Is Telehealth Covered by Insurance?
Key takeaways:
Telehealth is covered by most private health plans. Your specific coverage can differ based on your insurance carrier.
Medicare will continue to cover telehealth services through December 31, 2024. Medicaid also covers telehealth services, but each state sets specific coverage rules.
The cost of telehealth services varies widely depending on the care you need. The GoodRx Telehealth Marketplace offers virtual visits for as low as $15.
Online doctor visits are becoming a more popular option for people who want quality healthcare from the comfort of their own homes. All you need is a smartphone, laptop, or computer, and you can connect to a healthcare provider.
If you’ve never had a virtual visit before, you may have questions about insurance coverage and copays. Here’s what you should know before you schedule an appointment.
How much do telehealth visits typically cost?
The cost of a telehealth visit varies depending on factors such as:
Type of service: The reason for your visit can affect how much you pay. Providers may charge different fees for different types of services or consultations.
Medical specialty: You may pay less for a visit with a primary care provider than you would with a specialist.
Prescriptions: In addition to the cost of the visit itself, consider the cost of any medications you may need. Some telehealth providers charge extra for dispensing medications.
Search and compare options
Without insurance, you can pay as low as $15 for a telehealth visit using the GoodRx Telehealth Marketplace. According to a 2017 study, the average cost of a telehealth visit for a respiratory infection was nearly $80. But an online visit with a psychiatrist can cost close to $280 for the initial consultation.
Telehealth vs. telemedicine
You might have come across the terms telehealth and telemedicine, and there’s a slight difference between the two. Telemedicine is when you receive medical care virtually through the use of technology without having to visit a doctor’s office. Telehealth covers a lot of different things beyond just telemedicine, like scheduling appointments and providing education and training to healthcare providers.
Is telehealth covered by insurance?
Most health insurance plans cover telehealth. During the COVID-19 pandemic, many insurance companies started covering more telehealth services. Your specific coverage may vary depending on your insurance plan and the service you use.
For example, Independence Blue Cross allows members to receive medical care from their homes. Its coverage includes physical therapy, speech therapy, nutritionist visits, and more. Aetna offers coverage for virtual care for minor illnesses like coughs, stomach pain, and infections. You can also get a check-up with a primary care provider, medication refills, or talk with a licensed therapist from your home.
Plans may charge the same copay or coinsurance for both virtual and in-person visits with your healthcare providers. Some plans may have different copays for telehealth services. Others may only cover online visits if you use specific platforms. It’s a good idea to check with your insurance provider to understand the details of your coverage before scheduling an appointment.
Does Medicare cover telehealth?
Generally, you must meet certain requirements for Medicare to pay for telehealth services. But because of the COVID-19 pandemic, Medicare has expanded telehealth coverage to all enrollees.
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This means Medicare will likely pay for various telehealth services. These include provider visits, psychotherapy, and mental health consultations. But keep in mind that you may be responsible for paying your Medicare Part B deductible and 20% coinsurance for these services. Your out-of-pocket cost may vary depending on the type of service you receive.
Medicare will continue to cover telehealth services through December 31, 2024. This extension provides more flexibility if you need to access healthcare services remotely. It also allows you to get care from anywhere in the country. But after this period, you may need to be in an office or at a medical facility located in a rural area to receive telehealth coverage under original Medicare.
Most Medicare Advantage plans cover telehealth services, as well. These plans typically have their own coverage guidelines. Additionally, a Medigap plan will usually cover the portion of the cost of virtual visits that original Medicare does not pay for.
Does Medicaid cover telehealth?
Medicaid covers some telehealth services, but coverage often differs from state to state. Some states may have different rules for telehealth coverage depending on the type of Medicaid program you’re enrolled in. To find out what telehealth services are covered in your state, check with your local Medicaid office or healthcare provider.
Can I see an online doctor without insurance?
Yes. You can see an online healthcare provider even if you don’t have insurance. Many telehealth providers offer virtual medical consultations for a fee. This is regardless of whether you have insurance. In this case, you will be responsible for paying the full cost of the visit out of pocket.
Some providers charge a flat fee for an online consultation or visit. Others may charge fees based on your diagnosis or required testing. Some telehealth providers offer sliding scale fees, which means their fees are based on your income or other financial circumstances.
You may have to pay upfront using a debit or credit card. Or you may be billed later in some cases. This typically depends on the telehealth company you’re using or the healthcare provider’s preferences.
Shop around to save money
You can save on telehealth visits by shopping around and comparing costs. Here are some tips:
Compare prices. Check with your insurance plan to see which providers and services are covered. Also, ask about the provider’s rates, and compare prices across providers. If you don’t have insurance, use the GoodRx Telehealth Marketplace to see affordable options based on your health needs.
Look for discounts. Some providers offer discounts for telehealth visits. Check for available discounts when you schedule your appointment.
Ask about sliding scale fees. With a sliding scale fee, the cost of the visit is adjusted based on your income and ability to pay. This can make a virtual visit more affordable, especially if you’re uninsured.
When should you see a provider in-person?
Seeing a healthcare provider online can be convenient and cost-effective. But it may only be appropriate for some of your health needs. In some instances, an in-person visit may be necessary to diagnose and treat a health condition properly. For example, you will need to see a provider in-person for things like physical exams, bloodwork, and X-rays.
If you’re experiencing severe symptoms such as chest pain or shortness of breath, you should call 911 or go to the nearest emergency room for immediate medical attention.
The bottom line
Many private insurance plans, Medicare, and Medicaid provide coverage for telehealth services. But your benefits may vary. Most virtual visits cost about the same as in-person visits. It’s best to check with your health insurance carrier and provider’s office first to find out what copays and fees apply.
It pays to research, shop around, and compare costs before booking a telehealth visit.
Why trust our experts?
References
Amwell. (n.d.). Online doctor visits, 24/7.
Ashwood, J. S., et al. (2017). Direct-to-consumer telehealth may increase access to care but does not decrease spending. Health Affairs.
Blue Cross Blue Shield. (2020). Opening new doors to care with telehealth.
Centers for Medicare & Medicaid Services. (2020). Medicare telemedicine health care provider fact sheet.
Medicaid.gov. (n.d.). Telehealth.
Medicare.gov. (n.d.). Telehealth.
Telehealth.hhs.gov. (2023). Finding telehealth options. Health Resources & Services Administration.
Telehealth.hhs.gov. (2023). Private insurance coverage for telehealth. Health Resources & Services Administration.
