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Medicare Telemedicine & Mental Health

Medicare has been a hot topic lately: the H.R. 3 bill, which would allow Medicare to negotiate prescription drug prices, is currently in the Senate waiting to be passed, and talks surrounding expanding coverage to more older Americans continue on both sides. Not only that, but there have also been changes to Medicare brought on by the coronavirus pandemic, including the expansion of access to telemedicine. New guidance was recently issued by Congress and the Center for Medicare and Medicaid Services (CMS) on the delivery of psychology care services through the use of telemedicine, allowing psychologists to treat seniors through audio-only calls. But there are now new restrictions to mental health services provided through telemedicine that Medicare beneficiaries need to be aware of.

Background: The Coronavirus Preparedness & Response Supplemental Appropriations Act 2020

Under the Coronavirus Preparedness and Response Supplemental Appropriations Act of 2020, which went into effect on April 30, 2020, CMS is now waiving telehealth requirements for Medicare beneficiaries in order to make it easier for them to access mental health services. Psychologists can now provide many of their typical services through audio-only calls, and can:

Provide telemedicine services from their home.
Provide services to new and established Medicare patients.
Offer Medicare patients telemedicine services in their homes.

In addition, telehealth services are now reimbursed for the same dollar amount as in-person visits.

The New Restrictions

a man with his hands on his head sitting across from a man in a suit with his hand on his chin — *Medicare beneficiaries will now have to see a psychologist in person first before getting telemedicine coverage for mental health services.*

While this step towards greater access to mental health care through telehealth has been good news for Medicare beneficiaries, there is now a new restriction on reimbursement for these services that threatens to put patients back to where they started. The Consolidated Appropriations Act of 2021 states that “Payment may not be made…for telehealth services furnished by a physician or practitioner to an eligible telehealth individual for purposes of diagnosis, evaluation, or treatment of a mental health disorder unless such physician or practitioner furnishes an item or service in-person, without the use of telehealth…” within the 6-month period prior to the first time the telehealth services are furnished.

In other words, under this new Act, a Medicare patient must first have an in-person examination before they can seek mental health services through telehealth. This is a change from previous laws surrounding telehealth, which in most states allowed doctor-patient relationships to be created through telemedicine without an in-person examination.

The coronavirus pandemic paved the way for telemedicine to become a more popular and widely used way to get medical care, including mental health care. Most government action surrounding telehealth has moved in the direction of expanding access to it, but unfortunately this new restriction is a step backwards, and will mean that Medicare patients will now need to see a doctor in-person before using telemedicine to get mental health care.

It is unclear what the next step is going to be for telemedicine and mental health care, but if you are a Medicare beneficiary in need of mental health services, remember that they are still covered: Medicare Part B covers mental health services, as well as counseling services, and if you need help covering the 20% coinsurance that Medicare Part B does not cover, a Medicare Supplement Plan can help. If you are curious, or want to compare Medicare Supplement Plans in your area, EZ can help. To get free instant quotes, enter your zip code in the bar, or to speak to a licensed agent, call 888-753-7207.

Preparing For Health Insurance Open Enrollment: Added Healthcare

Health insurance plans change from year to year. Sometimes prices will change, and coverage will change: some things will no longer be covered, and some benefits will be added to your plan. As you look into plans for next year, you might find some newly added healthcare benefits are now included, like telemedicine, which is now included due to the coronavirus pandemic. Telemedicine is just one of the newly added healthcare benefits to look out for in next year’s plans. The Open Enrollment Period is ending in less than 2 weeks, so now is the time to compare plans if you haven’t already.

Benefits To Look For:

Telemedicine

It always seems to happen during the weekend or when your doctor’s office is closed: you or your child gets sick. You then need to consider going to urgent care or the emergency room. The illness might not warrant an expensive trip to the emergency room, and you might want to avoid going to urgent care because of COVID-19. Luckily, with many new plans, you will not have to go to urgent care when an unexpected illness happens. Starting next year, many plans will give you the option to use telehealth to “see” a doctor 24/7 over the phone or on your tablet or laptop, so that you can get the care you need as soon as possible. Check with different health insurance companies to see if they are offering this benefit.

Fitness Benefits

Want to get fit but don’t have the money to invest in a gym membership? Some 0health insurance companies will be offering fitness benefits as part of their plans. These benefits include incentives to get healthier, like paying a certain percentage of your gym membership’s monthly fees. Take control of your wellness, and feel happier and healthier, by taking advantage of this added healthcare benefit!

