CMS Expands Telehealth for Medicare Advantage Plans Starting in 2020

April 09, 2019

Last week, the Centers for Medicare & Medicaid Services (CMS) announced that it will allow Medicare Advantage (MA) plans to offer additional telehealth benefits to enrollees as part of their basic benefit package starting in plan year 2020. This policy change was included in the 2020 Medicare Advantage & Prescription Drug Benefit rule that CMS finalized on April 5.

Implementing a provision of the Bipartisan Budget Act of 2018, the rule permits MA plans to cover telehealth services beyond what currently is allowable under fee-for-service Medicare. Under fee-for-service Medicare, CMS pays for covered telehealth services only if the patient is in a rural area and at a clinical setting that generally does not include the patient’s home or other community setting. Starting in plan year 2020, MA plans can cover Medicare-covered telehealth services, regardless of where the patient is located, as a basic MA benefit.

Prior to the final rule, MA plans could cover such additional telehealth services only as supplemental MA benefits, which unlike basic MA benefits, are funded using rebate dollars or supplemental premiums paid by enrollees. By allowing MA plans to include additional telehealth services as basic MA benefits, CMS predicts that MA plans will be more likely to offer them to enrollees.

CMS projects that its new policies will save MA plan enrollees $557 million in travel costs over 10 years and will “result in an aggregate reduction in use of emergency room visits and inpatient admissions because the relative increased ease of receiving health care services should improve health outcomes and reduce avoidable utilization that results from untreated conditions that exacerbate illness.”

CMS’s policy change may have a significant impact in Wisconsin, where according to the Kaiser Family Foundation, 40% of Medicare beneficiaries in 2018 were enrolled in a MA plan in 2018, compared to the national average of 34%.

For more information, contact Andrew Brenton, WHA Assistant General Counsel, at 608-274-1820.

This story originally appeared in the April 09, 2019 edition of WHA Newsletter