covered either fully or partly, although the Part B deductible probably is not, especially if it’s a newer policy.

For beneficiaries who choose to get their Parts A and B benefits through a Medicare Advantage Plan (Part C), the cost for telehealth appointments depends on the specifics of your plan. This year, 95% of Advantage Plans are offering telehealth benefits, according to the Better Medicare Alliance.