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Category: Blog

Telemedicine During and After COVID: The Future of Telemedicine

Telemedicine is being widely adopted as the new normal. But what happens when the pandemic is over and we return to our regular routines? Will telemedicine continue to be the standard healthcare model? Since the pandemic has created so much uncertainty, telemedicine will likely continue to be a necessity, not just a luxury, for the foreseeable future.

Telemedicine Before the Pandemic

The pandemic created a unique situation that forced us to think differently about our healthcare access. With millions of people falling ill to a single disease, the need for urgent care was exponentially higher.

This significantly overwhelmed the medical system. It became harder to see a doctor in person, even for those suffering from other serious illnesses that needed immediate care.

According to records from the CDC, in 2020, approximately 37.7% of U.S. adults reported being unable to receive one or more types of care due to the pandemic. As of June of 2021, those numbers still hover around 12.7%.

Luckily, telemedicine has been able to fill in the gaps. Telemedicine allows doctors to provide care to their patients remotely, without ever seeing them in person. This will enable doctors to provide the best possible care to their patients, even when they can’t be physically present.

Telemedicine During the Pandemic

During the pandemic, telemedicine has been a lifeline for patients who might not otherwise have access to the care they need.

In one study done by the U.S. Department of Health and Human Services and the Assistant Secretary for Planning and Evaluation, in 2020, the share of Medicare visits conducted through telehealth increased 63-fold – from approximately 840,000 in 2019 to nearly 52.7 million.

As of December 2021, the CDC reported that approximately 19.7% of U.S. adults had a telehealth appointment (either over video or over the phone) within the last four weeks.

While many areas within the U.S. have allowed patients to return to their regular healthcare providers, telemedicine has played an essential role in providing care to those still suffering from the pandemic. It has also allowed for a smoother transition back to routine healthcare.

However, as COVID cases begin to resurge with approximately 1.35 million new cases on Jan. 11th alone – telehealth is once again proving to be a crucial tool for providing care to those who need it most.

The pandemic has also led to significant changes in how we think about telemedicine. In the future, we will likely see an increase in the use of telemedicine.

Not only does it help to free up medical staff, but it also opens up new doors for patient care. Here are a few ways that telemedicine will continue to shape the healthcare landscape in the future:

1. Improve Chronic Care Management

Telemedicine could improve how we manage chronic illnesses, especially those that require frequent follow-up visits. This is especially the case for those who cannot travel to their healthcare provider. With telemedicine, they can continue receiving the care they need, even if they cannot make the trip to the doctor’s office.

2. Improve Access to Primary Care

Telemedicine can provide a more streamlined process for accessing primary care for those with limited access to healthcare. One of the most common reasons people cannot access healthcare is because they are unable to travel to the doctor’s office. With telemedicine, there is no need to travel. Instead, patients can receive care from the comfort of their own homes. This also helps reduce the burden on the healthcare system and helps to keep costs down.

3. Improve Patient Experience

Telemedicine can provide a better patient experience. With telemedicine, patients can have a more personalized experience with their healthcare providers. Since they can schedule a telemedicine appointment at a time that works best for them, they are more likely to follow through. This not only helps to improve their health, but it also helps to improve their overall experience.

4. Increase in Integrated Data Sharing

The pandemic has also significantly impacted how we think about data sharing. Telemedicine allows for an increase in the amount of data shared between healthcare providers and their patients.

That’s because many telemedicine applications have started integrating with popular health platforms and apps. This allows for the secure transfer of patient data between providers and their patients. This improves the quality of care provided and helps increase the amount of data used to improve care and treatment.

Telemedicine Designed to Let You Take Charge of Your Health 

When it comes to your health, it’s essential that you have the ability to take charge. That’s why telemedicine has been such a game-changing technology. With the ability to access your healthcare provider remotely, you can take control of your health. That’s because you can access care when you need it most, regardless of where you live or what you can physically do. So, don’t be afraid to take full advantage of the telehealth options available to you!

