Virtual Health Medicare and Medicare Advantage FAQ

Yes, there are exceptions where video and phone visits may remain covered by Medicare/Medicare Advantage, including: 

• Services for the diagnosis, evaluation or treatment of a mental and/or behavioral health disorder (including a substance use disorder) in the home.
• Monthly End-Stage Renal Disease (ESRD) visits for home dialysis.
• Services for diagnosis, evaluation or treatment of symptoms of an acute stroke wherever the patient is, including in a mobile stroke unit.
• Post-operative or other video visits in the global period. 

Medicare Advantage Plans may offer more telehealth benefits than the basic coverage in Original Medicare. Contact your insurer to confirm what telehealth benefits may be available.

To confirm coverage with your insurance company you will need to: 

• Confirm the type of provider you are scheduled with for your visit.
• Confirm the reason for your visit with the representative (there may be special coverage rules for certain types of visits, such as for behavioral health visits).
• Let the insurance representative know if you have recently had a surgical procedure. The visit may be within a period of time in which all related follow-up care is included in the payment for the procedure.
• Ask if you are covered for a live 2–way audiovisual communication between the provider and patient when the patient is located at home. Please stress with the representative that you will be at home for the video visit. 

To confirm coverage with your insurance company you will need to: 

• Confirm the type of provider you are scheduled with for your visit.
• Confirm the reason for your visit with the representative (there may be special coverage rules for certain types of visits, such as for behavioral health visits).
• Let the insurance representative know if you have recently had a surgical procedure. The visit may be within a period of time in which all related follow-up care is included in the payment for the procedure.
• Ask if you are covered for an audio only visit between the provider and patient when the patient is located at home. Please stress with the representative that you will be at home for the phone visit.

We understand even without coverage some patients may wish to keep their video or phone visit. If your insurance does not offer video or phone visits as a covered benefit, you may be responsible for the cost of the visit. Call Patient Financial Services at (517) 364-7999 once you receive your bill for the service.

For scheduling questions, contact your clinic. It will vary depending on the clinic’s schedule and whether the provider will be available on-site during the scheduled appointment time. 

The out-of-pocket cost, including the uninsured discount, could range from $63.60-$186.80, depending on the complexity of the phone or video visit. 

For further questions about cost estimates, contact Patient Financial Services at (517) 364-7999.

Depending on the legislation that reinstates coverage, it is possible coverage could be applied retroactively. If coverage is not applied retroactively, patients who incurred charges during the lapse may be eligible for an uninsured discount for the visit. Call Patient Financial Services at (517) 364-7999 once you receive your bill for the service. If coverage is applied retroactively, Medicare would rerun charges as appropriate.