Telehealth Costs and Coverage: Answers & Advice

Telehealth services can be more cost effective than in-person visits. Here’s what to discuss with your providers and insurance carrier before you book an appointment.

IMAGINE YOU DEVELOP an itchy rash on your legs—is it poison ivy from a hike in the woods? An insect bite? Something else? Thanks to telehealth services, and the rapid and convenient way they allow you to connect with your healthcare providers, you could quickly have an answer or medication, and be on the road to recovery—all without having to visit a doctor in person.

The convenience of telehealth in the United States has led to increased services and expanded access. Since the COVID-19 pandemic, telehealth has been widely embraced in a range of medical practices from pediatrics to dentistry. Telehealth and teledentistry may now be easier to use than ever; and in further good news, video calls and other remote means of healthcare are often covered by many large insurance companies.

But what’s your appointment going to cost? And what questions should you ask your insurance provider about how they cover your telehealth appointments?

Here, answers to those questions and more:

What’s the Cost of Telehealth?

For a minor, non-emergency health issue, the average estimated cost for a telehealth consultation is $40 to $50. But prices vary, depending on which telehealth service you use and what kind of doctor you’re seeing. Rates for urgent care, for example, may differ from those for dermatology or cardiology.

You should generally be able to tap your HSA or FSA to pay for telehealth services, whether for physical or mental health.

Telemental health—or telepsychology—can be more complex, in both service offerings and payment. There are mental health apps that offer the option of texting or video-chatting with a therapist on a plan with an unlimited flat fee or one where you pay by the minute.

In general, though, telehealth’s savings can be significant; one study found that going virtual can cost anywhere from $19 to $121 less per visit. Of course, you could be saving even more by skipping the cost of traveling to a doctor’s office, and there’s the peace of mind that comes from avoiding a crowded waiting room full of sick patients. For some, that’s a benefit that doesn’t come with a price tag.

Cost- and time-saving tips:

  • Ask your regular providers if they provide telehealth services, and if prices differ from in-office visits.
  • If you need prescriptions, ask whether the medication requires an initial in-office visit. If they don’t, you could skip it.
  • If you do use telehealth services, and they require an app or secure portal used by your provider, set up your account with your provider right away, so you’ll be ready to go before you need care.

Is Telehealth Covered by Insurance?

The cost of your visit could be lowered significantly, or eliminated, if your insurance plan picks up the tab. Most of the big health insurance companies offer some form of coverage for telehealth services, and many of the nation’s large employers include it as part of their benefits package. Plus, 42 states and the District of Columbia have laws that govern how private insurers cover telehealth.

Even better, if the appointment is considered medically necessary, you should generally be able to tap your HSA or FSA to pay any costs for telehealth, and some telemental health visits as well. Additionally, the Coronavirus Aid, Relief, and Economic Security Act (CARES Act) has relaxed some of the rules around HSA spending through the end of 2021. Still, it’s always wise to check with your benefits provider and save your receipts.

Whether or not telehealth will qualify for coverage under your plan depends on your specific policy. The smart move is to never assume anything, and pose these questions to your insurance company:

  • Does my policy cover telehealth services?
  • Does the provider have to be in-network to be covered by telehealth?
  • What’s the co-pay for a telehealth visit?
  • Are there any restrictions around telehealth coverage, such as the number of allowable visits per year or a requirement that visits include video?
  • Do I need a referral from my primary care provider to use telehealth for specialists?
  • Does my policy require an in-person visit before I can consult with a provider via video?

By knowing what your policy covers and the costs of telehealth services before you book an appointment, you’ll be prepared to take full advantage of the convenience of telehealth services.

How is your privacy protected in a telehealth session? Learn how laws and technology work together to safeguard your personal information.