Understanding Telemedicine Coverage for Health Insurance
By Krista DeKuyper | March 21, 2025 |
In recent years, telemedicine has emerged as a powerful healthcare alternative. With telemedicine, patients are able to seek out advice from healthcare professionals without having to leave home. Telemedicine rose in prominence during the pandemic. It enabled those infected with COVID-19 to receive medical advice without spreading the virus. Since then, it’s remained a convenient pathway to medical care, actively included in most health insurance plans. For policyholders, understanding how telemedicine is covered under your plan is crucial. This article will delve into what telemedicine is, how insurance covers it, and the costs associated. We’ll also provide expert guidance on when to opt for telemedicine versus in-person consultations.
What is Telemedicine?
Telemedicine is the remote delivery of healthcare services, usually via phone or video conferencing software. Telemedicine is used for routine check-ups, specialist consultations, mental health services, and follow-up care for chronic conditions. With timely access to medical advice and care, telemedicine has become a preferred option for many patients.
Telemedicine Coverage Under Health Insurance
As a new way to receive medical care, how exactly does telemedicine coverage work, and how does it differ between providers? Many insurers offer telemedicine coverage in a similar manner to in-person visits. To be eligible, telemedicine services must be provided by a licensed healthcare professional.
- Types of Services Covered: Consultations with primary care physicians, specialists, mental health providers, preventative care services.
- Regulatory Considerations: Regulatory bodies across Canada have expanded telehealth policies to facilitate access to care. This has led insurers to temporarily broaden coverage for telemedicine in response to increased demand.
- Network Providers: Coverage may vary with telehealth providers that are out-of-network. Patients seeking out telehealth services should verify through their policy or by speaking to their insurance directly that the provider is in-network or eligible for coverage.
Cost and Payment for Telemedicine Services
Policyholders will have their telemedicine services covered either partially or fully by their insurance provider. The amount you pay for telemedicine services will differ based on your health insurance plan. Here are some common costs associated with telemedicine while under insurance:
- Copayments and Fees: Some insurance plans will require patients to pay a copayment for telemedicine visits. In this case, your insurance provider will cover your telehealth expenses partially, requiring you to pay a certain amount out-of-pocket. Check to see if there are any copayments associated with your telemedicine coverage, and if the same copayment amount applies to in-person visits.
- Out-of-Pocket Costs: Health insurance plans with high deductibles require patients to pay a specific out-of-pocket amount before coverage kicks in. A common example of a high-deductible policy is a catastrophic health insurance plan. Keep this deductible in mind while seeking out telemedicine services and ensure you’re in a place financially to pay out-of-pocket when necessary.
- Billing for Telemedicine: Generally, telemedicine providers do not bill in the same manner than in-person providers do. Inform yourself on your telemedicine provider’s billing practices and don’t be afraid to ask questions. This will help you not miss any payments and file claims accordingly.
When to Use Telemedicine Services vs. In-Person Services
There are some scenarios where telemedicine will leave gaps in your healthcare needs. Let’s quickly list a few examples of when to choose telemedicine vs. in-person healthcare services.
Use Telemedicine Services When:
- You require a follow-up consultation for a previously diagnosed condition.
- You are experiencing mild to moderate symptoms that do not require a physical examination.
- You seek mental health support or counseling.
- Transportation is a concern, or you live in a remote area.
- The illness you could have is highly contagious.
Use In-Person Health Services When:
- You have severe, acute symptoms that require immediate attention or a physical examination.
- You need diagnostic tests that cannot be performed remotely (e.g., blood tests, imaging).
- Your doctor recommends an in-office visit for specific treatments or assessments.
Telemedicine Coverage with HealthQuotes
Want a plan that delivers when it comes to telemedicine? Look no further than HealthQuotes to find a plan that meets all your criteria. Working with a large library of insurance carriers throughout Canada, our guidance is solely based on client needs. We provide service with no pressure or obligation when it comes to insurance quotes. If you’re confused by the insurance world and would like expert guidance and advice, speak to an HealthQuotes insurance agent. We can find you a health insurance plan that combines sufficient health, dental, and prescription drug coverage.
