Understanding Your Telehealth Insurance Options

by Ree

The convenience of healthcare access from your home makes telehealth more popular than ever. According to McKinsey, telehealth usage has stabilized at levels 38 times higher than before the pandemic. This surge in virtual care has prompted many insurance providers to expand their telehealth coverage, but you may not know how their telehealth insurance options work. 

Whether you’re looking for convenient access to medical professionals or seeking cost-effective healthcare solutions, you need to understand the telehealth insurance options available to you.

First, let’s explore what telehealth is and why coverage matters.

Contents

What is Telehealth and Why is Insurance Coverage Important?

Telehealth has become a buzzword in recent years, especially with the rise of digital health platforms and the COVID-19 pandemic. 

Telehealth, fairly synonymous with telemedicine, refers to the use of tech to provide healthcare services remotely. This can include video consultations, secure messaging, remote monitoring, texting, audio-only calls, and even virtual prescription refills. 

Benefits of telehealth services

In November 2021, 55% of respondents said they were more satisfied with telehealth or virtual care visits than with in-person appointments. 35% use other digital services, such as ordering prescriptions online and home delivery.

Telehealth benefits patients and healthcare providers in many ways (Hasselfeld, n.d.):

• Convenience: Patients can consult with their healthcare providers from the comfort of their homes, which eliminates the need for travel and reduces wait times.
  
  
• Access to Care: Telehealth is particularly beneficial for people in rural areas or those with mobility issues, providing access to specialists and primary care providers who may not be available in the local area.
  
  
• Cost-Effective: By reducing the need for physical visits, telehealth can lower healthcare costs for both patients and providers.
  
  
• Preventive Care: Regular virtual check-ups can help in the early detection and management of chronic conditions, improving overall health outcomes.

Importance of insurance coverage for telehealth

Insurance coverage for telehealth services is crucial for several reasons:

• Reduced Out-of-Pocket Costs: Without insurance, telehealth costs can add up quickly. Insurance coverage helps mitigate these expenses.
  
  
• Access to a Broader Network: Insurance plans often have agreements with a network of providers, making it easier for patients to find in-network telehealth services.
  
  
• Comprehensive Care: Insurance can cover a wide range of telehealth services, from primary care to specialist consultations, ensuring that patients receive comprehensive care.

Now that we understand the basics of telehealth, let’s look at the different types of insurance plans that offer coverage for these services.

Types of Insurance Plans with Telehealth Coverage

When it comes to telehealth, not all insurance plans are created equal. 

One study found that insurers paid less for third-party telehealth visits than in-person care. Before COVID-19, only six U.S. states required equal payment for telehealth and in-person visits. By late 2021, more states adopted these laws, reducing potential cost savings for insurers as telehealth payments increased (Cuellar et al., 2022).

Here’s a breakdown of the different types of insurance plans that cover telehealth services.

Traditional health insurance 

Most traditional/private health insurance plans now include telehealth benefits. These plans cover a variety of services such as video consultations, e-prescriptions, and remote monitoring (HRSA, 2023).

Standalone telehealth insurance

Some companies offer standalone telehealth insurance plans. These are subscription-based services that provide unlimited access to telehealth consultations for a monthly fee.

However, there may be limitations like the specific types of care covered, requiring initial in-person visits, or capping the number of telehealth visits. Recently, many private insurers have started providing telehealth services through third-party platforms like Teladoc or AmWell (Healthcare Service Corporation, 2020).

Medicare and Medicaid

Medicare Part B covers certain telehealth services, including virtual visits with doctors and specialists (Medicare.gov, n.d.). Medicaid coverage for telehealth varies by state, but many states have expanded their telehealth benefits in recent years (Schwamm et al., 2017).

Employer-sponsored plans

Many employers offer health insurance plans that include telehealth services. These plans often come with additional benefits like mental health services and secure messaging with healthcare providers.

With various telehealth insurance options available, it’s important to know what features to consider when evaluating plans.

What to Look for in Telehealth Insurance Plans

Choosing the right telehealth insurance plan can be overwhelming. Here are some key features to consider.

Scope of covered services

Ensure the plan covers a wide range of services, including:

• Primary Care: Regular check-ups and preventive care. Many plans cover virtual visits for routine health assessments.
  
  
• Mental Health: Access to telepsychiatry and counseling services. Mental health services via telehealth can be as effective as in-person visits.
  
  
• Specialist Consultations: Ensure the plan includes virtual visits with specialists like cardiologists, and dermatologists. This can save time and reduce the need for physical referrals.

Network of available providers

A robust network of in-network providers ensures that you have access to a variety of healthcare professionals without incurring additional costs. Check if the plan includes:

• Local Providers: Access to local healthcare providers who offer telehealth services.
  
