Tricare Telehealth – What Is & Isn’t Covered?

Since the idea of visiting a doctor’s office or a hospital in person during the COVID-19 pandemic is unappealing to many, telemedicine — also known as “telehealth” — may be a viable and convenient alternative. For U.S. servicemembers and their dependents enrolled in Tricare, there are new virtual features that enable Tricare beneficiaries to stay on top of their health, while remaining out of the hospital. In addition to safety and convenience, new Tricare telemedicine options allow servicemembers and their families to save time and money.

What Is Telemedicine?

Telehealth or “Telemedicine” is a health care delivery model that connects patients and providers via technology, such as telephones, smartphones, tablets, or computers. While Tricare has previously offered video conferencing via a secure platform, demand for virtual capabilities has skyrocketed during the COVID-19 pandemic, with the highest number of Tricare telehealth visits hitting a peak earlier this year. Although Tricare was initially slow to roll out guidance regarding costs for telemedicine services, it was announced in May 2020 that Tricare now covers telephone visits (audio-only) — which were previously prohibited — and has eliminated patient co-payments and cost shares for telehealth options through the COVID-19 pandemic. Two-way video appointments are also covered under Tricare for specific, “medically necessary” services. In addition to revising its cost structure, Tricare has also temporarily loosened licensure requirements across state lines for health care providers. This means that Tricare beneficiaries will have access to more providers. This is especially good news for those who live in remote areas and lack access to health care specialists, or those who live overseas. According to the new guidance, this temporary relaxation of licensure requirements enables beneficiaries to connect with providers in different countries as well, so long as the host country permits it and providers do not appear on any sanctions lists.

Tricare Telemedicine Services Eligibility

The May 2020 decision by the Defense Health Agency (DHA) that removes cost-sharing, including copayments and deductibles, for in-network telemedicine services is currently available for Tricare Prime and Tricare Select beneficiaries, regardless of geographic location. However, some normal Tricare “rules” still apply. For example, Tricare Prime beneficiaries still require a referral from their primary care manager (PCM) for specialty care — whether virtual or in-person. Tricare For Life beneficiaries also have access to audio-only telemedicine visits since Medicare has expanded its virtual options in light of the COVID-19 pandemic. Medicare covers the costs of telemedicine visits when both the service and provider are payable by Medicare. If they aren’t, Tricare For Life acts as the first payer, but beneficiaries will pay deductibles and cost shares. As a general rule, it’s important that eligible beneficiaries check in advance to make sure that their requests for telemedicine are both “considered medically necessary,” since this is a relatively vague definition, and conducted by a Tricare-authorized provider in order to be covered. For example, a physical exam is not eligible to be conducted virtually, and therefore it is not covered by Tricare. Mental health services are covered, broadly speaking, but active-duty servicemembers require a referral for these services in advance, which can be obtained from a primary care manager at a military treatment facility.

Types of Tricare Telehealth Services

Currently, Tricare has authorized certain “medically necessary” services that can be conducted virtually from the comfort of your home. This includes primary, routine, and specialty care office visits, preventive health screenings, mental health services, autism care, and end-stage renal disease services. However, since Tricare’s telemedicine offerings are constantly changing, it’s advisable to call your regional contractor to verify which services are covered before scheduling an appointment.

How Do I Start the Process?

Since Tricare’s guidance on telemedicine is still evolving, it’s best to contact your regional Tricare contractor first, since you might need an authorization or referral. Here are the websites for your convenience:

• Tricare West – HealthNet
• Tricare East – Humana
• Tricare Overseas – International SOS

It’s worth noting that while telemedicine options are growing, not all providers offer virtual visits. Therefore, be sure to check with your provider to see which, if any, telehealth options are available. While telemedicine appointments conducted over the telephone are relatively straightforward, virtual telehealth appointments conducted over video conferencing often require beneficiaries to download an app on their smartphone, tablet, or computer prior to the telemedicine visit. Therefore, it’s important to check in advance how the appointment will be conducted and prepare your technology in advance.

What Technology Do I Need to Get Started?

Devices

For telehealth visits requiring two-way video conferencing, you’ll need a smartphone, tablet, or computer with internet connectivity and a camera. If your telemedicine appointment is audio-only, however, you’ll simply need access to a telephone.

Tricare Telehealth Apps & Platforms

Tricare has not yet gone the way of the Department of Veterans Affairs toward rolling out a video app specifically designed for telehealth appointments. There is little guidance available regarding preferred apps. While some popular applications such as Skype and Facetime do not meet HIPAA privacy requirements and are therefore prohibited, Tricare appears to defer to providers on which mobile or web-based app will be used. From my personal telehealth experience, I have used two different apps for two different providers — MyChart and VidyoConnect — suggesting that each provider has a unique preference.

Tricare Telehealth Data Security

Per Tricare policy, video conferencing platforms that are used to conduct telehealth appointments must be HIPAA compliant so that user data is protected end-to-end. This means that the likelihood of conducting a telehealth visit via Zoom, Skype, Facetime, WhatsApp, or other popular communications methods are low, but not zero, due to privacy concerns. Additionally, providers are required to ensure that all transmissions — both audio and video — are encrypted, which acts as an additional security mechanism to protect your personal data. As an additional security provision, it’s a good idea to install any system updates or patches on your smartphone, tablet, or computer prior to your telehealth visit and download any necessary apps from a reputable app store, such as Apple’s App Store or Google Play Store, as opposed to a website. In addition to convenience and the safety provided by virtual visits, telemedicine can also employ remote technologies that can monitor and aggregate important health data, which makes it easier for health care providers to keep track of their patients’ overall health. With telemedicine, beneficiaries aren’t limited to visiting providers in their immediate vicinity, so there is an added benefit of connecting patients with providers across the country and in different time zones. All in all, Tricare telehealth services provide reliable options for military-connected patients.