Telehealth has been an efficient way to provide certain kinds of health care services for many people on Medicare – providing easier access to healthcare for patients and better use of time for providers ever since the pandemic.
That’s now changed, and Medicare has largely ended telehealth in certain areas, with new geographic restrictions that affect how and where (and sometimes whether) Medicare members get their care via telehealth.
The expansion of telehealth during the pandemic showed remarkable improvements in access to care as documented in a Kaiser Family Foundation report. Before the pandemic, Medicare’s telehealth coverage was limited. Only patients in rural areas or specific settings had access, and visits had to be conducted via real-time audiovisual technology.
The public health emergency lifted those barriers, letting Medicare members use telehealth for a broad range of services, including behavioral health, chronic disease management, and primary care visits.
A study published in Health Affairs highlighted how these changes improved care access for members who had struggled to see their doctors regularly. Older adults, those living in rural & underserved areas, and patients managing multiple chronic conditions helped the most.
Geographic Restrictions & Behavioral Health Services
On October 1 the geographic and other limitations on Medicare telehealth came back. Telehealth services (for Medicare members) are now limited to rural areas unless members receive specific services, like monthly visits for home dialysis or certain mental health treatments.
This means that telehealth services will generally be limited to rural areas, and patients will need to receive services at specific originating sites, such as medical facilities, rather than from their homes.
Medicare Telehealth Flexibilities and CMS Operations During Government Shutdown – ASCO
Note: there are still some exceptions to the geography rules for behavioral and mental health services. These services can still be provided via telehealth to Medicare beneficiaries in both rural and urban areas and patients can receive these services in their homes
Traditional Medicare will still cover telehealth services for some mental and behavioral health care, some substance use disorder treatment, end stage kidney disease assessments and emergency stroke care even in urban areas.
Traditional Medicare will no longer cover telehealth services for routine primary care visits, chronic disease management (e.g. diabetes care, heart disease, arthritis etc.), or follow up visits.
So, if you’re a traditional Medicare member in the Phoenix or Tucson metro areas and require telehealth for general care, chronic disease management, specialist consultations or most follow-up services, you’ll likely need to visit a healthcare facility in person now. Don’t blame your doctor, their staff or your health insurance. You can blame congress and the president.
- The Future of Telehealth in Medicare: Why Congress Needs to Act to Preserve Access & Improve Care
- Medicare telehealth coverage expiring, impact on Arizona patients
- Medicare telehealth coverage expiring, impact on Arizona patients – Arizona PBS
Medicare Advantage Plans May Offer More Flexibility
Medicare Advantage plans sometimes offer more flexibility when it comes to telehealth. These private plans sometimes have broader coverage options and may not be as restricted by geographic limitations. If you’re enrolled in a Medicare Advantage plan, check with your plan provider to understand the specific telehealth benefits and flexibility.
What Could Have Been
It didn’t have to be this way. The bipartisan CONNECT for Health Act offered a comprehensive and efficient solution. This bill proposed permanent expansions of telehealth in Medicare (including the removal of geographic site requirements that restrict telehealth to rural areas) and drops in-person visit rules for behavioral health.
Importantly, it also included measures to reduce potential fraud and abuse, something sorely needed to prevent fraud and make telehealth services sustainable over time. Those measures include setting stricter guidelines for billing and ensuring better auditing of services.
The CONNECT Act also addresses concerns about overuse of telehealth by focusing on finding high-value services that are proper for virtual care.
Sadly, it appears that Congress will wait until they hear from mad constituents before they take up the CONNECT Act – or when Congress finally makes a budget deal, maybe they’ll extend the added telehealth flexibility that proved so useful during the pandemic.
