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In 2020, your Medicare Advantage beneficiaries may be covered for telehealth. Here's how to prepare.

January 22, 2019

    If you don't think Medicare patients are big consumers of telehealth services, you're right—only about 4% of Medicare beneficiaries have tried a virtual visit. Generational differences are likely one driver of this low uptake, but another major reason is that CMS reimbursement has been limited for Medicare beneficiaries.

    However, late last year, CMS proposed a rule that might change that—at least, for Medicare Advantage (MA) patients.

    CMS proposed rule

    Currently, MA plans do have the option to expand their telehealth offerings beyond what is available under traditional Medicare—but they are limited to using a small pool of bonus dollars that can be used in a number competing ways (think fitness benefits or eyewear). Amid these competing priorities, offering telehealth benefits can be left aside.

    The proposed rule stipulates that, in 2020, plans will be able to use their entire pool of benefit dollars to finance broad telehealth coverage. While MA plans will not be required to expand telehealth coverage, they will have the option to fund it in a much more budget-friendly way. Many observers expect that the result of this policy change is that we'll see much bigger uptake of telehealth from Medicare Advantage plans starting in 2020.

    Let's be clear: Not all Medicare beneficiaries will be affected by this policy change. It only applies to MA—not Medicare Fee-For-Service (FFS). But, given that more than 40% of Medicare beneficiaries are expected to be in MA plans by 2025, a significant chunk of your Medicare population could soon have broad telehealth coverage.

    No matter where you are in your telehealth journey, here is how you can attract and cater to Medicare patients:

    Reduce the friction around trying a first virtual visit

    Just because patients have telehealth coverage does not mean they will automatically use it. MA patients have unique preferences that providers must appeal to in order to engage these patients.

    According to our Virtual Visit Consumer Preferences Survey:

    • Clinician buy-in begets consumer buy-in: We found that 28% of Medicare beneficiaries would definitely or probably try a virtual visit if their provider suggested it. A recommendation from someone they already trust for medical advice is likely to encourage these patients to make the leap, especially if technology is not second nature to them. Providers who mobilize their clinical staff to promote the service might have better luck convincing MA patients to use virtual care.

    • Make the first one free: Let the value of your telehealth program speak for itself before expecting people to pay for what they may see as daunting and unfamiliar. Two-in-five Medicare patients said they would definitely or probably try a virtual visit if it was free.

    Structure your program around MA patient preferences to earn their loyalty

    Consumer preferences can be a helpful compass not only for attracting patients—but also for keeping them once you've launched your program. According to our Virtual Visit Consumer Preferences survey, Medicare patients would much rather do a virtual visit with their provider than with a different provider from the same practice. Here are two ways to make this possible:

    • Encourage all clinicians to block off dedicated telehealth hours, where they conduct virtual follow-ups with their regular patients.

    • Incentivize clinicians who participate in your telehealth program, perhaps factoring telehealth-related metrics into bonus calculations (a tip from Lyle Berkowitz, CMO of MD Live).

    If your program is not yet ready to cater to patients' specific preferences, remember that this policy won't come into effect until 2020. Early-stage telehealth programs can use the next year to plan for an increased demand from MA patients by paying attention to what this market wants out of virtual care.


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