Virtual Care · Medicare Information
Medicare and telehealth: how to find out what is actually covered
Telehealth coverage under Medicare depends on your eligibility, the specific service, the provider's participation status and your plan's own rules. We will not tell you a visit is covered when that is not ours to promise. What we can do is show you exactly how to check — and what your self-pay option costs if it is not.
Educational information · We do not promise Medicare coverage
The short answer
Medicare patients are welcome at Presence, and membership is paid privately rather than billed to Medicare. Original Medicare and Medicare Advantage differ in what they cover for telehealth, so your plan must be verified before a visit. We will not tell you a benefit applies until it has been checked. Self-pay prices are published either way.
- Who it is for
- Medicare beneficiaries, and their families, who want to understand how telehealth and a private membership interact before spending anything.
- When it may not fit
- Anyone wanting a coverage guarantee here. Original Medicare and Medicare Advantage differ, and every plan must be verified individually.
- What it costs
- Self-pay prices apply regardless: $39 by phone, $49 by video, memberships from $19.99 a month.
- What to do next
- Ask us to check your specific plan before you book anything.
In an emergency call 911 or go to the nearest emergency department.
Prices and material terms
Insurance options available; coverage and in-network status vary by plan and must be verified before the visit.
Medicare patients are welcome; membership is paid privately. Original Medicare and Medicare Advantage differ and must be verified plan by plan.
Membership dues are a private fee and are never billed to a plan. Membership is not insurance and does not cover hospital, surgical, specialist or emergency care.
The short answer
- The short answer
- Whether a telehealth service is covered for you depends on four things: your Medicare eligibility, the specific service delivered, the provider's participation status, and your plan's rules. Coverage cannot be assumed from a website.
- Do you accept Medicare?
- Medicare patients are welcome, and we intend to serve Medicare patients as enrollment and billing readiness are completed. We will not tell you a visit is covered or billable until that is verified for your situation, and self-pay pricing is always published.
- Original Medicare vs Advantage
- Original Medicare telehealth rules are set federally and have changed repeatedly. Medicare Advantage plans set their own telehealth benefits, networks and cost sharing, so two people with Medicare can get different answers.
- Your fallback
- Self-pay pricing is published and available regardless of coverage: QuickCare $19.99, phone $39, video $49, extended video $69.
- Next step
- Use the verification pathway to have your situation checked, or read self-pay pricing.
This page sits under virtual care — start there if you want the full picture first.
What you can do today
- See self-pay pricing
You have Original Medicare
We cannot bill Medicare yet, so care here is self-pay today. Many people use it alongside their Medicare coverage rather than instead of it.
- Ask us to check with you
You have a Medicare Advantage plan
Advantage plans set their own networks and rules. Ask us to walk through the questions to put to your plan before you book anything.
- Older-adult primary care
You are helping a parent
Older-adult primary care with a board-certified adult-gerontology nurse practitioner is the usual starting point.
- Get care now
You need care today regardless of coverage
A self-pay virtual visit is available now from $19.99.
Presence intends to serve Medicare patients, and Medicare enrolment and billing are not yet in place. We never claim that all Medicare plans are accepted and we will not promise a covered visit.
The four things that decide coverage
Your eligibility and plan type
Original Medicare, a Medicare Advantage plan, or Medicare with additional coverage — each follows different telehealth rules.
The specific service
A live video visit, a phone visit and an online asynchronous review are different services with different coverage treatment.
Provider participation
Coverage generally depends on the rendering provider's participation status and enrollment, not on the practice's website.
Your plan's own rules
Advantage plans add networks, prior authorization, referral requirements and cost sharing that vary plan by plan and year by year.
Because these change, any blanket statement that telehealth is or is not covered under Medicare would be unreliable. Verify for your plan and your visit.
Questions to ask your plan
"Is a telehealth visit with a nurse practitioner covered under my plan?"
Ask specifically about the clinician type who will see you, not about telehealth in general.
"Does it matter whether the visit is video, phone or an online review?"
This is where most surprises come from. Get the answer for the exact format you intend to use.
"What will I owe, and does it apply to my deductible?"
Ask for the cost share in dollars, not a percentage without context.
"Do I need a referral or prior authorization?"
Common in Advantage plans, and the reason otherwise-covered visits get denied.
"Is the specific provider in network and participating?"
Give them the provider's name and credential type. Record who told you and when.
What we can and cannot say
We can say what our services cost and how they work. We can help you check your situation before a visit is scheduled. We can tell you clearly when a service will be self-pay so nothing is a surprise.
We will not publish a list of accepted plans, promise that Medicare will pay for a visit, or imply that coverage exists because a competitor's page says something similar. In healthcare, a confident wrong answer about coverage costs the patient money.
What is genuinely available today
- Published self-pay pricing you can rely on
- A verification pathway before scheduling, so you know before you owe
- Virtual visits well suited to medication review, lab follow-up and triage
- Caregiver participation with the patient's permission
What we will not claim
- That Medicare covers a specific visit for you
- That we accept any specific plan
- That coverage rules are stable — they have changed repeatedly
- That a membership is insurance or supplements Medicare
A Presence membership is not insurance and is not a Medicare plan, supplement or replacement.
If you are helping a parent
Caregivers do most of the coverage work in practice. With the patient's permission you can join the visit, hold the medication list and ask the coverage questions above on their behalf.
Our virtual care for older adults page covers what these visits are best used for — medication review, lab and blood pressure follow-up, post-hospital catch-up — and where in-person care is the better choice.
Questions people ask
Do you accept Medicare?
Medicare patients are welcome and we intend to serve Medicare patients. Original Medicare enrollment and each Medicare Advantage arrangement are being completed, so we verify what applies to you before scheduling rather than claiming that every Medicare plan is accepted.
Does Medicare cover telehealth?
It depends on the plan, the service and current rules, which have changed repeatedly. Verify with your plan for the specific visit format you intend to use.
Can I just pay cash instead?
Yes. Self-pay pricing is published and available regardless of coverage: QuickCare $19.99, phone $39, video $49, extended video $69.
Is a Presence membership a Medicare plan?
No. It is not insurance, not a Medicare plan, not a supplement and not a replacement for any coverage.
Will you bill Medicare for me?
Do not assume billing. Ask during verification, and we will tell you plainly whether a service is self-pay for you.
About this information
Written by the Presence care team for patients considering care with us. Presence care is delivered by licensed providers, including a board-certified Adult-Gerontology Primary Care Nurse Practitioner — not by a physician, and not by software. Meet your provider.
This page explains how our service works. It is general information, not a diagnosis, and it is not a substitute for an evaluation of your own situation. Whether testing, treatment or a prescription is appropriate is decided during a visit.
If this is an emergency — chest pain, trouble breathing, stroke symptoms, severe bleeding, or thoughts of harming yourself — call 911 or go to the nearest emergency department. See our emergency care notice.
Not sure what applies to your plan?
Have your situation checked before scheduling, or use published self-pay pricing and skip the guesswork.