Medicare telehealth expansion could be here to stay. Here’s where things stand

KEY POINTS

At least 10 million Medicare beneficiaries have used telehealth since early March, compared with about 13,000 weekly appointments pre-pandemic. 

Lawmakers and regulators are looking at making some of the current expansions permanent.

Among the issues that policymakers would need to address are the cost and quality of remote care, as well as determining which services are appropriate for telemedicine.

In early March, U.S. health officials had a stark warning for older Americans: You are more at risk for complications if you contract Covid-19, so avoid leaving your home.

For Medicare’s 62.5 million beneficiaries — the majority of whom are 65 or older and more likely to use medical services — this was more than an inconvenience or new threat. It meant needing to see a doctor could pose a dangerous choice.

Enter telehealth. As communities worked to stem the spread of the coronavirus through temporary business shutdowns and stay-at-home orders, lawmakers and regulators loosened policies to make remote health care through Medicare more broadly available during the public emergency.

Whether via video chat, a telephone call or other remote technology, telemedicine usage among Medicare beneficiaries spiked from pre-pandemic levels: At least 10 million Medicare beneficiaries have used telehealth since early March, according to a spokesperson for the Centers for Medicare and Medicaid Services. Before then, there were roughly 13,000 appointments weekly. 

“I think it’s pretty clear that the expansion in telehealth services was a very appropriate and successful response to the pandemic,” said Juliette Cubanski, deputy director for the Kaiser Family Foundation’s program on Medicare policy. “It was probably a lifesaver for people who took advantage of it, or it let them continue to get care.”

Yet as Congress and regulators consider making the temporary expansion in telehealth permanent, patient advocates are hoping they don’t move too quickly. 

“We have data about increased utilization, but we don’t know much about the beneficiary’s experience and what’s working and what isn’t,” said Lindsey Copeland, federal policy director for the Medicare Rights Center, an advocacy group.

Among the issues that policymakers would need to address are quality of care, the cost to beneficiaries and the services that are sensible for coverage.

“Using it for all circumstances and all services, as we’ve seen generally through the pandemic, might not be the best possible way forward from both a program cost perspective or beneficiary cost perspective,” Cubanski said.

By the looks of it, most telehealth experiences have been positive among Medicare beneficiaries. Among those enrolled in an Advantage Plan, 91% reported favorable experiences with telehealth and 78% would use it again, according to a survey by the Better Medicare Alliance.

Similarly, an informal poll done in an 8,000-member Facebook Medicare group hosted by insurance agency Boomer Benefits showed that most respondents who had used telehealth liked the arrangement — often with the caveat that it wouldn’t work for every medical issue encountered. Others questioned whether the cost should be the same as an in-person visit.

Debbie, a 65-year-old Medicare beneficiary living near Middletown, Delaware, used telehealth — a face-to-face video on her smartphone — to get treatment for a bout of poison ivy. For reasons that include the nurse practitioner’s inability to see the allergic reaction in detail over video, she said she was unimpressed.

“I don’t like it,” said Debbie, whose last name is not being used for privacy reasons. “Even if you can see each other [on the screen], it’s not the same as seeing someone in person.”

Prior to the pandemic, telehealth already was on a path toward broader usage within Medicare. However, it was generally limited to rural areas, with restrictions on where the remote visit could take place and which providers were allowed to offer such care.

During the public health emergency, beneficiaries can be in their own home, and the menu of services and providers that qualify was greatly expanded, ranging from emergency department visits to group psychotherapy to radiation treatment management.

In Congress, there are several bills addressing telehealth expansion. The HEALS Act — introduced in the Senate as the Republican version of the next coronavirus relief package — includes a provision that would make the regulatory waivers permanent through the end of 2021. The Trump administration also is pushing for some permanency in telehealth usage with Medicare.

Another issue to address is Medicare beneficiaries’ access to technology, as well as the know-how to use it. For some patients, that could be a barrier to care. 

“If we have this expansion in telehealth, we have to do it in a way that doesn’t leave those people further behind and increase existing disparities,” Copeland said.

Policymakers would also need to identify which services are most appropriate for telehealth appointments.

“There’s no question that there still needs to be in-person visits, but there are some that are highly appropriate for telehealth,” said Allyson Schwartz, president and CEO of the Better Medicare Alliance and a former congresswoman from Pennsylvania. 

For example, she said, check-ins for people with chronic conditions or mental-health consultations have worked well for those remote appointments.

“I don’t think anyone thinks telehealth would replace in-person 100%,” Schwartz said. “But there’s a strong feeling that there is a role for telehealth visits.” 

CMS Expands Telehealth, Rural Plan Options for Medicare Advantage

 

CMS chose to finalize some proposals in advance, including measures that increase access to telehealth and rural plan options for Medicare Advantage beneficiaries.

May 22, 2020 - CMS has finalized changes to Medicare Advantage and Medicare Part D telehealth policies and supplemental chronic disease management benefits. The agency has also expanded Medicare Advantage for rural and end stage renal disease (ESRD) care.

