Congress Boosts Medicare Coverage For Virtual Doctor Visits

This article originally appeared on Forbes by Bruce Japsen.

Access to telehealth services for seniors is poised to take off in coming years thanks to the newly approved federal budget that enables virtual doctor visits for Americans covered by Medicare Advantage plans.

The budget deal signed into law Friday by President Trump includes the so-called CHRONIC Care Act, a rare bipartisan healthcare measure that essentially makes it easier for private Medicare Advantage plans and other entities like accountable care organizations (ACOs) to offer telehealth services.

It could be a huge boon to companies like American Well, MDLive and Teladoc and an array of telehealth startups getting into the business of offering access to physicians and patients via smart phone, tablet or computer. Employers and private insurers are already embracing the trend as a way to make healthcare more convenient and avoid costly and unnecessary trips to the emergency room or a more expensive physician’s office.

“This legislation will improve health outcomes for Medicare patients, especially those who live in rural areas or have to make a big effort to get to the doctor’s office,” U.S. Sen. Brian Schatz, a Hawaii Democrat, who worked with Sen. Roger Wicker, a Mississippi Republican on the telehealth provisions in the legislation said Friday.

Increasingly popular Medicare Advantage plans contract with the federal government to provide extra benefits and services to seniors, such as disease management and nurse help hotlines, with some even providing vision and dental care and wellness programs. With the new legislation, insurers say plans will be allowed to offer additional telehealth benefits in their bids to the government beyond those currently covered under Medicare part B, starting in 2020.

“The solution offers seniors more flexibility and control to get Medicare Advantage plans that are right for them,” America’s Health Insurance Plans said of the budget deal approved by Congress Friday. AHIP represents insurers including WellCare Health Plans, Cigna, Anthem and other Blue Cross and Blue Shield plans.

Currently, just under 35% of Medicare beneficiaries, or about 20 million Americans, are enrolled in MA plans . But Medicare Advantage enrollment is projected to rise to 38 million, or 50% market penetration, by the end of 2025 , L.E.K. Consulting projects.

The passage of the legislation doesn’t quite make it a done deal for telehealth providers, the companies say. It needs the Centers for Medicare & Medicaid Services (CMS), which administers the health insurance program the elderly, to follow through. But telehealth providers say it’s an opportunity for seniors and companies.

“(The) legislation allows, but doesn’t require, CMS to cover and pay for telehealth services,” American Well CEO Dr. Roy Schoenberg said in a statement Friday following passage of the legislation. “The next step would be for CMS and the secretary (of Health and Human Services) to take advantage of this new discretion and to bring telehealth to elderly Americans who, until now, are excluded from its benefits. This is a first step to make healthcare less painful by embracing modern technology.”

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