  
• Specialists: A wide range of specialists are available for virtual consultations.
  
  
• National Networks: Some plans offer access to national networks of providers, which can be beneficial if you travel frequently.

Cost-sharing 

Healthcare marketplaces offer affordable individual health insurance plans. These plans must meet standards for cost-sharing, which are the out-of-pocket expenses people pay for medical services. 

Cost-sharing typically includes deductibles, copayments, and coinsurance, though not all plans use all three types (Rakshit et al., 2023):

• Copayments: The fixed amount you pay for each visit. The fixed amount you pay for each telehealth visit. Some plans may offer lower copayments for virtual visits compared to in-person visits.
  
  
• Deductibles: The amount you need to pay out-of-pocket before the insurance starts covering services. You may want to pair a high-deductible plan with Health Savings Accounts (HSAs) to help manage costs.
  
  
• Coinsurance: The percentage of costs you share with the insurance company after you’ve paid your deductible. For example, a plan might cover 80% of the cost, leaving you to pay the remaining 20%.

Technology platforms and user experience

The technology with a telehealth platform should be easy to use. Look for features like:

• User-Friendly Interface: An intuitive and easy-to-use platform.
  
  
• 24/7 Availability: Access to healthcare services at any time.
  
  
• Short Wait Times: Minimal waiting period for consultations.

Quality of care

While convenience is a significant factor, the quality of care should not be compromised. Look for plans that ensure (Wolters Kluwer, 2023):

• Clinical Effectiveness: The platform should support high-quality care across different specialties like chronic conditions and mental health issues.
  
  
• Access to Resources: Plans that provide easy access to educational resources can empower patients to take control of their health.

Comparison of Popular Telehealth Insurance Providers

Several insurance companies offer telehealth coverage, each with its own features and benefits. Here’s a comparison of some popular providers in the following table with info from the Center for Connected Health Policy (2021).

Provider	Pros	Cons	Unique Features	Customer Satisfaction
Aetna	Comprehensive coverage & wide network	Higher premiums	Integration with CVS Health	High
Blue Cross Blue Shield	Broad coverage & various plan options	Varies by state	Specialized telehealth programs	High
Kaiser Permanente	Integrated care model & user-friendly app	Limited to certain regions	Seamless care coordination	Very High
UnitedHealthcare	Extensive provider network & 24/7 availability	Complex cost-sharing	Virtual health assistants	Moderate

Studies show patients prefer video telehealth over audio-only, reporting higher satisfaction and better outcomes. Video telehealth users are less likely to need emergency or in-person care (Lee et al., 2023). 

Armed with knowledge about different plans and their key features, let’s learn how to pick the best telehealth insurance plan for your needs.

How to Choose the Right Telehealth Insurance Plan for You

Selecting the right telehealth insurance plan requires careful consideration of your healthcare needs and preferences. Here are some steps to guide you.

Assess your healthcare needs

Identify your healthcare needs and preferences. Consider the following questions:

• Do you need frequent specialist consultations?
  
  
• Are mental health services important to you?
  
  
• Do you have any chronic conditions that need regular monitoring?

Evaluate costs

Consider your budget and review the costs associated with each plan, including premiums, copayments, and deductibles.

• Premiums: The monthly cost of the insurance plan.
  
  
• Out-of-Pocket Costs: Copayments, deductibles, and coinsurance. For example, Medicare Part B covers certain telehealth services after you’ve paid the deductible, with a 20% coinsurance.
  
  
• Additional Fees: Any additional fees for using telehealth services, such as subscription fees for standalone telehealth plans.

Check provider networks

Ensure the plan has a network of providers that includes your preferred doctors and specialists. This can help you avoid out-of-network charges and ensure continuity of care.

Review policy terms

Read the policy terms and conditions carefully. Look for any exclusions or limitations on telehealth services (Upvio, n.d.). For example, some plans may limit the number of telehealth visits they cover per year.

Consider integration with an existing plan

If you already have a health insurance plan, check if the telehealth plan works seamlessly with your existing coverage to provide a more comprehensive healthcare solution.

Tips to Maximize Your Telehealth Insurance Benefits

Once you have chosen a telehealth insurance plan, here are some tips to get the most out of it.

Understand your coverage limits

Know the limits and restrictions of your coverage. This includes the number of visits covered and any specific conditions that apply (Upvio, n.d.). For example, some Medicare Advantage Plans offer more telehealth benefits than Original Medicare. 

Prepare for virtual appointments

Prepare for your virtual visit. Get your medical history and questions ready. Ensure you have a stable internet connection and a quiet, private space for the consultation.

Keep records

Maintain records of your telehealth visits and expenses to help you track your healthcare costs and manage your budget. Keeping detailed records can also be useful for any follow-up care or claims disputes.

