Medicare and Medicaid Coverage for Telemedicine

CMS expands telehealth options for Medicare beneficiaries

Not everyone can make it to the doctor's office for a visit and not every doctor is able to do home visits. There may not always be an appointment available on any given day. There could be transportation issues or it could be physically difficult for someone to make the trip if they have an underlying illness. Thank goodness telemedicine, also known as telehealth, is available to offer services from the comfort of your own home. The Centers for Medicare and Medicaid Services (CMS) are increasing coverage for these services.

A woman having a telemedicine consult with her doctor via computer
verbaska_studio / iStock / Getty Images Plus

What is Telehealth?

Telehealth comes in three varieties.

  • Live conferencing: This is the most common type of telemedicine used today. It is defined as a real-time audio and video consultation between a medical provider and a patient.
  • Remote patient monitoring: This type of telemedicine involves the evaluation of pre-recorded patient information. Examples include evaluation of physiologic measurements like weight, blood pressure, pulse oximetry, and respiratory rate.
  • Store-and-forward: In store-and-forward cases, sessions are recorded and reviewed at a later time by a medical provider. Store-and-forward can be used for patient-doctor visits but is often used for consultations between medicals providers, e.g., a specialist speaking with a primary care physician. Teleradiology is another example, where an imaging study is performed and subsequently analyzed by a licensed radiologist.

Medicare only covers live conferencing. Medicaid, depending on the state, may cover any of the three types of telemedicine.

Medicare Coverage for Telehealth

Medicare has traditionally limited access to telehealth. For people on Original Medicare (Part A and Part B), the service was only available to people if they lived in a qualifying rural area and were requiring medical care via live audio-visual conferencing from one of eight designated locations. Notably, care from home was not covered.

The designated covered locations are:

  • A community mental health center
  • A critical access hospital (CAH)
  • A doctor's office
  • A federally qualified health center
  • A hospital
  • A hospital-based or critical access hospital-based dialysis facility
  • A rural health clinic
  • A skilled nursing facility

Your Part B benefits cover approved telehealth visits. Medicare pays for 80% of the cost, leaving you with a 20% coinsurance.

The Bipartisan Budget Act of 2018 allowed for the expansion of Medicare's covered telehealth services. In 2019, CMS finalized telemedicine policies for Medicare Advantage plans. For one, telestroke services have been expanded to cover both rural and urban locations for evaluation of suspected stroke.

For people who receive dialysis at home, Medicare will now allow telehealth services in the home as long as other criteria are met. These new telehealth visits will be covered only if the person using them also has an in-person visit with their medical provider at least once a month during the first three months of their home dialysis treatment and then at least once every three months.

Remember that you can choose to be covered by Original Medicare or Medicare Advantage but not both.

This legislation has also expanded telehealth services for people on Medicare Advantage (Part C). Up to that time, telemedicine had been limited to a supplemental benefit and was not included in all Medicare Advantage plans included.

These changes will allow these Medicare plans to add the service as part of their basic benefits package. Considering that 24 million people were enrolled in Medicare Advantage in 2020, far more people will now be able to access telehealth when they need it.

Medicaid Coverage for Telehealth

Medicaid has traditionally been more generous when it comes to covering telehealth and telemedicine services.

While each state varies in how it defines the term and what it specifically covers, 50 states and the District of Columbia provide Medicaid reimbursement for some form of the service.

All Medicaid programs cover live conferencing, albeit according to their own rules. For example, New Jersey only covers telepsychiatry for live conferencing. Teledentistry is offered in Arizona, California, Colorado, Georgia, Hawaii, Illinois, Minnesota, Missouri, New York, North Carolina, North Dakota, Ohio, Oregon, Tennessee, Utah, Virginia, and Washington.

Some states have additional requirements based on the type of service received (e.g., an office visit, an in-hospital consultation), the type of provider who performs the service (e.g., a physician, a nurse practitioner, a physician assistant), in what state the medical professional is licensed, what type, if any, prescriptions are allowable, and where the service is provided (e.g., at home or at a medical facility).

