Paige Cerulli Last Updated On: April 24, 2024

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Telehealth Insurance Coverage

Telehealth Insurance Coverage

Thanks to telehealth, you can access quality healthcare right from your home. Telehealth, also called telemedicine, has rapidly grown in popularity, and more medical offices offer these remote services.

But just like an in-person appointment, you’ll want to consider whether your health insurance covers your healthcare services. Is telehealth covered by insurance? Here’s what you need to know before you schedule an appointment.

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What Do Telehealth Visits Cost?

The cost of your telehealth visit depends on several factors. The type of consultation or service will affect the cost, with mental health services generally being more expensive than standard telehealth or sick visits.

In addition to the cost of your telehealth appointment, some providers may charge extra for prescribing medication. The cost of your visit can also vary from provider to provider.

Telehealth appointments may help you save money. One study found that the cost of a telehealth appointment for an acute respiratory infection averaged $79, while a physician office visit for the same condition averaged $146. Keep in mind that you’ll save on gas and even minimize the amount of time you need to take off of work when you schedule a telehealth appointment instead of an office visit.

Is Telehealth Covered By Insurance?

So, does insurance cover telehealth? Usually, yes. Most private pay health insurance companies cover at least some of the cost of a telehealth appointment. As telehealth became more widespread during the COVID-19 pandemic, insurance companies started to cover these services.

Additionally, there are now laws in many states requiring private insurance companies to cover a portion of the cost of telehealth services, but these laws vary. All 50 states require reimbursement for video telehealth appointments, but fewer states require reimbursement for remote patient monitoring services. You can easily see the laws in your state using the Center for Connected Health Policy’s Policy Finder.

Things get even trickier when you explore the coverage each insurance company offers. Every insurer develops their own telehealth coverage, so reimbursement rates and the types of visits covered may differ. Preferred provider organization (PPO) plans are more likely to cover telehealth than health maintenance organization (HMO) plans, so you’ll need to consider the specific coverage your plan offers.

Before you schedule a telehealth appointment, contact your insurance company to find out exactly what’s covered. It’s helpful to have information about the type of telehealth appointment, like whether it’s a phone or video appointment, the provider’s information, and the reason for the appointment. Your insurance company can tell you whether the service is covered and your copayment amount. 

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How to Pay for Telehealth Without Insurance

You can still have a telehealth appointment without insurance coverage, but you must pay out of pocket for the service. Some providers charge a flat fee, while others have a sliding appointment pay scale. If you have a limited income, a sliding scale fee may mean you’ll pay less for the appointment.

If you’re open to changing providers, you can shop around to save money on your visit. Contact providers and ask about their telehealth appointment rates. Some companies may also offer discounts, so ask about any discounts you might qualify for.

While you might pay for a few telehealth appointments out of pocket, health insurance can help you afford more regular telehealth services if you need them. Get free, personalized health insurance quotes today to explore available policies and find the coverage that’s best for you.

Paige Cerulli Paige Cerulli is a freelance content writer and journalist who specializes in personal finance topics. She graduated from Westfield State University and brings more than a decade of professional writing experience to the ConsumerCoverage team. Paige’s work has appeared in outlets including USA Today, Business Insider, and more.

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