Medicare covers telemedicine visits the same way it covers in-person office visits, but only through certain providers and only for certain types of care.

Medicare Part B pays for video visits with your doctor, nurse practitioner, or physician assistant if they are enrolled in Medicare and you have an established relationship with them — meaning you have seen them in person within the past three years. The visit must take place through a HIPAA-compliant platform, which means a find video system that protects your health information. Your doctor's office will tell you which platform they use.

You pay the same copay or coinsurance as you would for an office visit. If you have not met your deductible, you pay the full cost until you do. If you have a Medigap or Medicare Advantage plan, your out-of-pocket cost depends on that plan's rules, not on Medicare's.

Key Takeaways

  • Medicare Part B covers video visits with doctors, nurse practitioners, and physician assistants you have seen in person within the past three years.
  • The visit must use a HIPAA-compliant platform — your provider's office will tell you which one they use and how to access it.
  • You pay the same copay or coinsurance as an office visit, and your deductible still applies.
  • Mental health visits, therapy, and psychiatry visits by video are covered under the same rules as in-person visits.
  • Some types of care — physical exams, lab work, imaging — cannot be done by video and require an in-person visit.

Which Providers Can Offer Telemedicine Under Medicare

Your provider must be enrolled in Medicare to bill for a telemedicine visit. This means they have a Medicare provider number and a contract with Medicare. If you are unsure whether your doctor is enrolled, call their office or check the Medicare Provider Enrollment, Chain, and Ownership System (PECOS) on the Centers for Medicare & Medicaid Services website.

You must also have an established relationship with the provider. This means you saw them in person at least once within the three years before the telemedicine visit. A visit to an urgent care or emergency room does not count as an established relationship for telemedicine purposes — it has to be an office visit with that specific provider.

If you have never seen a doctor before and want to start with a telemedicine visit, Medicare will not cover it. You will need an in-person visit first.

What Types of Visits Medicare Covers by Video

Medicare covers telemedicine for most routine office visits: follow-ups for chronic conditions like diabetes or high blood pressure, medication management, mental health counseling, and discussions about test results. If your doctor thinks a video visit is appropriate for your situation, they can offer it.

Mental health visits — including therapy with a licensed clinical social worker, psychologist, or psychiatrist — are covered by video under the same rules as in-person visits. You pay the same copay.

Some care cannot happen by video. Physical exams that require the doctor to touch you, blood draws, imaging like X-rays or ultrasounds, and procedures all require you to be in the office or at a lab or imaging center. If your doctor thinks you need these, they will schedule you in person.

How to Set Up a Telemedicine Visit

Call your doctor's office and ask if they offer telemedicine visits. They will tell you whether your provider participates and which platform they use. Common platforms include Zoom for Healthcare, Cisco Webex, and practice-specific systems. Your doctor's office will send you a link or instructions on how to join.

You will need a device with a camera and microphone — a computer, tablet, or smartphone — and a stable internet connection. Test your device and connection before the visit. Join a few minutes early so you can troubleshoot any technical problems.

Bring your insurance card and a list of any medications you are taking. Have your blood pressure cuff or other monitoring equipment ready if your doctor asked you to check your vitals before the visit.

What You Pay for Telemedicine Visits

Your cost depends on what type of Medicare coverage you have. If you have Original Medicare (Part A and Part B), you pay 20 percent of the Medicare-approved amount after you meet your Part B deductible. Most office visits cost between $15 and $50 out of pocket, but the exact amount varies by provider and location.

If you have a Medicare Advantage plan, your copay for a telemedicine visit is set by your plan and may be different from your in-person copay. Some plans charge less for telemedicine; others charge the same. Check your plan documents or call your plan to find out.

If you have a Medigap policy, it may cover some or all of your coinsurance, depending on which Medigap plan you have. Your Medigap policy works the same way for telemedicine as it does for office visits.

Telemedicine and Your Deductible

Your Part B deductible still applies to telemedicine visits. If you have not met your deductible for the year, you will pay the full Medicare-approved amount for the visit until you do. Once you meet your deductible, you pay 20 percent.

The deductible resets on January 1 each year. If you are tracking your deductible, ask your doctor's office to tell you the Medicare-approved amount for your visit so you know how much counts toward it.

When Medicare Does Not Cover Telemedicine

Medicare does not cover telemedicine visits with providers who are not enrolled in Medicare, even if they accept Medicare patients for in-person visits. If your provider is not enrolled, you will have to pay out of pocket.

Medicare does not cover telemedicine for a first visit with a new provider. You must see them in person first to establish a relationship.

Some types of mental health care — such as intensive outpatient programs or partial hospitalization — have different rules and may not be available by telemedicine. Ask your provider or your Medicare plan whether your specific type of care can be done by video.

Frequently Asked Questions

Do I need to use my doctor's specific platform, or can I use Zoom or another app I already have?

Your doctor's office will tell you which platform they use, and you will need to use that one. They choose a HIPAA-compliant platform to protect your health information. You cannot substitute your own Zoom account or other app, even if you already have it.

What if I do not have internet or a device to do a video visit?

Call your doctor's office and explain the situation. Some offices can do a phone visit instead, though Medicare's coverage rules for phone visits are narrower than for video. Your doctor can tell you whether a phone visit is an option for your care.

Can I do a telemedicine visit from another state, or do I have to be in the state where my doctor is?

You can be in another state. Medicare covers telemedicine regardless of where you are located. However, some states have their own rules about where providers can practice, so your doctor's office may have restrictions. Ask them before you travel.

If I use telemedicine, does Medicare still count it as a visit for my annual wellness visit?

Yes. A telemedicine wellness visit counts the same as an in-person one. Medicare covers one wellness visit per year at no cost to you (after you meet your deductible). You can do this by video if your doctor offers it.

What happens if my internet cuts out during the visit?

Tell your doctor's office right away. They can reschedule the visit or, if most of the visit was completed, they may still bill Medicare for it. Do not assume the visit did not happen — contact the office to confirm what was covered and what needs to be rescheduled.