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Private Payer Telehealth Coverage During the Public Health Emergency

By January 19, 2021January 27th, 2021No Comments

The COVID-19 pandemic has placed renewed focus on the United States’ insurance-based health care system. In March 2020, the largest U.S. health insurers announced that they would waive cost-sharing obligations for COVID-19 tests and treatment, including for telehealth visits. This signaled a different approach from America’s health insurance industry in combating the spread of the virus. What followed was a series of temporary and, in some cases, permanent changes to payer’s telehealth coverage policies. CCHP staff analyzed coverage policies and bulletins for the largest U.S. private payers and summarized the findings in a new report, Private Payer Telehealth Coverage During the COVID-19 Pandemic.

The report builds on CCHP’s COVID-19 research and resources by detailing the efforts that major U.S. health insurance carriers took to expand telehealth access in response to the pandemic. The eligibility windows for these policy changes ranged from March 2020 through the end of the public health emergency (PHE). We focused our analysis on private payer policies that were implemented prior to November 25, 2020. The report provides an overview of the key findings from our analysis and discusses their implications. Among those findings, five stood out:

  1. All of the national insurance carriers voluntarily expanded telehealth coverage for their commercial health plans on a temporary basis during the PHE.
  2. Nearly all major insurers (6 of 7) waived cost-sharing for COVID-19 telehealth treatment services and also for non-COVID primary or urgent care telehealth visits.
  3. Four major insurers agreed to cover limited out-of-network telehealth services, with at least 1 major payer (Anthem Blue Cross Blue Shield) waiving cost share obligations for out-of-network telemedicine visits through Spring 2020.
  4. Six major payers agreed to reimburse providers at the in-person rate, including for audio-only services.
  5. The majority of these expansions expired by the end of 2020, while a limited number of payers aligned expiration with the end of the PHE.

It is important to point out that because we conducted our analysis in Fall 2020, we anticipate that many of the coverage policies discussed here may have not been extended by payers and will have expired by the time this report is published. Still, these changes represent a seismic shift from business as usual in private payer telehealth coverage. While many of the more expansive changes have expired, some payers have extended their temporary coverage into 2021 and a few will become permanent. In particular, the Centers for Medicare & Medicaid Services (CMS) recommendations around audio-only coverage and expanding the originating site to include the home, are likely to become a fixture of major private payer telehealth policies in 2021 and beyond. At least 1 large national carrier has already added several common telehealth services covered during the PHE to their 2021 reimbursement policy. These developments have presented private payers with a unique opportunity to reassess their telehealth coverage policies in light of utilization trends and consumer preferences prompted by COVID-19.

Click here to view to An Analysis of Private Payer Telehealth Coverage During the COVID-19 Pandemic