Not all states consider teleradiology to be of the store-and-forward type. Excluding teleradiology, as of 2020, only 18 states reimburse store-and-forward through their Medicaid programs.

The states that reimburse store-and-forward include:

  • Alaska
  • Arizona
  • California
  • Georgia
  • Kentucky
  • Maine
  • Maryland
  • Minnesota
  • Missouri
  • Nevada
  • New Mexico
  • New York
  • Oregon
  • Tennessee
  • Texas
  • Virginia
  • Washington
  • West Virginia

Some of these states have limitations on what will be reimbursed. In addition, if they don't reimburse for store-and-forward, they sometimes provide exceptions so it will be covered. For example, while the Medicaid program in Maryland states that it doesn't officially reimburse for store-and-forward, they don't consider technology used in dermatology, ophthalmology, and radiology to fit the definition of store-and-forward.

Remote patient monitoring is covered by Medicaid programs in twenty-one states:

  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • Colorado
  • Illinois
  • Indiana
  • Kansas
  • Louisiana
  • Maine
  • Maryland
  • Minnesota
  • Mississippi
  • Missouri
  • Nebraska
  • New York
  • Oregon
  • Texas
  • Utah
  • Vermont
  • Virginia

Only 10 states cover all three services—live conference, remote patient monitoring, and store and forward. These include:

  • Alaska
  • Arizona
  • Maine
  • Maryland
  • Minnesota
  • Missouri
  • New York
  • Oregon
  • Texas
  • Virginia

Telehealth During the COVID-19 Pandemic

The Centers for Medicare & Medicaid Services (CMS) has responded to the COVID-19 pandemic by expanding telehealth coverage. The goal is to make sure that everyone has access to care, especially when going into the office could increase their risk for exposure to COVID-19. During the national emergency, visits will be covered for all beneficiaries from any location but will still require you to pay a 20% coinsurance.

Before the pandemic, telehealth visits could only be performed via audio-video conferencing. That meant you had to both hear and see your healthcare provider. Unfortunately, not everyone has the broadband access or the technology to be able to use telehealth that way.

During the pandemic, however, CMS allowed visits to be conducted by audio only too. This increased options to more people, so much so that of the 9 million Medicare beneficiaries that used telehealth services by phone from March to May 2020, a third of them did so by phone.

Audio-only services will continue through the national public health emergency. However, Congress is looking to keep the option after the pandemic too. The Permanency for Audio-Only Act was introduced in December 2020. It is unclear if the legislation will pass.

A Word From Verywell

Telehealth has become more popular in the United States, and CMS has taken notice. In fact, they expanded services for Medicare in 2019.

Original Medicare has increased coverage for stroke evaluations and for people on dialysis. Medicare Advantage plans are offering telehealth services as part of their basic benefits package, instead of limiting it to supplemental benefits.

Keep in mind that people on Medicaid may have more telehealth options than those on Medicare depending on where they live.

5 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Summary of Policies in the Calendar Year (CY) 2019 Medicare Physician Fee Schedule (MPFS) Final Rule, Telehealth Originating Site Facility Fee Payment Amount and Telehealth Services List, CT Modifier Reduction List, and Preventive Services List. Centers for Medicare and Medicaid Services.

  2. Freed M, Damico A, Neuman T. A Dozen Facts About Medicare Advantage in 2020. Kaiser Family Foundation.

  3. Center for Connected Health Policy. State Telehealth Laws and Reimbursement Policies.

  4. Verma, S. Early Impact of CMS Expansion of Medicare Telehealth During COVID-19. Health Affairs. doi:10.1377/hblog20200715.454789

  5. H.R.9035 - Permanency for Audio-Only Telehealth Act, 116th Congress, 2nd Session.

Additional Reading

By Tanya Feke, MD
Tanya Feke, MD, is a board-certified family physician, patient advocate and best-selling author of "Medicare Essentials: A Physician Insider Explains the Fine Print."