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How Can Medicare Advantage Members Maximize Benefits

The rising cost of medication can be a significant concern for many health care consumers. Still, Medicare Advantage members can take advantage of the savings that come with using a Medicare Advantage plan. But how can members maximize the benefits of their medication coverage? Let’s take a closer look at how you can get the most out of a Medicare Advantage plan and your medication benefits.

What is the Medicare Advantage Plan?

A Medicare Advantage plan is a type of health insurance that provides coverage for Medicare services, including prescription drug coverage. This type of plan is sometimes referred to as a “Part C” plan because it is a type of “compliment” to the traditional “Part A” and “Part B” coverage provided under traditional Medicare.

Unlike traditional Medicare, which is partially financed through federal tax dollars, Medicare Advantage plans are privately run and paid for through premium dollars, much like other types of private health insurance. They offer comprehensive coverage, and in most cases, enrollees enjoy more significant benefits and lower costs than those provided under traditional Part A and Part B Plans.

How do Medicare Advantage Plans Work?    

Most Medicare Advantage plans are managed care plans, meaning that they provide health services to members through a network of contracted physicians, hospitals, and other providers.

They also typically offer comprehensive coverage for prescription drug costs, with lower out-of-pocket costs than those generally associated with traditional Medicare.

As with other types of health insurance, it is essential to learn about the specific details of your plan, including the benefits, exclusions, and limitations, as well as the costs associated with both primary and specialty care. This will allow you to make the best possible decisions concerning your health care needs and maximize the value of your coverage.

What Medications Does the Medicare Advantage Plan Cover?

Most Medicare Advantage plans offer comprehensive prescription drug coverage, including the most commonly prescribed medications for cholesterol, high blood pressure, diabetes, and other conditions.

As with other types of private health insurance, the specific medications covered under your medication plan will vary depending on the specifics of your plan. In most cases, this will include the most commonly prescribed drugs, with coverage for all other medications determined on a case-by-case basis.

This means that you should always double-check with your plan administrator to determine the specific medications covered under your plan’s drug list.

How Does Clear Spring’s Medicare Advantage Plan Compare to Others?

Clear Spring Health has worked hard to provide the highest level of benefits and value for our members, and our Medicare Advantage plans are no exception. Not only do we offer Medicare Advantage and stand-alone Medicare Part D products, but we also offer Medicare Advantage Prescription Drug (MAPD) plans that allow you access to all your Medicare benefits, plus extra no-cost programs and services in a single, convenient plan.

This means that our MAPD plans include prescription drug coverage with both HMO and PPO plans. This provides you with the additional benefits and savings associated with a Medicare Advantage plan without purchasing separate prescription drug coverage.

With HMO and PPO options, you have the flexibility to choose the coverage that gives you the best possible value for your needs and preferences. In most cases, this will mean that you can select a plan with the highest level of prescription drug coverage that also provides the greatest level of value for your premium dollars.

How Medicare Advantage Members Can Maximize their Medication Benefits

As a Medicare Advantage member, you have access to all of your Medicare benefits and services, including prescription drug coverage. Your plan may offer a wide variety of prescription drug coverage options, which will provide you with the opportunity to maximize your medication benefits.

While familiarizing yourself with your drug list and what is covered and what isn’t is the first step in maximizing your medication benefits, you also want to become familiar with your extra benefits.

Depending on your unique plan, your extra benefits could entitle you to such things as free vision, hearing, and over-the-counter medications. By taking advantage of these additional benefits, you can maximize the value of your plan and ensure that you are taking full advantage of your coverage.

Of course, you can also consider adding a stand-alone Prescription Drug Plan (PDP) to your current benefits. With Clear Spring, we offer both a Value and Premier PDP that can help you maximize your medication benefits:

  • Value: Offers comprehensive coverage with low copays and deductibles.
  • Premier: Offers affordable premiums, no deductibles for Tier 1 and 2 medications, and  low copays for generic drugs

Note: Each plan can and will vary by patient and location. To get the most accurate information, complete our online enrollment form or call 1(877)364-4566 for more information. 

Clear Spring Health Medicare Advantage Plans

As a Medicare Advantage member, you have access to all of your Medicare benefits and services, including prescription drug coverage. Your plan may offer a wide variety of prescription drug coverage options, which will provide you with the opportunity to maximize your medication benefits. So, make sure you are taking the time to familiarize yourself with all your options and reach out to your provider should you have any questions or concerns.

