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Medicare Advantage and Telehealth

writtenByWritten by: Tessa Chatham Registered Nurse
Tessa Chatham Registered Nurse

Tessa Chatham Registered Nurse

Tessa is a MSN prepared Registered Nurse with 10 years of critical care experience in healthcare. When not practicing clinical nursing, she enjoys academic writing and is passionate about helping those affected by medical aliments live healthy lives.

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reviewBy Reviewed by: Ken Cosby M.D.
Reviewer

Ken Cosby M.D.

Dr. Ken Cosby received his medical degree from Howard University College of Medicine (Washington, DC) and completed his research post-doc work at Johns Hopkins University School of Medicine and the National Institutes of Health including the National Heart Lung Blood Institute and the National Cancer Institute.

July 6, 2021 Read Time - 5 minutes

What is Telehealth?

Telehealth or telemedicine has become more popular over the past year. The Coronavirus Preparedness and Response Supplemental Appropriations Act waived certain Medicare telemedicine requirements during the public health emergency and was signed into law in March 2020. This Act resulted in services being altered that ultimately benefited those who got Medicare services.

Telehealth services were once reserved for those living in rural areas and were unable to visit the doctor due to physical distance. Now that all Medicare beneficiaries are approved to get telehealth services, more and more people are using telemedicine to resolve their medical problems.

Telehealth works by allowing beneficiaries the opportunity to have telemedicine visits at home. Prior to the pandemic, they had to live in a rural area and obtain services at a hospital, clinic, or another medical facility. The pandemic shed light on the inherent need for more telehealth services. Telehealth bridges the gap to many healthcare disparities for those who receive Medicare coverage.

  • Book on our free mobile app or website.

    Our doctors operate in all 50 states and same day appointments are available every 15 minutes.

  • See a doctor, get treatment and a prescription at your local pharmacy.

  • Use your health insurance just like you normally would to see your doctor.

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What Is Medicare Advantage

Medicare Advantage is a type of Medicare used and is a type of health insurance plan in the United States that provides Medicare benefits through a private-sector health insurer. Medicare Advantage (MA), also referred to as Medicare Part C, offers insurance plans to beneficiaries. Medicare Advantage insurers have fixed networks of doctors and hospitals. 

Each Medicare Advantage plan will have rules about coverage; however, Medicare Advantage plans offer telehealth services to all beneficiaries.

Medicare Advantage and Telehealth

Many health plans are waiving cost-sharing for Medicare Advantage (MA) beneficiaries. For example, Aetna is waiving out-of-pocket costs for in-network primary care and specialist telemedicine visits for individual and group MA plan members. Cigna is waiving copays, deductibles, and coinsurance for in-network medical or behavioral telemedicine visits for MA beneficiaries.

Does Medicare Advantage Cover Telehealth?

Yes, similar to original Medicare coverage (part A and part B), Medicare Advantage covers telehealth visits. More than half of Medicare Advantage (MA) plans now offer telemedicine services as part of the primary benefit. 

Does the Original Medicare Cover Telehealth?

Yes, original medicare covers telehealth. This includes Medicare parts A and B. Interestingly, Medicare Advantage plans may offer more telemedicine services than original Medicare.

You may be wondering, am I eligible for telehealth? The answer is yes, you are eligible for telehealth if you have any form of medicare. 

Medicare Advantage Telehealth Virtual Check-Ins

One big Medicare Advantage telehealth service which is offered is virtual check-ins. You can have a “virtual check-in,” in which you communicate briefly with an online doctor, nurse practitioner, or physician assistant through:

  • Patient portal
  • Email
  • Video
  • Secure text messaging
  • Phone

Virtual check-ins or “e-visits” are covered by Medicare Advantage, which are beneficial because these visits are often done to determine whether patients need an in-person office visit or if the issue can be managed using telemedicine. This overall cuts costs to the insurer and provides an easier method for the patient to communicate with the healthcare provider. 

Medicare Advantage covers the cost of e-visits. You can communicate with a variety of healthcare professionals such as your:

  • Doctor 
  • Nurse
  • Nurse practitioner
  • Social worker
  • Physical therapist

The virtual check-in online patient portal is convenient, safe, effective, and affordable, which is why so many Medicare Advantage beneficiaries have taken advantage of this system. 

Telehealth and virtual check-ins for Medicare Advantage beneficiaries have improved access to healthcare, reduced healthcare costs, and increased the quality of healthcare and overall patient satisfaction.

Medicare Telehealth Cost

Medicare offers coverage for most telehealth services. Typically, patients pay 20 percent of the Medicare-approved amount for these services. In addition, for those with original Medicare, the Part B deductible applies to telehealth costs. However, due to the Families First Coronavirus Response Act, the Centers for Medicare and Medicaid Services (CMMS) is allowing health care providers to waive cost-sharing for telemedicine visits at this time for some services. 

In addition, the Office of the Inspector General is allowing doctors to waive the 20 percent copay for telemedicine visits. This is great news for those with Medicare Advantage. With telehealth visits charging little to no out-of-pocket costs, virtual doctor visits are a good option for those who wish to receive care from the comfort of their home. 

How Much Does a Medicare Telehealth Visit Cost?

The following are some quick facts about Medicare Advantage and Telehealth Costs:

  • You pay nothing for Medical Advantage well visits.
  • Medicare Advantage covers certain screenings, services, and programs that aid in the treatment and recovery of mental health and substance use disorders.
  • Medicare Advantage plan members can receive telehealth services from specialists in fields such as dermatology, psychiatry, cardiology, ophthalmology, nephrology, gynecology, endocrinology, infectious disease, otolaryngology, neurology, and allergy and immunology.
  • Book on our free mobile app or website.

    Our doctors operate in all 50 states and same day appointments are available every 15 minutes.

  • See a doctor, get treatment and a prescription at your local pharmacy.

  • Use your health insurance just like you normally would to see your doctor.

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Medicare Virtual Doctor Visits

Telehealth appointments work by using a smartphone device, computer, or tablet. Telehealth virtual appointments will remind you of similar video conferencing services you are familiar with, such as FaceTime or Skype.

How to Get a Medicare Telehealth Appointment

In order to get a Medicare telehealth appointment, request an appointment here. At PlushCare, you can talk to a board-certified doctor from your phone or computer with convenience and ease. At PlushCare, we treat and prescribe 24/7. 

If you have Medicare or Medicare Advantage and would like to try a telehealth virtual visit, book an appointment today and speak with a PlushCare doctor. Virtual doctor visits are more convenient, reduce the wait times, are more engaging, and are perceived as a very positive experience. Click here to try a virtual visit today.


Read More About Medicare Advantage and Telehealth


Sources:

PlushCare is dedicated to providing you with accurate and trustworthy health information.

Center for Medicare and Medicaid Services. (2021). E-Visits. Accessed on May 23, 2021 from E-Visits Coverage (medicare.gov) 

Center for Medicare and Medicaid Services. (2021). Medicare telemedicine health care provider fact sheet. Accessed on May 23, 2021 from https://www.cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet 

Center for Medicare and Medicaid Services. (2021). Telehealth. Accessed on May 23, 2021 from Telehealth Insurance Coverage (medicare.gov)

Most PlushCare articles are reviewed by M.D.s, Ph.Ds, N.P.s, nutritionists and other healthcare professionals. Click here to learn more and meet some of the professionals behind our blog. The PlushCare blog, or any linked materials are not intended and should not be construed as medical advice, nor is the information a substitute for professional medical expertise or treatment. For more information click here.

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