Medicare expands telemedicine coverage over coronavirus fears

WASHINGTON — Medicare coverage for telemedicine will immediately expand nationwide to help seniors with health problems stay home to avoid the coronavirus, federal health officials said Tuesday.

The new option will allow millions of older people to take care of ongoing medical problems as well as new concerns, while heeding public health advice to stay home during the outbreak.

For example, a patient with diabetes wouldn't have to postpone a regular follow-up visit with the doctor to keep safe — he or she could do it via Skype. And people concerned they may have the virus could “see” their doctor or nurse practitioner virtually to find out how to get tested in person.

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“It helps us prevent the spread of the virus,” said Medicare administrator Seema Verma.

For seniors who don't navigate technology, relatives or friends can assist.

“If it's your mom, you may need to go over to her house to help her do this,” said Verma.

Risk of serious illness from the coronavirus is greater for older people and those with underlying health problems such as lung conditions, diabetes or heart problems. Many Medicare beneficiaries are managing chronic health issues that put them at heightened risk. The telemedicine expansion is geared directly to this vulnerable group.

Current telehealth coverage under traditional Medicare is limited. It's available in rural areas, and patients need to go to specially-designated sites for their visits. Since last year Medicare has also been paying for brief “virtual check-ins.” Tuesday's announcement goes beyond that, allowing clinicians and hospitals to bill Medicare for visits via telemedicine that previously had to take place in person, at a medical office or facility.

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The policy change carries out a waiver of Medicare rules recently authorized by Congress, and set in motion under emergency declarations from the Trump administration. Expanded telemedicine coverage will remain in effect during the outbreak.

Verma said the federal Centers for Medicare and Medicaid Services is also encouraging states to expand the use of telehealth in their Medicaid programs for low-income people. Separately, Medicare Advantage plans offered by private insurers have been allowed to offer telemedicine as a supplemental benefit, like dental coverage or a gym membership, for several years now. The private plans serve about one-third of Medicare's 60 million beneficiaries.

For most people, the coronavirus causes only mild or moderate symptoms, such as fever and cough. For some, especially older adults and people with existing health problems, it can cause more severe illness, including pneumonia. Worldwide, about 185,000 cases have been reported, and while most people recover in weeks, more than 7,300 have died.

Medicare is the government's flagship health insurance program, covering people age 65 and over, as well as younger people who qualify because of a disability. About 40 million people are in traditional Medicare, the government-administered part of the program that was the focus of Tuesday's announcement.

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Doctors' groups and hospitals had been urging Medicare to make the move. Under Tuesday's announcement:

1. Patients and clinicians will need a two-way visual and voice connection that allows real-time interaction. Laptops, tablets and smartphones should work.
2. Hospitals and a range of clinicians, including doctors, nurse practitioners, clinical psychologists, nutrition professionals, and licensed social workers will be able to offer telehealth.
3. Standard Medicare copays and deductibles still apply to telemedicine visits. But there's flexibility. Normally, health care providers such copays for telehealth visits. During the coronavirus emergency, health providers will be allowed to waive or reduce cost-sharing for telehealth visits.
4. Legislation authorizing the waiver required medical offices to have an established relationship with a patient to bill for telehealth services. But Medicare said it will refrain from enforcing that requirement via audits during the coronavirus public health emergency. Verma said that's to allow for circumstances such as a medical practice being forced to close because of the outbreak.

“Providers will be allowed to use everyday technologies to talk to telehealth patients, more telehealth services will be covered ... and providers will be allowed to offer these telehealth benefits to Medicare beneficiaries at a lower cost than traditional services,” Health and Human Services Secretary Alex Azar said in a statement.

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If telemedicine shows its worth in the coronavirus emergency it could lead to permanent changes making it more widely available to seniors.

Telehealth has grown steadily in recent years. Most mid-size or large employers now offer some way to connect patients and health care providers virtually.

But researchers say patients have been relatively slow to try telemedicine, especially if they are used to in-person visits.

The benefits consultant Mercer found that 88% of companies with 500 or more employees offered telemedicine as part of their health benefits last year. But only about 9% of eligible employees used it.