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CMS to add more telehealth benefits to Medicare Advantage plans

por John R. Fischer, Senior Reporter | April 12, 2019
Health IT Insurance Telemedicine
CMS is adding additional telehealth
benefits to Medicare Advantage plans
The Centers for Medicare & Medicaid Services (CMS) is tacking on additional telehealth benefits to Medicare Advantage plans in a new set of finalized policies.

Patients under these plans will soon have the option of receiving healthcare services at home and in other locations, rather than visiting a healthcare facility.

"Patients in MA plans have always been able to receive broader telehealth services than those in Original Medicare because MA plans could offer telehealth as a supplemental benefit," a CMS spokesperson told HCB News. "Now, with the final rule there is an even greater likelihood that these patients will have expanded access to telehealth services from more providers and in more parts of the country than before because MA plans can finance Part B telehealth services as basic benefits. This will encourage MA plans to offer innovative telehealth benefits to all beneficiaries, without the geographic restrictions and limitations under the Original Medicare telehealth benefit."

The policies leverage new enforcements of power provided to CMS by the Bipartisan Budget Act of 2018, with the benefits set to take effect in the plan year of 2020. Its enactment builds on the 2020 Rate Announcement and Final Call Letter issued this month, which extends the flexibility of Medicare Advantage plans to offer chronically ill patients a broader range of supplemental benefits that are not necessarily health-related and can address social detriments to health.

The implementation of the benefits stems from a number of changes taking place around health insurance. For instance, seniors under original Medicare, as in plans sold and managed by the federal government, were originally only entitled to specific telehealth services if they lived in rural communities. Such plans, as of the beginning of this year, now enable beneficiaries across the country to virtually contact their doctors by phone or video chat, putting them on par with Medicare Advantage beneficiaries, who historically have had greater access to more telehealth services. These services, however, have been deemed part of supplemental benefits, which consumers typically pay for out of their own pockets.

The final rule is expected to change this by making it more likely for plans to offer additional telehealth benefits outside of supplemental benefits, increasing the number of providers available to a patient that offer telehealth services and raising access to such offerings in more parts of the country, in both rural and urban areas. As a result, patients over the next 10 years are expected to save $558 million, primarily due to reduced travel time and mileage to and from providers because telehealth delivery does not require travel.

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