Chronic Condition Management

Unfortunately, many Americans are dealing with some kind of chronic condition, such as respiratory disease, diabetes, or heart disease. The ongoing treatment for these conditions can become very expensive, because they require constant monitoring and medication. All health plans currently sold on the Marketplace cover chronic care management, but some are limited in what they cover. In general, most plans have some type of coverage for doctor visits, lab tests, prescriptions, preventive care, behavioral health services, rehabilitation services (including physical therapy) and hospital care related to your chronic condition.

Luckily, as of January 1st, some health insurance companies will be expanding benefits for ongoing management of chronic conditions. With some plans, you will be given your own care manager who will work with you to coordinate care and help you manage your condition.

Travel Coverage

Although it doesn’t seem like we will be doing much traveling anytime soon due to the pandemic, the time will come when we will start going on vacations and business trips again, and you might find that you need medical coverage for your trips. Your current plan probably requires you to purchase additional medical coverage before you travel, which most likely costs an arm and a leg. But many health insurance plans will begin to offer travel coverage to members at no extra cost next year. This type of coverage will include:

Medical emergency services: You will receive coverage for medical care such as medical referrals, emergency medical evacuation, prescriptions and more.
Travel emergency services: This will help with things such as lost luggage/documents, and will offer legal and interpreter referrals, as well as care of minor children and pets when experiencing a travel emergency.

Price Estimation Tool

Starting next year, some companies will offer a price estimation tool that will help you budget better for the year. This tool will provide estimates of the price of medical procedures, surgeries, and prescription drugs. It will show you how much in-network healthcare providers charge for services and medications based on your specific plan.

If you are interested in receiving all of these benefits, some of them, or even just one of them, then it is best to compare plans. It can be time consuming and confusing to figure out which plan will offer these benefits, and will also meet your financial needs. EZ.Insure offers free guidance in figuring it all out. We make the process easier by comparing all available plans in your area in minutes. We will compare plans and find one that includes the added benefits you might want/need, but is still in your budget. To get free instant quotes in minutes, simply enter your zip code in the bar above, or to speak to an agent, call 888-350-1890.

Understanding Emergency Care Vs Urgent Care & Telehealth

It’s 6 PM and your child is running a high fever. The pediatrician’s office is closed, but you want to speak to a doctor immediately. Should you go to the emergency room? Use telehealth services? Or should you head to an urgent care center? When you are faced with an unexpected illness or injury, it is important to understand the difference between emergency care, urgent care, and telehealth services. This knowledge can make a huge difference in the type of care that you receive and in how much money you could end up paying.

Emergency Room

Emergency departments provide medical care at any time, day or night, for anyone experiencing serious injuries and life-threatening medical issues. While your first instinct might be to rush to the emergency room when illness strikes, it isn’t the best place to handle every bump, bruise, burn, cut, or fever. The less serious the condition is, the longer you will end up waiting for treatment at the emergency room. You should consider going to the emergency room when experiencing:

little girl with ice bag on her head and scratch on her shin with a doctor pointing 4 fingers up towards her — *The emergency room is ideal when experiencing major issue such as a head injury.*

Head or eye injuries
Slurred speech
Chest pain or difficulty breathing
Serious burns
Loss of vision
Stroke symptoms
Mental illness concerns
Concussion or confusion
Fever with a rash
Fainting
Facial laceration
Seizures
Vaginal bleeding during pregnancy
Weakness or numbness on one side

When visiting the emergency room, you will most likely end up paying a larger co-payment, and more coinsurance than after a visit to an urgent care facility. You will also have to meet your deductible before your healthcare plan begins paying for your costs.

Urgent Care

young caucasian girl holding her hear with her hand — *Urgent care will treat minor illnesses and injuries, such as an ear ache.*

Urgent care is not the same as emergency care, but these offices are a great backup for when your regular doctor is not available. They can handle a variety of medical problems that need to be treated right away, but are not considered true emergencies. They will perform basic lab tests and treat minor illnesses and injuries such as:

Minor fractures, sprains, and strains
Fever without a rash
Cough, sore throat, or sinus pain
General cold and flu symptoms
Nausea and vomiting
Diarrhea
Ear pain
Dehydration
Wheezing or shortness of breath
Abdominal pain
Small cuts that require stitches

Urgent care facilities offer fast, convenient access to medical care, and are normally staffed by nurse practitioners and physician’s assistants. You will generally pay less for treatment at an urgent care facility than you would at an ER, and most accept insurance. Make sure to ask if they accept your insurance before you go to the urgent care facility or accept treatment. The best part of urgent care is that they work hand-in-hand with emergency rooms, so if they cannot treat your condition, then they will refer you to the closest emergency room.