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HMO vs. PPO: How to Select the Best Healthcare Plan for You

Choosing a healthcare insurance plan requires knowing which type of coverage you need. You can choose between a health maintenance organization (HMO) or a preferred provider organization (PPO). 

So, what is an HMO versus. a PPO and how do you know which one will be the best plan for you? When considering an HMO or a PPO, you must understand what each plan covers and the associated costs.

To help you figure out which plan to select, you can take a moment to review this guide that explains what each plan is and what advantages each one has to offer. 

It will also cover the frequently asked questions people have when making their choice. That way, you can make an informed decision and one that meets your specific needs and those of your family.  

 

PPO vs. HMO: Which is Better?

You will need to consider your healthcare coverage needs based on medical history to answer this question. Do you have pre-existing conditions that will require specialist referrals? 

Also, you will need to think about what type of out-of-pocket expenses you can afford or whether you want to visit a doctor outside of your network. Determine what your expectations are when seeking care. 

Another way to determine which plan better for you is to consider whether you want to wait to file a claim for reimbursement for services you pay for upfront. That is how you can determine which plan is better for you. 

 

FAQs About Selecting an HMO vs. a PPO

Everyone’s healthcare preferences are specific to their individual needs. Here are some frequently asked questions people inquire when looking for the right way to meet those needs. 

 

How much will each plan cost? 

HMO: Lower Costs

An HMO plan will generally offer lower monthly premiums. You will also pay less out of pocket for doctor visits if any payment is required.

PPO: Higher Costs 

PPOs often have higher monthly premiums. However, you get the flexibility to use both in and out of network providers without needing a referral. You can expect to pay more for medical costs out of pocket.

 

Do I need to have a primary care physician?

HMO: Yes

Your primary care provider (PCP) will coordinate your healthcare service. You will not be able to see a specialist without a referral from your doctor.  

PPO: No

Under a PPO plan, you are not required to have a PCP, nor do you need that provider to refer you to a specialist
.

Do I need a referral to see another doctor? 

HMO: Yes

To obtain a referral from your PCP, you will need to schedule an appointment with your doctor. They will then refer you to see a specialist or other doctor based on their assessment.

PPO: No

A PPO plan does not require that you obtain a referral for any services or care you need.

 

Will each plan cover the costs if I see a specialist or an out-of-network doctor?

HMO: No

You will not be covered under an HMO if you seek care with a provider outside of your network. The only time you can see an out-of-network doctor is for medical emergencies.

PPO: Yes

PPO plans offer you the flexibility to see any doctor you wish. You can even see one outside of your network. Do keep in mind, you will pay more to visit the out-of-network doctor, and you will have to pay a separate deductible with that provider.

 

Do I need to file a claim?

HMO: No

There is no requirement to file a claim with your HMO plan in most cases. The reason is that in-network providers are covered, and your insurance provider pays the doctor directly.

PPO: Yes

If you see a doctor who is not in your network, you will have to pay the doctor directly. Your PPO plan will then require you to file a claim to have the insurance provider reimburse you for the visit and the treatment provided. 

 

Choosing Your Healthcare Plan

The significant differences between an HMO versus a PPO may help you determine which plan you should choose. However, that requires you to know what you are looking for in a provider.

If you still are unsure which coverage option is best for you, speak to a healthcare plan member services professional. They can tell you more about each plan based on your current situation. 

In general, an HMO may make more sense for you if lower costs and fewer out-of-pocket expenses are important to you. If you would rather have the flexibility to see any provider you want without waiting on a PCP referral, a PPO might be best. 

A PPO is also a better option if you already have a team of medical professionals managing your care that do not belong to your network.

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Does Medicare Cover Hearing Tests and Hearing Aids?

How to Understand Your Coverage?

Hearing problems are common for people 65 years and older and advance as they age. For those on Medicare, hearing care coverage is a viable concern. When it comes to Medicare, hearing care has extremely restrictive coverage. Some Medicare plans do not cover them at all. There are supplemental plans that cover all or a portion of these services. 

