Since the COVID-19 pandemic, remote telehealth has been a major part of Medicare coverage for many across the state of Nevada. Unfortunately, many Medicare coverage options are starting to return to pre-pandemic levels, which means telehealth may no longer be available to Medicare subscribers. Here’s what you need to know.
Changes in Medicare telehealth options
Without congressional action, pandemic Medicare telehealth flexibilities will expire on March 31, 2025. That means any patients who receive reimbursed telehealth visits from home may lose their ability for remote healthcare options.
This is especially difficult for Medicare subscribers in rural areas or who many not be able to make it to a physical healthcare facility.
While telehealth coverage may be restricted, DEA flexibilities for prescribing controlled substances is expected to continue through the December 2025.
Return of pre-pandemic telehealth restrictions
After March 31, 2025, telehealth restrictions for Medicare members will potentially go back to pre-pandemic levels. That means telehealth is only covered if a patient meets these requirements:
- Physical location requirements – Patients must receive Medicare telehealth services from an approved originating site, which includes physician offices, hospitals, RHCs, FQHCs, SNFs, mental health centers, etc. Only limited home telehealth exceptions apply, such as SUD treatment, mental health, or ESRD home dialysis to name a few.
- Geographic restrictions – Telehealth visits must take place in non-MSA counties or rural HPSAs unless the patient has an exception like SUD treatment, ESRD dialysis, stroke care, etc.
- Modality requirements – All covered telehealth calls must use two-way, interactive audio-video technology. You must be able to see and hear the healthcare provider, and they must be able to see and hear you. The only exception is behavioral/mental health visits, which can be audio-only if necessary.
Unless congress acts, these telehealth restrictions will go into effect for all Medicare subscribers at the end of the month.
What to do if you’re impacted by Medicare telehealth restrictions
If you are a Medicare subscriber, there are a few steps you should take before the telehealth restrictions potentially take effect on March 31, 2025.
The first thing you should do is assess the impact. What will happen for you? If you regularly use telehealth services, it may be a good idea to start researching nearby approved telehealth sites or local hospitals.
Once you identify approved originating sites in your area, reach out to see if you can maintain your telehealth access through their services.
There is a chance that private insurers may follow Medicare’s lead, but there haven’t been any definitive statements so far. It’s a good idea for everyone to assess their options, just in case.
If you or someone you know have questions about telehealth or your Medicare plan, it’s always helpful to talk to an expert. Contact a Medicare advisor at Health Benefits Associates by calling 775-828-1216 today. We’ll discuss your needs and find an option that works best for you.