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New CMS Rule Gives Telehealth for Medicare Advantage a Boost

• Author: Healthcare Team

telehealth for medicare advantage

More telehealth services coming to a Medicare Advantage plan near you? This could be the reality, as the Centers for Medicare and Medicaid Services (CMS) issued a final rule earlier this month that will allow Medicare Advantage (MA) plans to offer telehealth services as a part of their basic government funded benefits package. Prior to this rule, Medicare Advantage plans could include telehealth services only as a supplemental benefit. Also, the new rule lifts any geographic restrictions limiting telehealth options. Seniors will now be allowed to use telehealth services at home, rather than having to go to a previously designated healthcare facility. Such changes take effect for the 2020 plan year.

According to the U.S. Census Bureau, the total population of Americans aged 65 and older will reach 71 million by 2030, which equals about 20 percent of the overall population. Also by 2030, there will be a shortage of between 40,800–104,900 physicians, according to a study from the American Association of Medical Colleges (AAMC). With this in mind, telehealth could play an increasingly important role in meeting the growing needs of the Medicare-eligible population while also saving payers money.

The growth of telehealth in the Medicare space has been slow due to barriers such as geographic restrictions, reimbursement regulations for payers and strict government policies. Business Insider points out that these moves by CMS should increase the growth of telehealth and telemedicine adoption. They also call this policy change a “precursor to increased legislation favoring telehealth.”

It’s important to note that even with these policy changes, consumers, particularly seniors, have not embraced telehealth with open arms. The APNORC Center’s LongTerm Care Poll cites concerns with lower-quality care, security of their health information and privacy. However, the poll also found that adults ages 40 and older are just as likely as those ages 18-39 to be comfortable using at least one form of telemedicine. It is one thing to address payment issues and access to telehealth services, but it is another to change consumer behavior.

Overall, CMS continues the trend of allowing greater flexibility to Medicare Advantage plans. We recently wrote about changes that allow MA plans to tailor benefit packages to patients with specific chronic conditions, also for the 2020 plan year. With greater flexibility comes more opportunity for product teams to design unique Medicare Advantage plan offerings. It will be an interesting AEP for healthcare marketers, as MA plans compete for patients based on both the new telehealth and supplemental benefits and overall costs. Healthcare marketing teams need to be ready to promote these new benefits once a company or a client adds them to their suite of products.

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