“CMS’s rapid changes to telehealth are a godsend to patients and providers and allows people to be treated in the safety of their home,” said CMS Administrator Seema Verma in the press release. “The changes we are making will help make telehealth more widely available in Medicare Advantage and are part of larger efforts to advance telehealth.”

The new telehealth policies cover a wider range of specialty providers for telehealth benefits, according to the fact sheet. The list includes dermatologists, psychiatrists, cardiologists, ophthalmologists, primary care physicians, gynecologists, infectious disease specialists, and others.

CMS sought to ease policies regarding rural healthcare in order to make more Medicare Advantage options available to rural residents. Now 85 percent of beneficiaries must live within the maximum time and distance standards to participate in a Medicare Advantage plan. Previously, CMS required 90 percent.

Medicare Advantage plans have had difficulty gaining traction in rural areas. In these areas, enrollment and primary care provider density can force premiums higher than in urban areas.

Medicare Advantage plans will also receive 10 percent credit for the percentage of beneficiaries that fall within that 85 percent.

CMS will also ease network adequacy standards regarding outpatient dialysis and residents of states with Certificate of Need laws and other laws which restrict competition.

The rule enacts the Cures Act mandate regarding ESRD Medicare-eligible beneficiaries. Starting the first day of 2021, all Medicare beneficiaries with ESRD will be eligible for Medicare Advantage.

The Medicare Advantage and Medicare fee-for-service payment adjustments will also go into effect, including the exclusion of kidney acquisition costs from Medicare Advantage benchmarks. These payment rates were disputed by some as insufficient.

CMS looked to refine the Medicare Advantage Star Ratings system and the Medicare Part D Star Ratings by implementing the Tukey outlier deletion to erase outliers that exert too much influence over the star ratings. Member experience will have more weight in the reformed star ratings systems.

The final rule adjusts the 2021 and 2022 Medicare Advantage and Medicare Part D Star Ratings to address the impacts of coronavirus on the process. Specifically, CMS said, the adjustments account for the fact that data collection and measure scores will be affected.

The final rule expands medical loss ratio (MLR) regulations to include “incurred claims” and adopts a deductible-based adjustment to make increase Medicare Advantage plans’ incentives to offer medical savings account contracts.

CMS extended the definition for special election periods as well to include a number of exceptional circumstances, including:

• Federal Emergency Management Agency emergencies and federal, state, or locally declared emergencies (“Government Entity-Declared Disaster or Other Emergency”)
• Individuals involuntarily disenrolled from an MA-PD plan Due to Loss of Part B
• Individuals Enrolled in a Plan that has been identified by CMS as a Consistent Poor Performer
• Individuals Enrolled in a Plan Placed in Receivership

Finally, the new rule also covers supplemental benefits for the chronically ill and crack down on “look-alike” dual eligible special needs plans.

The finalized rule will be published on June 2, 2020. An unpublished version is available on the Federal Register.

Information from Health Payer Intelligence

Alzheimer's and Medicare: What is covered and what is not | Jerold Johnson

 According to the Alzheimer’s Association, 1 in 3 seniors dies from Alzheimer’s disease or another dementia. Let's look at what Medicare covers in relation to Alzheimer’s.

There are seven stages of the disease, with early stages marked by symptoms that generally don’t require care but do spark the initial visit to a doctor in the search for a diagnosis. During this time, an individual might struggle to find the right word, ask the same question repeatedly, become forgetful or experience mood swings. This initial doctor visit will most likely be the first of many.  

Because an “Alzheimer’s test” doesn’t exist, doctors instead begin eliminating other potential diseases that could be causing these symptoms, requiring possible collaboration with neurologists, psychiatrists, psychologists, as well as ordering various brain scans.

It can quickly become a pricey process, but it’s also a diagnostic one, so Medicare Part B is applied. Part B of original Medicare will pay 80% of the bill after the patient has met the Part B annual deductible. For reference, the annual deductible for 2020 is $198. If the patient has purchased Medicare Supplemental Insurance — something worth having during the early stages of this disease — it will handle the remaining 20%.

If that diagnostic process ends with a determination that it is Alzheimer’s, the treatments vary. Most patients immediately start taking medications that can help slow the progress of the disease. Medicare Part D will help cover the cost of the drug so long as it is on its approved drug list, as many common Alzheimer’s drugs are.

Other treatments can include various forms of therapy — physical, occupational or sessions with a mental health care professional. Provided these services are considered “medically necessary” and prescribed by a doctor, Medicare Part B will again cover 80% of these costs. And if you have a Medicare Supplement — also referred to as a Medigap policy — it will pick up the 20% not covered by Medicare Part B.

As the disease worsens, the initial symptoms become more pronounced and other symptoms surface. For example, a patient may begin to struggle with coordination and motor skills. Family members may decide that more oversight is needed, either through their own supervision, in-home health care or adult day care. It is important to note that not all of these costs will be covered by Medicare.

