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Medicare
During the PHE, individuals with Medicare had broad access to Telehealth services, as a result of waivers facilitated by the Coronavirus Preparedness and Response Supplemental Appropriations Act, 2020, and the Coronavirus Aid, Relief, and Economic Security (CARES) Act.
The Consolidated Appropriations Act, 2023, extended many Telehealth flexibilities through December 31, 2024, such as:
- People with Medicare can access Telehealth services in any geographic area in the United States, rather than only those in rural areas.
- People with Medicare can stay in their homes for Telehealth visits that Medicare pays for rather than traveling to a healthcare facility.
- Certain Telehealth visits can be delivered audio-only (such as a telephone) if someone is unable to use both audio and video, such as a smartphone or computer.
Medicare Advantage plans may offer additional Telehealth benefits. If your health care provider participates in an ACO, check with them to see what Telehealth services may be available.
Medicaid and CHIP
For Medicaid and CHIP, Telehealth flexibilities are not tied to the end of the PHE and have been offered by many state Medicaid programs long before the pandemic. Coverage will ultimately vary by state. CMS encourages states to continue to cover Medicaid and CHIP services when they are delivered via Telehealth.
To assist states with the continuation, adoption, or expansion of Telehealth coverage, CMS has released the State Medicaid & CHIP Telehealth Toolkit and a supplement that identifies for states the policy topics that should be addressed to facilitate widespread adoption of Telehealth: https://www.medicaid.gov/medicaid/benefits/downloads/medicaid-chip-telehealth-toolkit-supplement1.pdf.
Private Health Insurance and Telehealth
As is currently the case during the PHE, coverage for Telehealth and other remote care services will vary by private insurance plan after the end of the PHE. When covered, private insurance may impose cost-sharing, prior authorization, or other forms of medical management on Telehealth and other remote care services.
For additional information on your insurer’s approach to Telehealth, contact your insurer’s customer service number located on the back of your insurance card.
Keep an eye out for later editions of this newsletter that will address prescribing controlled substances via telemedicine and the temporary extension of flexibilities.
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