Telehealth went from a niche service covering roughly 0.1% of healthcare claims in 2019 to about 24% of all visits during the first wave of the pandemic, a spike of more than 760%. That explosive growth has settled considerably, but telehealth use today remains far above pre-pandemic levels, with about 71% of physicians using it weekly and roughly 5 to 25% of visits happening virtually depending on the population measured.
The 2020 Surge in Numbers
Before COVID-19, telehealth was barely a rounding error in American healthcare. Among privately insured working-age adults, telemedicine accounted for just 0.3% of all healthcare interactions between March and June 2019. During the same months in 2020, that number jumped to 23.6%, a 766% increase in a matter of weeks. Across all payer types, an estimated 20% of U.S. healthcare visits in 2020 were conducted by telemedicine.
The Medicare population tells an even more dramatic story. In 2019, only about 239,000 Medicare beneficiaries received a telehealth service. By 2020, that number exploded to 14.2 million, roughly 40% of all traditional Medicare beneficiaries. Medicare spending on telehealth ballooned from $130 million in 2019 to a peak of $1.9 billion in the second quarter of 2020 alone.
Where Things Settled After the Peak
The initial surge was never going to last. As offices reopened and patients returned to in-person care, telehealth use dropped, but it didn’t return anywhere close to pre-pandemic levels. By the end of 2021, telehealth claims in a large national database of private and Medicare data hovered around 5% of all claims. That’s 50 times higher than the 0.1% recorded in 2019.
Medicare utilization followed a similar pattern. The 14.2 million beneficiaries who used telehealth in 2020 declined to 9.7 million in 2021 (29% of beneficiaries). By 2024, about 25% of Medicare fee-for-service users had at least one telehealth service, a figure that held steady from 2023 to 2024. That plateau suggests telehealth has found a durable place in the system rather than continuing to fade.
How Physicians Use Telehealth Now
In 2024, 71.4% of physicians reported using telehealth weekly in their practices. That’s nearly triple the 25.1% who said the same in 2018, and only slightly below the 79% peak recorded in 2020. The pandemic didn’t just introduce doctors to video visits; it fundamentally changed how most of them practice.
Not all specialties adopted telehealth equally. Medical specialists, a category that includes psychiatry, neurology, and dermatology, were the heaviest users. More than a quarter of medical specialists (27.4%) conducted at least half their patient visits via telehealth in 2021. Primary care physicians were more moderate: about 54% used telehealth for fewer than one in four visits, and only 14.7% used it for half or more. Surgical specialists were the least likely to go virtual, with just 5.5% conducting half their visits remotely, which makes sense given that surgery requires hands-on care.
Mental Health Led the Way
Behavioral and mental health services became the clearest success story for telehealth. Several of the Medicare telehealth flexibilities for behavioral health have now been made permanent, including the ability for patients to receive mental health telehealth services from home with no geographic restrictions. Audio-only phone sessions are also permanently allowed for behavioral health, recognizing that not every patient has reliable video capability.
The cost picture reinforces why telehealth works well for mental health. For conditions like depression and neurodevelopmental disorders, the total charges for a telehealth episode were comparable to those of an in-person visit. In other words, going virtual didn’t lead to more follow-up visits or additional testing that drove up costs. Across all conditions, the average 30-day cost of a telehealth episode was $96.60 compared to $509.21 for in-person care, though much of that gap reflects the types of conditions treated virtually rather than telehealth being inherently cheaper for the same problem.
Who Uses Telehealth Most
Telehealth adoption isn’t evenly distributed across the population. In 2021, 42% of women had used telemedicine in the past year compared to 31.7% of men. Use increased with age: 29.4% of adults 18 to 29 had a telehealth visit, compared to 43.3% of adults 65 and older. Higher education and higher income both correlated with greater use, with college-educated adults (43.2%) using telehealth at roughly 1.5 times the rate of those without a high school diploma (28.7%).
Race and ethnicity gaps also appeared. White adults (39.2%) and American Indian or Alaska Native adults (40.6%) were more likely to use telehealth than Hispanic (32.8%), Black (33.1%), or Asian (33.0%) adults. Geography mattered too. Adults in large metro areas used telehealth at a rate of 40.3%, while those in the most rural areas came in at 27.5%. These gaps likely reflect differences in broadband access, digital literacy, and the availability of providers offering virtual visits rather than differences in interest or willingness.
Policy Changes Keeping Telehealth Alive
Much of telehealth’s pandemic growth was made possible by emergency regulatory waivers that loosened Medicare rules. Before COVID, Medicare generally required patients to be at an approved healthcare facility in a rural area to use telehealth. The emergency flexibilities let patients connect from home, anywhere in the country, using any device including a simple phone call.
Congress has extended most of these flexibilities through December 31, 2027. That means Medicare patients can continue receiving telehealth from home for any type of care, providers of all eligible types can offer virtual visits, and audio-only visits remain covered for non-behavioral health services. For behavioral and mental health specifically, several key provisions have been made permanent: no geographic restrictions, home-based visits allowed, audio-only sessions covered, and new provider types like marriage and family therapists can deliver care remotely.
The 2027 extension gives healthcare systems, insurers, and technology companies a longer runway to build around telehealth rather than treating it as a temporary workaround. Whether these temporary provisions eventually become permanent for all types of care will likely depend on how utilization data and cost analyses continue to develop over the next few years.