Communicate effectively

Effective communication with your healthcare provider is key. Be clear about your symptoms and concerns. Beyond calling, you can use secure messaging within your patient portal to ask follow-up questions or clarify any doubts.

Stay informed

Keep track of any updates to your policy. Insurance plans can change, and staying informed ensures you continue to receive the best care. Check for updates from your insurance provider regularly, and review any new benefits or changes in coverage.

Use available resources

Take advantage of any educational resources provided by your telehealth platform. These resources can help you better understand your health conditions and treatment options, and empower you to make informed decisions about your care.

Conclusion

Telehealth insurance options have expanded significantly, providing us with more flexibility, convenience, and access to virtual care. However, navigating telehealth insurance options can be complex. By understanding the various plans available and considering your unique healthcare needs, you can select a telehealth insurance option that provides comprehensive coverage and peace of mind. 

Remember to review your policy on a regular basis and stay informed about new developments in telehealth insurance. Over time, insurance coverage will likely adapt their virtual care options to meet our changing healthcare needs. Take the time to explore your options and make an informed decision to ensure you’re getting the most out of your telehealth insurance coverage.

References

An Analysis of Private Payer Telehealth Coverage. (2021). Center for Connected Health Policy. Retrieved from https://www.cchpca.org/2021/04/Private-Payer-Telehealth-Coverage-Reportfinal.pdf

Bestsennyy, O., Gilbert, G., Harris, A. & Rost, J. (2021). McKinsey & Company. Retrieved from https://www.mckinsey.com/industries/healthcare/our-insights/telehealth-a-quarter-trillion-dollar-post-covid-19-reality

Centers for Medicare & Medicaid Services. (n.d.). Telehealth. Medicare.gov. Retrieved from  https://www.medicare.gov/coverage/telehealth

Cordina, J., Levin, E., Stein, G.  (2022). Consumer Health Insights: How respondents are adapting to the “new normal.” McKinsey & Company. Retrieved from https://www.mckinsey.com/industries/healthcare/our-insights/covid-19-consumer-healthcare-insights-what-2021-may-hold

Cost-Sharing Charges. (2023). Center on Budget and Policy Priorities. Retrieved from https://www.healthreformbeyondthebasics.org/cost-sharing-charges-in-marketplace-health-insurance-plans-answers-to-frequently-asked-questions/

Cuellar, A., Pomeroy, J. M. L., Burla, S., Jena, A. B. (2022). Outpatient Care Among Users and Nonusers of Direct-to-Patient Telehealth: Observational Study. Journal of Medical Internet Research;24(6):e37574. doi:10.2196/37574 

Five key features telehealth patients want: Insights for healthcare developers. (2023). Wolters Kluwer. Retrieved from https://www.wolterskluwer.com/en/expert-insights/5-key-features-telehealth-patients-want-healthcare-developers-insights

Hasselfeld, B. W. (n.d.). Benefits of Telemedicine. Johns Hopkins Medicine. Retrieved from https://www.hopkinsmedicine.org/health/treatment-tests-and-therapies/benefits-of-telemedicine

How to Check Telehealth Insurance Coverage. (n.d.). Upvio. Retrieved from https://upvio.com/blog/telehealth/how-to-check-telehealth-insurance-coverage

Lee, E. C., Grigorescu, V. Enogieru, I., Smith, S. R. Samson, L. W., Conmy, A. B., & De Lew, N. (2023). Updated National Survey Trends in Telehealth Utilization and Modality (2021-2022). Assistant Secretary for Planning and Evaluation (ASPE). Retrieved from  https://aspe.hhs.gov/sites/default/files/documents/7d6b4989431f4c70144f209622975116/household-pulse-survey-telehealth-covid-ib.pdf

Private insurance coverage for telehealth. (2023). Health Resources & Services Administration (HRSA). Retrieved from https://telehealth.hhs.gov/providers/billing-and-reimbursement/private-insurance-coverage-for-telehealth 

Rakshit, S., Rae, M., Claxton, G., Amin, K., & Cox, C. (2023). Private Insurer Payments for Telehealth and In-Person Claims During the Pandemic. Kaiser Family Foundation. Retrieved from  https://www.kff.org/mental-health/issue-brief/early-in-the-pandemic-private-insurers-paid-similarly-for-common-telehealth-and-in-person-claims/

Schwamm L.H., Chumbler N., Brown E., et al. (2017). Recommendations for the implementation of telehealth in cardiovascular and stroke care: a policy statement from the American Heart Association. Circulation;135(7):e24–e44. doi: 10.1161/CIR.0000000000000475

Stay Informed on COVID-19. (2020). Health Care Service Corporation. Retrieved from  https://www.hcsc.com/newsroom/category/company-news/covid-19-information/

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