Medicare Sees Increased Use Under Extended Telehealth Coverage

Medicare beneficiaries are using telehealth more often due to extended coverage and access measures introduced during the COVID-19 pandemic, according to a Kaiser Family Foundation brief. And making these measures permanent could further benefit members and influence other payers to follow the same strategy.

Prior to the pandemic, Medicare only covered telehealth services for members living in rural areas, with restrictions on where members could receive services and which providers could deliver them. The Centers for Medicare and Medicaid Services expanded coverage in early 2020 to address the pandemic, and renewed the extension in April 2021, to allow members to access healthcare services while avoiding in-person contact. 

For its study, KFF collected telehealth use data from Medicare beneficiaries between summer and fall of 2020. Kaiser researchers noted the increase in use among members, as well as the populations who used telehealth more frequently during the COVID-19 emergency.

Of the Medicare members with an established source of care, almost two-thirds (64 percent) reported that their provider offered telehealth appointments. Before the pandemic, only 18 percent of members could say that. Some beneficiaries reported that they did not know if their provider offered telehealth services, including almost one-third (30 percent) of members living in rural areas. 

More than a quarter (27 percent) of Medicare and Medicare Advantage beneficiaries had a telehealth visit with a healthcare professional, according to the survey, which equals 15 million people who used telehealth during the pandemic. Of the members whose established providers offered telehealth, almost half (45 percent) had a telehealth visit. 

Telehealth use was higher among beneficiaries under 65 who qualify for Medicare due to a long-term disability, dual eligible beneficiaries, Black and Hispanic beneficiaries, and beneficiaries with six or more chronic conditions, with more than 50 percent of each group reporting using telehealth.

The study also offered evidence supporting continued coverage for audio-only telehealth services, which have been popular during the pandemic. 

More than half (56 percent) of Medicare beneficiaries who used telehealth reported using a telephone for their visit. Of those, 65 percent were 75 or older, 61 percent were Hispanic, 65 percent lived in rural areas and 67 percent were dual eligible enrollees. 

Audio-only telephone visits are permitted during the public health emergency but will be dropped from coverage once the PHE ends. KFF research indicates that permanent coverage of audio-only telehealth could benefit older beneficiaries, people of color and, beneficiaries living in rural areas, especially since less than half of Black and Hispanic beneficiaries (42 and 34 percent) own a computer.

Under Medicare’s emergency extensions of telehealth coverage, healthcare professionals can provide and get reimbursement for telehealth services; prior to the pandemic, that coverage was limited to telehealth services for patients who’ve been meeting with the provider for at least three years. 

CMS has also extended telehealth services to rural health clinics and federally qualified health centers, locations not covered under pre-COVID-19 rules.

CMS has increased telehealth reimbursement rates during the pandemic as well, in some cases offering payment parity - a factor that, if extended, could pull more providers onto the platform. Reimbursement has long been a challenge to telehealth adoption, with providers saying they aren’t being paid enough to try new platforms and payers arguing that they should be able to negotiate their own rates with care providers.

Medicare Advantage plans are more telehealth-friendly, with 98 percent covering connected health services to members even before the pandemic.

Still, the path to increased or even permanent coverage is uneven.

In May 2021, the Government Accountability Office told Congress to hold off on expanding Medicare telehealth coverage past the public health emergency, citing concerns about spending, program integrity, patient health and safety, and equity. The GAO is asking for more evidence showing that telehealth services are cost-effective and produce positive health outcomes for Medicare beneficiaries. 

The results from the KFF brief show the impact that expanded telehealth coverage has had on members and how these outcomes could help influence Medicare and other payers’ decisions about telehealth coverage going forward.