Key takeaways

•  Twenty-two states including California, New York, and Texas have amended their laws or policies as a result of the pandemic to mandate more robust coverage of telehealth services.

• In Original Medicare, beneficiaries pay 20% of the Medicare-Approved amount for the services of their doctor or other health care providers, and the Part B deductible applies. For most telehealth services, beneficiaries will pay the same amount as if they receive the services in person.
• Depending on the plan and location, eligible Cigna customers can "connect with board-certified medical providers and licensed therapists online using a phone, tablet, or computer". The information has been updated in the project spreadsheet.

Introduction

Legislation on Telehealth

• According to Health for California Insurance Center, "Supplemental health insurance plans are health care plans used to cover anything above and beyond basic medical coverage. These plans provide extra medical coverage and can also be used to contribute to other costs not covered by your primary insurance plans such as copayments, coinsurance, and deductibles".
• Telehealth has experienced a swift rise in use as a result of the COVID-19 pandemic, both among privately-insured individuals and Medicare beneficiaries.
• Before the pandemic, only beneficiaries residing in rural areas have access to telehealth services under traditional Medicare. There were restrictions on where these services can be received and which providers can receive payments to offer them.
• After the declaration of public health emergency by the federal government due to the COVID-19 pandemic in early 2020, Congress and the Centers for Medicare & Medicaid Services (CMS) expanded the coverage of telehealth services under traditional Medicare so that beneficiaries can access healthcare and reduce their exposure to COVID-19.
• However, at the end of the public health emergency, the limited coverage of telehealth services under Medicare that existed before the pandemic will be restored, except actions are taken by policymakers to extend the expanded telehealth coverage.
•  Twenty-two states have amended their laws or policies as a result of the pandemic to mandate more robust coverage of telehealth services. States focused on three major areas: "requiring coverage of audio-only services, waiving cost-sharing or requiring cost-sharing no higher than identical in-person services, and requiring reimbursement parity between telemedicine and in-person services".
• Certain telehealth services are covered under Medicare Part B (Part B covers "certain doctors' services, outpatient care, medical supplies, and preventive services").
• In Original Medicare, beneficiaries pay 20% of the Medicare-Approved amount for the services of their doctor or other health care providers, and the Part B deductible applies. For most telehealth services, beneficiaries will pay the same amount as if they receive the services in person.
• Medicare Advantage Plans may offer more telehealth services than Original Medicare.

UnitedHealthcare Telehealth Options

• UnitedHealthcare has options for accessing telehealth services with local providers or UnitedHealthcare’s preferred national providers.
• For COVID-19 testing-related telehealth services, beneficiaries will have "$0 cost-share with in-network and out-of-network providers through the national public health emergency period, currently scheduled to end Oct. 17, 2021".
• Coverage for in-network and out-of-network telehealth services for COVID-19 treatment and other healthcare services will be determined by the beneficiary's plan. Beneficiaries will be responsible for any "copay, coinsurance, deductible or out-of-network costs, according to their benefits plan".
• These telehealth services are included in UnitedHealthcare Exchange, Individual and Employer-sponsored health plans, and are subject to state-specific rules, regulations, and emergency periods. UnitedHealthcare guidelines apply where there are no state-specific exceptions. "Some employer-insured health plans have different coverage policies".

Cigna Telehealth Options

• Cigna's telehealth services are part of its basic medical coverage.
• Depending on the plan and location, eligible Cigna customers can "connect with board-certified medical providers and licensed therapists online using a phone, tablet, or computer".
• Telehealth services are not mentioned in Cigna's supplemental insurance plans.

Highlights Specific to California, New York, Texas, and Florida

Before the Start of the COVID-19 Pandemic

• California, New York, and Texas require providers to cover telemedicine with parity in cost-sharing.
• California requires parity in provider reimbursement.

During the COVID-19 Pandemic

• California added the requirement that audio-only must be covered by agency action.
• New York added parity in cost-sharing by agency action.
• Texas added parity in provider reimbursement by agency action.
• Texas also added the requirement that audio-only must be covered by executive order.
• Florida is one of the few states without laws or policies regarding the coverage of telehealth services.