Medicare coverage of telemedicine limited

Patricia Hafermann • Benefit Specialist

As technology advances, the way we receive our health care changes.

Telemedicine allows consumers to receive physician services remotely. These services are received through video conference and feature real-time audio and video.

The Kaiser Health News article Medicare Slow To Adopt Telemedicine Due To Cost Concerns states that “[n]early 20 years after such videoconferencing technology has been available for health services, fewer than 1 percent of Medicare beneficiaries use it.”

The article continues by noting that in 2012, Medicare spent $5 million on telemedicine, which is “barely a blip compared with the program’s total spending of $466 billion.”

Medicare covers telemedicine in limited situations.

• First, to be covered, a beneficiary must have Medicare Part B.

• Second, the beneficiary must live in a rural area.

• Third, during the video conference, the beneficiary must be physically present in a doctor’s office, hospital, critical access hospital, rural health clinic, federally-qualified health center, hospital-based dialysis facility, skilled nursing facility, or a community mental health center.

The standard 20 percent copay applies.

Supporters of telemedicine argue it can help seniors keep follow-up appointments. In particular, supporters say that telemedicine can help alleviate seniors’ transportation problems.

Robert Wergin, president of the American Academy of Family Physicians, stated that “such technology can help patients who are disabled or don’t have easy transportation to the doctor’s office.”

Opponents of telemedicine believe that it will encourage beneficiaries to overuse physician services. They fear that overuse of services will be very costly for the Medicare program.

If you have any additional questions, you may call Pat Hafermann, Elderly Benefits Specialist with the Aging and Disability Resource Center at (920) 467-4076.

Sources: Published with permission from the Legal Services Team at the Greater Wisconsin Agency on Aging Resources’ Elder Law & Advocacy Center.

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