Telehealth

Telemedicine is usually the most convenient option for immediate help. If you are feeling ill, you can call and speak to a doctor over the phone from the comfort of your own home. During a virtual visit, a doctor will help with the same things that you would normally have to wait days or weeks to discuss with your primary care physician.

young african american girl holding a thermometer in her hand with a doctor on the laptop screen. — *Telehealth is convenient for cough, cold, or flu symptoms, and more.*

Consider using a telehealth visit when you have one of the following concerns:

Cough, cold, flu, or other respiratory infections
Headache
Nausea and vomiting
Sore throat
Allergy and asthma flare-ups
Joint aches and pain
Rashes or insect bites
Small wounds or infections

Not everything can be treated during a video or telephone visit with your doctor. If you actually need in-person care, then you should consider going to an urgent care facility to be treated.

Your primary care physician knows your history, and knows best how to take care of your health concerns. But during times of emergencies when you or a loved one is sick or injured, and your doctor’s office is closed, you need to seek help elsewhere. Understanding the difference between emergency room care, urgent care, and telehealth will help you save time and money.

Telehealth Is Changing The Landscape of Senior Healthcare

For seniors, access to healthcare can be a real issue. Research has shown that, despite the universality of Medicare, seniors in the United States face greater barriers to healthcare and are overall sicker than their counterparts in other high-income countries. With the COVID-19 pandemic bringing shelter-in-place orders and a particular risk for seniors, we are now faced with an even more pressing need for accessible healthcare. Telehealth can help bridge this gap, and we are seeing seniors and healthcare facilities turn to it in large numbers – one medical center in New York saw telehealth visits increase from 300 per day pre-COVID to 7,000 per day in the peak of the pandemic. Will this much usage continue after the pandemic has died down? It’s possible that telehealth is changing the landscape of healthcare, so let’s look at what telehealth is, and how it can play a role in supporting seniors’ health for the long term.

What Is Telehealth?

older man holding a tablet with a doctor on the tablet and holding medicine bottle in the other hand. — *Telehealth offers you the ability to speak to your doctor from the comfort of your home.*

Telehealth is a variety of methods for remote healthcare services, communications, and education. The four main categories of telehealth are:

Live, synchronous video calls: A two-way conversation in real time between patient and provider.

Asynchronous transmissions: Recorded health histories that are transmitted electronically to another healthcare provider. This is particularly useful in rural areas, as it allows a primary care physician to consult with specialists in another location.
Remote Patient Monitoring (RPM): Often used for seniors, especially those living in senior communities, RPM collects patients’ health data and then electronically transfers it to healthcare providers for monitoring and review.
Mobile Health (mHealth): mHealth makes use of health-based apps that can be used on tablets, laptops, or smartphones. Apps range from ones that can monitor a diabetic’s blood sugar levels to daily reminders to drink enough water.

Post-COVID Benefits for Seniors

Telehealth has been a great healthcare option for seniors (and everyone else) during the coronavirus crisis, as it has meant fewer visits to the doctor and less risk of virus transmission. But its benefits go beyond helping to flatten the curve during a pandemic. Some experts foresee that telehealth is around for the long haul, because it allows for:

Routine monitoring of chronic conditions. With aging comes more chronic health issues, such as cardiovascular disease, diabetes, and arthritis. These conditions require regular monitoring by healthcare professionals. Telehealth can save on the cost of frequent visits, while still allowing doctors to keep tabs on things like blood pressure, sugar levels, and pain.
Regular sick visits. Many people forego visits to the doctor when they’re sick due to cost, scheduling issues, or lack of transportation. Telehealth makes seeing the doctor easier, and means doctors are more likely to catch an illness before it turns into something more serious, like a common cold that could become pneumonia.

With telemedicine, you can see any doctor from different cities or states.

Improved communication. When monitoring multiple conditions, as many seniors are, it can be helpful to have a second person in the doctor’s office, noting things like medication changes, symptoms to look out for, and risk factors. Telehealth makes it easier for a family member or caregiver to keep track of what happens at appointments, making for better continuity of care.

Range of care. With telemedicine, seniors have access to a wider range of providers, such as specialists in other cities or even across the country. This improves quality of care and makes treatment that was previously inaccessible much more realistic.
Removal of barriers. Pandemic or not, there are always barriers to treatment, such as location and mobility. For seniors who live in rural areas, are unable to drive, do not feel comfortable with or are unable to navigate public transportation, or have mobility issues, telehealth makes a visit to the doctor’s office much less stressful.

