Does Medicare Cover Virtual Doctor Visits?

Medicare generally provides coverage for virtual doctor visits, often called telehealth, under specific conditions. This allows beneficiaries to receive healthcare services remotely. The availability and scope of these services have evolved with recent policy changes aimed at enhancing access to care.

Understanding Medicare Virtual Visit Coverage

Medicare recognizes three main categories of virtual healthcare services: telehealth visits, virtual check-ins, and e-visits. Each offers a distinct method for patients to interact with providers.

Telehealth Visits

A telehealth visit involves real-time, interactive audio and video communication between a patient and a distant provider. These visits are comparable to in-person office visits, covering a comprehensive range of medical services, including evaluations, management, and psychotherapy.

Virtual Check-ins

Virtual check-ins are brief communications, lasting 5 to 10 minutes, using real-time audio or audio-video technology. These services are for quick consultations to determine if a patient needs an in-person visit. Providers can use them to assess symptoms or respond to patient inquiries without requiring a full appointment.

E-Visits

E-visits involve non-face-to-face communications through an online patient portal. These digital interactions are patient-initiated and can span up to seven days. E-visits are suitable for managing existing conditions or new concerns that do not require a real-time conversation.

Coverage Requirements and Specific Services

For Medicare to cover virtual visits, certain conditions regarding the healthcare provider, technology, and patient location must be met. A wide range of healthcare professionals can provide telehealth services, including physicians, nurse practitioners, physician assistants, clinical nurse specialists, clinical psychologists, clinical social workers, registered dietitians, nutrition professionals, certified registered nurse anesthetists, marriage and family therapists, and mental health counselors.

Technology Requirements

Telehealth visits require an interactive audio and video telecommunications system for real-time communication. For behavioral and mental health services, audio-only communication is permanently permitted if the patient is at home, or unable or unwilling to use video, and the provider is technically capable of video. Other non-behavioral/mental telehealth services can also use audio-only communication through September 30, 2025.

Patient Location

Through September 30, 2025, Medicare beneficiaries can receive non-behavioral/mental telehealth services from any location, including their home, without geographic restrictions. After this date, most telehealth services will require the patient to be in a rural area at an office or medical facility. However, behavioral and mental health services can permanently be received from a patient’s home, regardless of geographic location.

Covered Services

Medicare covers a variety of medical services delivered virtually. These include routine office visits for evaluation and management, psychotherapy, and consultations. Other covered services encompass wellness visits, urgent care, preventive health screenings, mental health counseling, substance use disorder treatment, monthly End-Stage Renal Disease (ESRD) visits for home dialysis, and diagnosis or treatment for acute stroke symptoms.

Costs for Virtual Visits

The financial responsibility for Medicare-covered virtual visits aligns with costs for in-person medical appointments. Beneficiaries with Original Medicare pay the standard Medicare Part B deductible, which is $257 for 2025.

After the Part B deductible is met, Medicare pays 80% of the approved amount for the service. Beneficiaries are responsible for 20% coinsurance for most virtual visits. The cost-sharing is generally the same as for in-person services.

For Medicare Advantage plans, the cost-sharing structure for virtual visits may differ. These private plans provide Medicare Part A and Part B benefits and often have their own copayments, coinsurance, and deductibles. Beneficiaries should consult their plan documents or contact their plan directly to understand their out-of-pocket costs for virtual services.

Accessing and Utilizing Virtual Visits

Engaging in a Medicare-covered virtual doctor visit involves several practical steps. Beneficiaries can inquire with their current healthcare providers about Medicare-covered virtual visit options. Many providers offer telehealth services directly and can provide information on how to get started.

To find providers offering Medicare-covered virtual visits, use the Medicare Care Compare tool. This online resource allows individuals to search for healthcare professionals by specialty, practice name, or location to identify those offering telehealth services. Contacting 1-800-MEDICARE or a Medicare Advantage plan directly can also help locate in-network virtual care providers.

Preparing for a Virtual Visit

Before a virtual appointment, prepare the necessary technology and environment. Patients should ensure they have a stable internet connection and a device with audio and video capabilities, such as a computer, smartphone, or tablet. Testing the chosen platform or application in advance can help prevent technical issues during the visit.

Find a private, quiet, and well-lit space for the consultation to ensure confidentiality and clear communication. Preparing a list of symptoms, current medications, and questions for the provider can maximize the effectiveness of the virtual visit. During the appointment, beneficiaries should discuss their medical history and take notes.