As the disease enters the late stages, a patient might experience extreme confusion, become delusional, begin wandering, and incontinence can set in. This is the point where residential 24-hour care will most likely be required. Medicare does not offer long-term care to help pay for residential care. Medicare coverage will apply only in “limited circumstances” — for example, if a patient is hospitalized for at least three days and then needs nursing home care, Medicare will cover skilled nursing home care for up to 100 days.

The reality is that 100 days may prove to be a fraction of the amount of nursing or in-home health care that an Alzheimer’s patient may require. Once a person needs help with activities of daily living — referred to as ADLs including but not limited to dressing, personal hygiene, eating, basic mobility — Medicare considers this “custodial care,” meaning it’s non-medical. As such, it is not considered medically necessary and therefore Medicare does not cover the bill.   

In the very end stage — when a patient has less than six months to live — a Medicare hospice benefit is available. It comprehensively covers the costs of doctors, nursing, drugs, counseling for family members and other home services. There is no cost for hospice care, and medications are provided for a small copay. If the patient is in a nursing home, Medicare will cover only the hospice services, not room and board.

The period just before hospice — when long-term care is required — can be financially devastating. Long-term care can cost thousands of dollars a month and be required for an extended period. (We will address the intricacies of long-term care in a future article.) The average Alzheimer’s patient lives four to eight years after diagnosis, and this is where having a long-term care policy — something you’ll need to purchase outside of Medicare — is key. And here’s the crucial thing to know: Once someone is diagnosed with Alzheimer’s, they cannot apply for long-term care insurance.  

It’s wise to start looking into long-term care insurance when you’re in your 50s or early 60s, before premiums skyrocket or your health begins to worsen and the policies available to you narrow. It’s wise to consult with an independent agent who can discuss the various options with you, so that you and your loved ones can be better equipped from an insurance standpoint should a disease like Alzheimer’s be diagnosed.

Information from knoxnews.com

Free Medicare Benefits to Tackle Heart Disease

 Heart disease is the leading cause of death in the U.S. According to the CDC, heart disease is responsible for one out of every four deaths, but people can reduce their risk through lifestyle changes and medicine. Help your Medicare clients get the care they need to keep their hearts healthy.

Prevention and Diagnosis

Under Medicare Part B, cardiovascular behavioral therapy visits are covered once every year, as long as they are carried out with the patient’s primary care doctor or another primary care practitioner in a primary care setting. There is no cost to the patient as long as the patient’s doctor or other qualified health care provider accepts the assignment. During these sessions, the doctor will check the patient’s blood pressure and discuss tips that can help lower a person’s risk for heart disease. 

Medicare Part B also covers cardiovascular disease screening blood tests once every five years. Once again, Medicare beneficiaries pay nothing out of pocket for these tests as long as a doctor or other qualified health care provider accepts the assignment. The blood tests check cholesterol, lipid, and triglyceride levels, which can indicate dangerous health conditions that could lead to a stroke or heart attack.

If your clients have not taken advantage of these free benefits, remind them to do so.

Doctors may recommend additional tests, especially for patients with certain risk factors. These tests may not be covered by Medicare, however, so your clients may have to pay out of pocket to have them done.

Coverage for Care

For patients with heart disease, coverage is available under the different parts of Medicare.

For example, if a patient experiences heart failure and needs an implantable automatic defibrillator, Medicare Part A covers surgery performed in a hospital inpatient setting, while Medicare Part B covers surgery performed in a hospital outpatient setting.

Medicare Part B also covers a cardiac rehabilitation program for eligible patients. These programs can include exercise, education, and counseling.

Medicare Advantage and Special Needs Plans

Patients with heart disease may find better coverage under Medicare Advantage plans. In addition to looking at the regular Medicare Advantage plans in the area, your clients may want to look for Special Needs Plans.

Special Needs Plans are Medicare Advantage plans designed for specific groups. Chronic Conditions Special Needs Plans, or C-SNPs, provide care for enrollees with certain health conditions, which may include cardiovascular disorders and chronic heart failure. All C-SNPs include prescription drug coverage, and they may include extra benefits to help with the condition they serve.

If your client has a cardiovascular disorder or chronic heart failure, and if there’s a C-SNP in the area that caters to the condition, enrollment is possible at any time of the year.

Topics: medicare benefits, Medicare benefits to tackle heart disease, heart disease

information from western asset protection

Medicare Summer Newsletter

 

Here are some basic medicare tips to get you started...

1. Being informed is the best way to avoid mistakes that cost money.

2. Don’t expect to be notified when it’s time to sign up.

3. Do enroll when you’re supposed to.

4. Don’t worry that poor health will affect your coverage.

5. Do remember that Medicare is not free. You pay premiums for coverage and co-payments for most services, unless you qualify for a low-income program or have other, extra insurance.

6. Don’t assume that Medicare covers everything; It covers a wide range of health services (including expensive ones like organ transplants), prescription drugs and medical equipment. But there are gaps.

7. Don’t expect Medicare to cover your dependents.