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Medicare has more restrictive rules for telehealth payments than Medicaid and many private insurers, despite the fact that virtual doctor visits are perceived to be of particular benefit to seniors who have a hard time making it to the clinic. The concern—expressed by some private payers, as well—is that patients would access telemedicine then end up seeing a clinician in person anyway, resulting in a double-hit for the insurer. Medicare reserves telehealth payment mainly for seniors who live in rural communities. According to the National Conference of State Legislatures, standards for Medicaid and private payers are on the books in 34 states, while 15 have standards just for Medicaid; only Rhode Island has no policy. On the federal level, Congress is mulling over the CONNECT for Health Act, which would make telehealth and remote patient monitoring standard for Medicare’s alternative payment models and Medicare Advantage. Advocates say the bottom line is that telehealth facilitates care outside of traditional hours or in areas underserved by healthcare, and eliminates the cost associated with travel and wait times (though payers would likely point out that none of those expenses detract from their bottom line or add to the health system’s burden).

Cost Concerns Have Medicare Lagging in Telemedicine