What Happens Next?

In order to make telehealth a reality nationally, a lot needs to change. To start with, over 19 million people in the United States lack access to the internet speeds required for telehealth, and others would need technology like a smartphone or tablet with a camera. Furthermore, funding is a huge issue. Currently, some insurers have temporarily expanded coverage to support telehealth throughout the pandemic. Some representatives in Congress have recently introduced a bipartisan bill called the HEALTH Act, which calls for Medicare reimbursement to support telehealth services in community health centers and rural health clinics. The bill notes that “access to telehealth has become more than just a convenience, but rather a critical necessity in America”.

What do you think? Have you used telehealth? How was your experience? Tell us about it in the comments section!

How You Can Save Thousands On Health Insurance & How EZ Can Help

If you feel like healthcare costs are out of control, you’re not alone. It seems like costs are constantly rising, making it hard for many to afford a health insurance plan or their medications. Because of this, many people end up going without health insurance and avoiding doctor visits, which can mean missed diagnoses and delays in treating major health conditions. But health insurance doesn’t have to be unaffordable or unattainable. EZ knows how to save you thousands on health insurance without sacrificing coverage, so you can remain insured and healthy, while saving money at the same time.

Opt For A Higher Deductible Plan

Your first option for saving money? Cut your monthly premium by switching to a high deductible health plan. One of these plans could work for you if you don’t go to the doctor often, or if you don’t need any ongoing treatments, because if this is the case, you probably won’t ever need to meet your deductible. High deductible plans can be risky, though: if something ends up happening to you, you’ll have to pay a lot out-of-pocket to meet your deductible.

Go With A Lower Drug Formulary Tier

pill bottle sitting on top of a dollar bill with pills on the bill too — *Save money on your prescription medication by opting for a different drug tier.*

Another way to lower your healthcare costs is by taking a look at your prescription drugs, and at your plan’s drug formulary. If your doctor is prescribing you a name-brand medication that has a high copay, check to see if there are any less expensive generic drugs available – you could end up saving 30-50%.

Check your plan’s drug formulary (the list of medications included in your plan, and their costs), as well, and see how your insurance company classifies your medications. Every plan’s formulary has four different pricing tiers, and each insurance company – and every plan! – has a different formulary, so comparing them all can get quite confusing. EZ’s agents are here to help, though – our agent will go over your medical needs, and compare plans and their drug formulary tiers to help you find a plan with affordable drug costs.

Enroll In A Wellness Incentive

If you are enrolled in your employer’s health insurance plan, find out if they offer any wellness programs or incentives. Some companies will offer a lower premium to employees who participate in wellness challenges or other incentivized programs. This could end up saving you a lot of money, or could even get you free coverage!

Use A Health Savings Account (HSA)

If you decide to opt for a high deductible health plan, or if you already have one, then start contributing to a health savings account (HSA). HSAs are only available to those with a qualified high deductible health plan, and they allow you to put money aside tax-free to pay for qualified healthcare expenses. You will accrue tax-free interest, and you will also be able to withdraw money from the account tax-free. Not only are these accounts triple tax-advantaged, but the funds in your account rollover automatically each year and continue to grow until you use them!

white question mark in a blue circle — *Before getting any lab work or tests done, make sure to ask it it is covered!*

Make Sure Tests Are Covered

Avoid surprise medical bills – before you agree to any tests ordered by your doctor, make sure that they are covered under your plan. Be aware that, even if your doctor prescribes a test, such as blood work to confirm a diagnosis or rule out health conditions, it may not be covered. If it isn’t, ask your doctor for other options.

Not knowing what’s covered in your plan can end up costing you thousands of dollars. If you find that you are often being sent for tests that are not covered, consider finding a different plan that offers more coverage. Our agent can compare plans for you and find a plan that offers the coverage you need to get any necessary tests done, so you can avoid surprise bills – and save money.

