Telehealth has become ‘essential’ for older Medicare patients

Nearly half of Medicare mental health visits happen over video or phone, and millions of older adults are using telehealth to manage routine chronic conditions such as diabetes and high blood pressure. Those are key findings from a new analysis published in Annals of Internal Medicine.

Approximately 1 in 6 Medicare beneficiaries between 2021 and 2023 used telehealth at least once, and tens of millions of virtual visits each year were for non-mental health conditions, including diabetes, hypertension and COVID-19.

Researchers from the University of Utah School of Medicine and the University of Michigan Medical School linked each outpatient visit in a nationally representative sample of nearly 15,000 Medicare enrollees to its associated medical condition and classified whether the encounter was in person or via telehealth.

Their findings, published Feb. 16, come just weeks after Congress extended key Medicare telehealth flexibilities through December 31, 2027, under H.R. 7148, the Consolidated Appropriations Act, 2026.

Telehealth visits are split between mental health and chronic disease

In the Annals analysis, 16.4% of Medicare beneficiaries had at least one telehealth visit between 2021 and 2023.

Mental health still dominated virtual care. Nearly half of all outpatient visits for mental health conditions were delivered via telehealth — an estimated 31 million virtual mental health visits each year. But almost as many telehealth appointments — approximately 29 million annually — were for non-mental health conditions.

Anxiety-related and depressive disorders were the most common conditions treated via telehealth overall, with an estimated 9.4 million and 8.8 million virtual visits per year, respectively. Among non-mental health conditions, uncomplicated diabetes (approximately 2.2 million telehealth visits annually), hypertension (1.5 million) and COVID-19 (1.1 million) topped the list.

“We were surprised at the number of non-mental health conditions, like high blood pressure or diabetes, that were commonly addressed through telehealth,” said Terrence Liu, M.D., MS, assistant professor of internal medicine at University of Utah Health and first author on the study. “Even though a smaller percentage of these visits were conducted through telehealth, because these are very common conditions, the total number of estimated visits was very similar to telehealth visits for mental health conditions, numbering in the tens of millions.”

Higher-need patients are more likely to go virtual

In the study, telehealth users were more likely to be medically complex patients than relatively healthy, tech-savvy seniors.

Compared with those who saw clinicians only in person, telehealth users were more likely to have higher levels of education, to report physical or cognitive limitations, to rate their health as fair or poor and to have substantially more outpatient visits overall.

Put simply, people juggling more medical problems and more contact with the health system were also more likely to use telehealth at least some of the time.

How it looks on the ground

Medical Economics spoke with Sarah Matt, M.D., MBA, a practicing physician, health technology strategist and author of “The Borderless Healthcare Revolution,” to better understand what virtual care looks like in practice.

“For some physicians, their entire practice is now telemedicine-based,” Matt said, explaining that this is common in primary care, women’s health and urgent care, where the entire patient experience is virtual, with some patients never seeing a clinician in person.

“On the other hand, many providers who previously only offered in-person visits are now working in a hybrid model. They may have specific office hours for telehealth, incorporate remote patient monitoring or use other digital tools alongside traditional visits,” she said.

Some physicians worry that something essential is lost when care moves to a screen. Matt’s view is that the core of the relationship is less about the technology and more about how it is used.

“Digital empathy and in-person empathy are equally important. Just because technology sits between the provider and the patient doesn’t mean a real relationship can’t form,” Matt explained.

A policy roller coaster

When the U.S. government entered what would become the longest government shutdown in the nation’s history on October 1, 2025, COVID-19 pandemic-era Medicare telehealth flexibilities expired, narrowing coverage options and leaving many patients and practices in limbo.

On the importance of virtual care to patients today, Kyle Zebley, CEO of the American Telemedicine Association (ATA) and executive director of ATA Action, told Medical Economics that telehealth use is “exponentially greater than it had been prior to the pandemic,” estimating that one in four Medicare beneficiaries use telehealth in a given year,” including 7 million fee-for-service patients.

“Congress must authorize these extensions of the telehealth flexibilities and the acute hospital care at home program,” Zebley said in October 2025. “They need to proactively do so through a policy language included in a piece of legislation. It could exist outside of any government spending bill.”

Congress has made some flexibilities for mental and behavioral health telehealth permanent.

Patients can receive mental health care from home, and federally qualified health centers (FQHCs) and rural health clinics (RHCs) can serve as distant-site providers for behavioral telehealth on an ongoing basis.

For nonbehavioral services, however, Medicare has been operating on a series of temporary waivers and short-term fixes.

• Related content: “What changed in Medicare telehealth under the 2026 spending bill”

Telehealth flexibilities first enacted during the COVID-19 public health emergency were extended several times, then briefly lapsed amid the fall 2025 government shutdown. The Consolidated Appropriations Act, 2026 (H.R. 7148) retroactively patched that gap and extended key Medicare telehealth waivers for non-mental health services through Dec. 31, 2027.

Under current federal guidance, through the end of 2027:

• Medicare patients can receive nonbehavioral telehealth services in their homes, with no geographic originating-site restrictions.
• All eligible Medicare providers may continue to furnish nonbehavioral telehealth services.
• FQHCs and rural health clinics can be distant-site providers for nonbehavioral telehealth.
• Audio-only telehealth remains covered for certain nonbehavioral services when clinically appropriate.

“Navigating the insurance labyrinth of Medicare, Medicare Advantage and supplemental plans is already a complicated task for any older adult,” said Alexander Chaitoff, M.D., M.P.H., assistant professor of internal medicine at the University of Michigan and second author on the paper. “Having more certainty on whether their telehealth care will be supported on a more permanent basis could be helpful, given how important it is for managing chronic conditions.”

Unless Congress acts again, though, much of that broader nonbehavioral flexibility will expire at the end of 2027. The Annals data show that virtual visits are now deeply embedded in how older adults receive both mental health care and routine chronic disease management.

“It’s hard to imagine going back to a world where telehealth is a tiny fraction of all the health care that’s delivered,” Liu said. “It’s not the predominant mode of delivery, and it still has issues that need to be worked out. But I think with greater confidence and support for making telehealth coverage more permanent for non-mental health conditions, health systems will have additional incentive to invest in it and find ways to improve it.”