To know if your specific Medicare plan covers the cost of a hearing test or a hearing aid requires understanding your coverage. Supplemental plans available include:

  • Medicare Part A
  • Medicare Part B
  • Medicare Part C

Some services cover hospice care and prescriptions. This article will not address the coverage for these plans. You can read more about them on the plan comparison chart on the Medicare website.

To learn more about whether your Medicare healthcare plan covers hearing care, this article will break down this information for you.  

Does Medicare Cover Hearing Tests?

According to the Medicare website, “Medicare doesn’t cover hearing exams, hearing aids, or exams for fitting hearing aids.” However, there are circumstances in which Medicare will cover some costs of a hearing exam.

If your primary care physician (PCP) or one of your other doctors recommends an exam, Medicare will cover the cost. It will require this referral for Medicare to pay for your hearing test. 

Medicare Part B plans cover diagnostic exams and balance exams if one of your healthcare providers determines one is necessary. If one of your doctors determines you need medical treatment for issues unrelated to general hearing loss, they will order an exam.

For example, your doctor will refer you for a hearing test if you sustain injury to your head or experience an illness that affects your hearing. Although, you will have to pay 20% of the Medicare-approved costs.

Does Medicare Cover Hearing Aids?

No. Original Medicare plans do not cover the costs of hearing aids. According to the Medicare website, “Medicare doesn’t cover hearing aids or exams for fitting hearing aids. You pay 100% for hearing aids and exams.”

If you enroll in one of the supplemental plans, you may qualify for additional coverage for hearing care. These plans are known as Medigap, and cover vision, dental, and hearing care for some services. You will need to contact the plan provider for specific information about what your supplemental plan covers. 

Alternatives to Medicare for Hearing Test and Hearing Aid Coverage

Are you one of the more than 62 million Americans enrolled in Medicare with questions about what alternative to Medicare will cover your hearing care needs? Here are three that may help you with the costs associated with hearing care:

1. Medicaid  

Medicaid is a federally funded program in the United States for people who need help with their healthcare costs and with limited resources and income. There are dual health plans for individuals with Medicaid and Medicare. It can offer additional coverage for things like:

  • Medical treatments
  • Prescriptions
  • Exams
  • Medically prescribed devices (like hearing aids)

Depending on your age, financial circumstances, and the state you reside in, you may be able to receive Medicaid coverage for hearing care and hearing aids. There are resources available that break down this coverage based on the state where you live. 

2. Medicare Advantage Plans 

Known as Medicare Part C, this plan covers more than other Medicare plans do. You may receive dental, vision, and hearing care under Medicare Advantage Plans. You can also receive coverage on fitness and over-the-counter (OTC) medications. 

You can enroll in this plan at extremely affordable monthly premiums, depending on the area where you live. Your all-inclusive health plan may offer:

  • $0 (or low) plan premiums (subject to your state of residence)
  • $0 copay for PCP visits
  • $0 deductible on prescription medications 
  • HMO plans do not require referrals
  • Free eCare Experience™ tablet
  • Additional OTC benefits
  • Additional medical benefits (contact your plan provider for details)

3. Hearing Loss Association of America (HLAA) 

In 1979, Howard E. Stone founded HLAA. This organization is the leading consumer advocacy organization for people with hearing loss. 

The organization assists consumers with the costs associated with hearing care. The means they provide coverage is different for everyone, based on their personal circumstances. 

Working with government officials, the HLAA strives to improve healthcare coverage for those with hearing care needs. Their goal is that every Medicare recipient will someday have complete hearing care coverage. 

Contact them to find out what services they offer if you need assistance in anything relating to your hearing loss. 

From information to education to support and advocacy, the HLAA dedicates itself to hearing loss patients who need additional help with their condition.

Understanding Your Medicare Coverage 

Many people on Medicare live on fixed incomes. They need to understand what plans they qualify for, their plan’s coverage, and what will be an out-of-pocket expense for medical care. 

Hearing care is one of the treatments that Medicare doesn’t generally cover. Yet, if you know what alternatives you can take to get an exam and low-cost hearing aids, you won’t have to worry about getting the care you need.

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