This article is for educational purposes only and does not constitute medical, legal, or financial advice. Every family situation is different, and you should consult with appropriate professionals about your specific circumstances.

Medicare and Telehealth: Virtual Visit Coverage

Your father's knees are acting up again. He called his orthopedist to schedule a follow-up appointment. The scheduler said something about a virtual visit. Your father asked if that would be covered by Medicare, and the scheduler said yes, but your father still has questions. He's not particularly tech-savvy. He doesn't own a computer. He has a smartphone, but he's not sure how to use it for a medical appointment. He's wondering if a phone call would work instead. He's wondering if Medicare covers virtual visits the same way it covers in-person visits.

The news is good. Medicare does cover virtual visits. The coverage is the same as in-person visits, so your parent's copay is the same. Your parent doesn't need fancy technology. A phone call works. A video on a basic smartphone works. The accessibility has improved dramatically since the pandemic first forced everyone into virtual care. What seemed impossible five years ago is now routine and covered.

Understanding what Medicare covers for telehealth, which types of visits work best virtually, and what technology your parent actually needs removes the barriers to your parent getting care in a way that's convenient for them.

What Medicare Covers for Telehealth

Medicare covers doctor visits via video or phone at the same copay as in-person visits. If your parent's regular copay for a doctor visit is 20 percent of the approved amount, the copay for a telehealth visit is also 20 percent of the approved amount. If your parent has a Medigap plan that covers your parent's copay in-person, it covers the copay for a virtual visit too. There's no additional charge for the "virtual" part. You're paying for the doctor visit, whether it's happening in an office or on a screen.

Many different types of specialists offer telehealth visits now. Your parent can see their primary care doctor virtually. Your parent can see a cardiologist, psychiatrist, physical therapist, or dermatologist virtually. Some surgical specialists don't offer telehealth because you need a physical exam before surgery, but many specialists have figured out how to deliver their expertise through a screen.

Mental health visits work particularly well virtually. Your parent's psychiatrist or therapist doesn't need to physically examine your parent to discuss how your parent is feeling, what medication side effects your parent is experiencing, or whether your parent needs an adjustment in treatment. Many people actually prefer therapy via video because the setting feels safer or more comfortable.

Coverage expanded significantly during the COVID pandemic and has largely remained in place. Before the pandemic, telehealth was much more limited. Medicare might have covered a virtual visit if your parent was in a rural area and no doctors were available in person. Now Medicare covers telehealth visits broadly, whether your parent lives in a rural area or a city.

Which Visits Work Best Via Telehealth

Follow-up appointments for stable conditions are ideal for telehealth. Your father's knee appointment to see how his recovery is progressing from knee surgery is a good candidate for a virtual visit. The orthopedist can ask how your father's physical therapy is going, whether your father is having pain, and how your father is doing. The orthopedist might ask your father to move his leg or walk across the room so the orthopedist can see how your father's function has improved. This is the kind of visit that works well without an in-person exam.

New diagnoses often require an in-person physical exam. If your parent has chest pain and calls the doctor, the doctor needs to examine your parent to check whether the pain is cardiac or musculoskeletal. If your parent is having new symptoms, the doctor needs to listen to your parent's heart and lungs, check your parent's blood pressure, and feel your parent's abdomen. These exams can't happen via telehealth.

Psychiatry and behavioral health work well virtually. Your parent's mental health visit doesn't require a physical exam. Your parent's psychiatrist can discuss your parent's mood, sleep, appetite, anxiety level, and whether your parent's medication is working. If the psychiatrist needs to prescribe medication, the psychiatrist can do that after a virtual visit.

Pain management works well virtually if your parent is established in the pain management program. A follow-up visit with the pain specialist to discuss how your parent's condition is progressing can happen virtually. A first visit to establish pain management probably needs to be in-person so the doctor can do a full physical exam and understand your parent's situation completely.

Preventive care visits can happen virtually, though annual wellness visits might benefit from face-to-face time. Your parent's doctor can discuss preventive health measures, update your parent's medications, and review recent test results during a virtual visit. Some doctors prefer to do annual wellness visits in-person so they can do a full physical exam, but many doctors now offer at least part of the wellness visit virtually.

Technology Requirements for Your Parent

A video visit requires a device with a camera. A laptop or desktop computer with a built-in or external camera works. A tablet with a camera works. A smartphone with a camera works. Most smartphones, tablets, and newer computers have cameras built in. Many libraries offer computers with cameras if your parent doesn't have one at home.

A phone visit requires only a telephone. A cell phone or a home landline both work. This might be the best option if your parent is uncomfortable with video technology or if your parent doesn't have regular internet access.

Broadband internet is required for video visits. Your parent needs reliable internet that's fast enough for video. Most home internet connections are fast enough. Cell phone internet works if your parent has a good signal. If your parent's internet is slow and often drops out, a phone visit might be more reliable than a video visit.

