This article was updated on May 26, 2020
The Centers for Medicare & Medicaid Services (CMS) announced changes to Medicare Advantage (MA) and Part D to provide better coverage and increase access for medicare beneficiaries on May 22.
The new requirements will:
- Increase access to telehealth for seniors in Medicare Advantage plans.
- Expand the types of supplemental benefits available for beneficiaries with an MA plan who have chronic diseases.
- Provide support for more MA options for beneficiaries in rural communities.
- Expand access to MA for patients with End Stage Renal Disease (ESRD).
“CMS’s rapid changes to telehealth are a godsend to patients and providers and allows people to be treated in the safety of their home,” said CMS Administrator Seema Verma. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”
More advantage to Medicare Advantage plans
The ruling encourages Medicare Advantage plans to increase their telehealth benefits and increase plan options for beneficiaries living in rural areas. The CMS is giving MA plans more flexibility to count telehealth providers in certain specialty areas towards meeting CMS network adequacy standards.
Telehealth specialties include:
- Primary Care
- Infectious Diseases
This additional accessibility will encourage plans to enhance their benefits to give beneficiaries access to the latest telehealth technologies and increase plan choices for beneficiaries residing in rural areas, in addition to the steps that the Trump Administration has taken to expand access to telehealth so beneficiaries can get care at home instead of traveling to a healthcare facility.
Due to the upcoming June 1, 2020, MA and Part D bid deadlines for the 2021 plan year, CMS plans to address the remaining proposals for plans later in 2020 for the 2022 plan year.
“We understand that the entire healthcare sector is focused on caring for patients and providing coverage related to coronavirus disease 2019 (COVID-19), and we believe this approach provides plans with adequate time and information to design the best coverage for Medicare beneficiaries,” said CMS.
Trump’s Telehealth Expansion
The Trump Administration has expanded Medicare Telehealth coverage that will enable beneficiaries to receive a wider range of healthcare services from their doctors without having to travel to a healthcare facility. The Trump administration and public-health officials are urging consumers to use telehealth services to receive remote treatment, fill prescriptions, and get medical attention during the new coronavirus pandemic. Beginning on March 6, 2020, Medicare will temporarily pay clinicians to provide telehealth services for beneficiaries residing across the entire country.
Trump administration plan
“The Trump Administration is taking swift and bold action to give patients greater access to care through telehealth during the COVID-19 outbreak,” said Trump’s Medicare and Medicaid Chief, Seema Verma. “These changes allow seniors to communicate with their doctors without having to travel to a healthcare facility so that they can limit risk of exposure and spread of this virus. Clinicians on the frontlines will now have greater flexibility to safely treat our beneficiaries.”
The goal is to keep people with symptoms at home and to practice social distancing if their condition does not warrant more intensive hospital care.
Almost 80 percent of hospitals in the U.S. have some sort of telehealth service.
Telehealth is designed to make doctors and other front-line providers more accessible and to maximize the number of patients they can treat by encouraging patients with unrelated ailments, such as diabetes, to seek care online.
Physicians who are wary of their own health, such as experiencing a cough, slight fever, or other COVID-19-like symptoms can remain helpful via telehealth.
“I am not seeing patients out of caution and I don’t want any patients exposed to coronavirus,” a Mississippi doctor, Dr. Justin Turner said.
Dr. Turner is using Telehealth to treat patients, while he keeps his distance from the office.
“Most of our offices have software where they can see patients. Unfortunately, every patient does not have technology to have access to a computer or iPhone or iPad,” Turner said.
For those patients without access to technology, a simple phone call will do.
How does Telehealth work?
Technology such as email, videoconferencing, video chat services, like Skype and Facetime, and phone calls enable patients to get care remotely. Responses from healthcare professionals can either be provided in real time, for instance via webcam, or by directing individuals’ questions to answers that are already online.
How do I make an appointment/find a remote provider?
Check your provider’s website or check with your health insurer on how to access telehealth services. Be aware that you may experience longer wait times due to the current high demand.
Does Medicare cover telehealth?
Medicare will cover telehealth services and Medicare Advantage plans may waive or reduce cost sharing. Insurance plans may also cover telehealth, if it is provided directly by a doctor or hospital. Copays or other out-of-pocket charges may apply.
For those without Medicare and who pay directly out of pocket for the entire cost of a direct-to-consumer visit, prices may vary $50 to $80 a visit. Also, there may be an annual membership fee.
Can telehealth providers write prescriptions?
Yes, doctors can send prescriptions directly to a local pharmacy via telehealth.
Can telehealth providers treat Coronavirus?
Healthcare providers can not diagnose a Coronavirus infection during a telehealth visit, but they can help to coordinate testing, according to the American Telemedicine Association, offer self-care and quarantine tips, educate patients about when they need to go to a hospital, and more.