Negotiate

If you receive a high bill from your doctor’s office or hospital, don’t automatically assume that it is correct – as many as 8 out of 10 times, higher than expected medical bills have some type of error. If a bill seems off to you, then contact your provider and ask them to go over it with you and explain why it is so much. If your high bill is not due to a billing error and you are having trouble paying it, then negotiate with your provider – ask if they can lower the bill, or if they can offer you a monthly payment plan.

african american man with his daughter on his lap checking her temperature while sitting in front of a laptop with a doctor on the screen. — *Telehealth can save you hundreds of dollars by avoiding a doctor visit copay or emergency room visit.*

Utilize Telemedicine

Going to the ER should be your last resort. When you are not feeling well or need immediate care then you should consider more affordable options like urgent care or telemedicine. Telemedicine is a great option, because it allows you the convenience of speaking to your doctor over the phone and getting prescription medication sent over to your pharmacy. This eliminates having to pay a doctor visit copay, or a huge hospital bill. If your plan doesn’t offer telemedicine, EZ can help you find an affordable plan that does offer this option.

Health insurance is not cheap, but that doesn’t mean that you can’t find an affordable plan. EZ understands the need for affordable health insurance, especially in times of uncertainty. Don’t stick with the plan that you already have if it’s too pricey, or doesn’t offer the coverage you need. One of our agents can find you a more affordable plan with just as much coverage, or more. We can easily compare all available plans in your area within minutes, at no cost to you. Taking advantage of our free services is just another way you can save money with EZ. To get started, enter your zip code in the bar above, or to speak to an agent directly, call 888-350-1890.

Medicare’s Expansion Of Telehealth

Over the past few months, many people have gotten used to seeing their doctor virtually, or being able to call them from the comfort of their own home. Access to telemedicine was greatly expanded during the recent pandemic, and this has been especially beneficial for seniors. Having access to telehealth services means that older adults are not forced to jeopardize their health by going to a doctor’s office, and that they can access care even if they live in rural areas or are unable to get to a doctor’s office.

Now, in order to continue to protect older adults, both CMS and Congress are proposing actions to continue the expansion of telehealth. CMS Administrator Seema Verma announced that telehealth and telemedicine will be expanded to Medicare beneficiaries even after the pandemic is over. “I can’t imagine going back,” said Verma of returning to normal doctor’s visits. Now Medicare beneficiaries won’t have to. Congress is also trying to continue the expansion of telehealth services with their bipartisan Helping Ensure Access to Local TeleHealth (HEALTH) Act. If passed, this bill would mean that community health clinics and clinics in rural areas would continue to get reimbursement for telehealth services.

clack and white picture of congress — *CMS and Congress are looking into passing a bill to expand telehealth services for Medicare.*

The Temporary Expansion

CMS has been allowing telehealth services to cover more than 100 medical services since the CARES Act was signed into law in March of this year. This piece of legislation included provisions that removed restrictions on a patient’s location when receiving telehealth services, and permitted CMS to waive any Medicare reimbursement requirements.

Both providers and patients across the country have been taking advantage of the availability of telehealth services since the beginning of the pandemic. Medicare patients have been able to safely access both physical and mental health services throughout these hard times. But as state and federal governments enter their reopening phases, some of the expanded access to telehealth services is beginning to expire.

“Through the temporary telehealth changes thus far, community health center patients have been able to access primary care and behavioral health services while physically distancing to limit spread of coronavirus. However, patients and providers alike will benefit from permanent telehealth access even once the virus is under control,” Chris Shank, CEO and president of the North Carolina Community Health Center Association said in a statement.

Possible Changes Ahead

As state and federal governments enter their reopening phases, some of the expanded access to telehealth services is beginning to expire. CMS is seeking to stop this expiration and to:

Allow telehealth services to be covered under Medicare permanently
Remove “originating site facility and location requirements for distant site telehealth services.” In other words, community health centers and clinics would be able to service anyone in any location.
Reimburse community health centers and rural clinics for telehealth services

Congress is also trying to make sure that telehealth is accessible to seniors who could have trouble reaching a provider, as well as to those who receive care through federally qualified health centers. If passed, the HEALTH Act would mean that these community health centers and rural health clinics will continue to be reimbursed by Medicare for telehealth services. The HEALTH Act would provide “permanent cost-related payments for telehealth services furnished by federally qualified health centers [FQHC] and rural health clinics under the Medicare program.”

“The changes that we can make through the standard rule-making process, actions such as adding services to the telehealth list and making those permanent, those will appear in the physician fee rule,” said Emily Yoder, an analyst in CMS’ Division of Practitioner Services, while speaking during the American Telemedicine Association’s virtual conference.

Telehealth has become the new normal, and many Medicare beneficiaries have become dependent on it, especially those who have trouble accessing in-person care. The proposal to expand some telehealth services even after the pandemic is over is a welcome one for seniors who rely on telemedicine to get the care they need.

Tag: telemedicine