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How Will Medicare & Medicaid Handle Telemedicine?

On Behalf of | Aug 20, 2018 | Health Law Attorneys, Medicare Reimbursements

Telemedicine is the wave of the future for health care. The use of technology for health concerns has risen in the past five years and is expected to grow 18.8% annually until 2025. Estimates project 7 million patients will use telemedicine services in 2018. Despite the significant growth, health maintenance organizations (HMOs) and government funding are falling behind in reimbursement for these services. Medicaid is working diligently to keep up with changes, offering a variety of care options. Medicare is beginning to lag in the billing process, leaving many patients without a telemedicine option.


The use of telemedicine is establishing itself as the new norm for receiving care. Patients can communicate with providers through email, chat, or teleconference for appointments. For immobile and geriatric patients, the method is increasingly popular. Technological advances allow patients to track their own health, monitor blood pressure, check blood glucose, and gather pertinent medical advice.


Telemedicine is a convenient method for care, but getting reimbursement from companies is a slow process. Many HMOs are providing reimbursements for the services, but Medicare is behind. Known as one of the slowest and most restrictive payors, Medicare currently pays for telemedicine only for patients in rural locations. In addition, the program has strict regulations for the option of providers. The programs base the reimbursement of services on two criteria:

  • Services that are like other services currently on the list
  • Services that are not similar but require approval

If services are already on the approval list, the patient will easily receive reimbursement. The problem is the list of available services is so small, most patients are subject to approval before telemedicine care. Of course, this process is a large reason for the backlog of telemedicine cases.

Medicaid has been much faster to jump on board with the telemedicine change. The program views telemedicine as a cost-effective alternative to care. If the providers meet Medicaid provider standards, the care is eligible for coverage. Mental health counseling, training, kidney disease services, and education services are popular programs for care.

The Future of Telemedicine

The trend is continuing toward comprehensive telemedicine care, but Medicare will likely be the last to offer full reimbursements for physicians. When trends emerge in the health care industry, Medicare is typically the last to implement changes, but it does eventually catch up. Currently, Medicare is in the catch-up cycle and will continue to improve services throughout 2018 and 2019. Medicare patients will likely see better telemedicine coverage by 2019, as the program works toward new approvals and coding.

Patients experiencing problems with telemedicine coverage reimbursement should contact an experienced health law attorney. These professional Medicare and Medicaid attorneys understand the intricacies of the Medicare and Medicaid programs and remain abreast of all changing circumstances.