Your parent should find a quiet place for the appointment. If there's a lot of background noise, the doctor might not be able to hear your parent well. If your parent's living situation is chaotic or loud, a phone call instead of a video visit might be better.

Your parent shouldn't need to download an app or install special software. Some doctor's offices use special platforms for telehealth visits, but most use platforms that work through a web browser. The doctor's office will send your parent a link to click. When your parent clicks the link at the time of the appointment, the video connection opens and your parent can see and hear the doctor.

If the technology isn't working, your parent can call the doctor's office. They'll help troubleshoot or reschedule as a phone visit instead.

Finding Doctors Who Offer Telehealth

Ask your parent's doctor whether they offer telehealth visits. When your parent makes an appointment, ask whether a virtual visit is available. Some doctors offer telehealth by default now. Some doctors only offer it for certain types of visits. Some doctors don't offer it yet, though the number of doctors not offering telehealth is shrinking.

Check the doctor's website. Most practice websites now have information about whether telehealth is available. Some websites let you select "virtual visit" when you book an appointment. If your parent's doctor's website doesn't mention telehealth, call the office and ask.

If your parent is looking for a new doctor and wants to have access to telehealth, mention that in your search. Some practices market that they offer telehealth. If your parent finds a doctor you like but the doctor doesn't offer telehealth, ask if they plan to add it. Many doctors have added telehealth recently, and more are considering it.

Making Telehealth Work for Your Parent

Help your parent set up the technology if your parent needs help. If your parent has never done a video call, practice with your parent first. Call your parent using video on a smartphone or laptop. Let your parent learn how the technology works with you before the doctor's appointment. This practice makes the actual doctor's appointment less stressful.

Help your parent position the device so the doctor can see your parent's face clearly. The device should be at eye level or slightly below, not looking up from your parent's chin. The doctor needs to see your parent's face to assess your parent's general health and to make sure your parent can see the doctor clearly too.

Make sure your parent can hear and be heard. Ask your parent to do a sound check. If your parent has hearing trouble, make sure the volume is high enough. If the doctor has trouble hearing your parent, your parent can use earbuds with a microphone for better sound quality.

Have your parent prepare like they would for an in-person appointment. If your parent always brings a list of medications, bring the list to the virtual appointment too. If your parent brings notes about symptoms or questions, bring them to the virtual visit. Your parent should wear appropriate clothes, though your parent only needs to wear clothes from the waist up if it's a video visit. Your parent should have a list of current medications and their doses available in case the doctor asks.

When Telehealth Doesn't Replace In-Person Care

Your parent still needs in-person care for certain situations. An annual wellness visit benefits from a face-to-face encounter. Medicare covers an annual wellness visit at no cost, and the visit is designed to assess your parent's overall health. Some doctors prefer to do this visit in-person so they can do a full physical exam, check your parent's blood pressure, listen to your parent's heart and lungs, and assess your parent's overall function. You can ask your parent's doctor whether this visit can be partly virtual and partly in-person, or entirely virtual. Many doctors now offer more flexibility.

Medication changes often need in-person monitoring. If your parent's doctor is starting your parent on a new medication, the doctor might want to see your parent in person to do a baseline exam before the medication starts. Your parent might need in-person visits after starting the medication to check for side effects and make sure the medication is working.

New symptoms deserve in-person evaluation. If your parent has a new problem, your parent's doctor needs to examine your parent to figure out what's going on. Your parent shouldn't have a new symptom evaluation via telehealth unless the doctor feels confident they can assess the situation without an exam.

Chronic disease management for complex conditions might need in-person visits too. If your parent has diabetes, heart disease, and kidney disease, and those conditions are complicated, your parent's primary care doctor might want regular in-person visits to do a full assessment. Your parent's specialist visits might be able to be virtual, but the primary care visits might need to be in-person.

The Practical Reality

Virtual visits are now a normal part of medical care. Your parent doesn't need to feel like virtual care is inferior or second-rate. Virtual care is legitimate medical care with the same coverage and the same quality standards as in-person care.

For routine follow-ups, virtual visits are often more convenient. Your parent doesn't need to take time off work, arrange transportation, or spend time driving to the doctor's office. Your parent can take the appointment from home. If your parent is chronically ill and has frequent appointments, this time and energy savings is meaningful.

Your parent should feel comfortable saying no to a virtual visit if your parent prefers in-person care, or if your parent's situation requires an in-person exam. Some doctors will offer a choice. Some doctors will insist that a particular visit needs to be in-person. Both are reasonable medical decisions.

What matters is that your parent now has options. Virtual care exists, Medicare covers it, and it's available through most doctors. Whether your parent chooses to use virtual care is your parent's decision. But at least your parent has the option, and your parent doesn't have to worry that choosing virtual care will result in unexpected costs or inferior treatment.

How To Help Your Elders is an educational resource. We do not provide medical, legal, or financial advice. The information in this article is general in nature and may not apply to your specific situation. If you have concerns about whether a telehealth visit is appropriate for your parent's condition or health situation, consult with your parent's healthcare provider for guidance and support.