Telemedicine and Health Insurance: The Future of Healthcare Access

Telemedicine and Health Insurance: The Future of Healthcare Access


The COVID-19 pandemic has shone a harsh light on many weaknesses in our healthcare systems and highlighted opportunities for improvement. At the same time, it accelerated the adoption of telemedicine as people sought safer ways to access medical care. Post-crisis, experts foresee lasting prominence for telemedicine, expecting it to shape healthcare services significantly in the years ahead. However, scaling telemedicine also requires aligning it with health insurance to make virtual care financially accessible for all. In this post, Explore the synergy of telemedicine and health insurance, expanding access to quality healthcare for a more equitable and resilient system.

Part 1: The Rise of Telemedicine

The COVID-19 pandemic forced rapid changes in how healthcare is delivered to allow for social distancing and reduce risks of spreading infection in medical facilities. Many providers had to quickly transition much of their practice online to continue serving patients through telehealth platforms. While telemedicine has existed in some form for decades, its adoption grew exponentially in a very short period of time due to the pandemic.

Some statistics illustrating the surge are quite striking:

  • A May 2020 report from the Centers for Disease Control and Prevention found that the percentage of adults in the U.S. who received virtual medical care increased from 2% pre-COVID to 27% during the pandemic.
  • Telehealth claims for Medicare beneficiaries jumped from around 840,000 in 2019 to nearly 14.1 million between April and June 2020.
  • A study of 38 healthcare systems published in JAMA found their share of virtual visits skyrocketed from less than 1% pre-pandemic to over 80% in just a few weeks during the peak of COVID shutdowns in spring 2020.
  • A McKinsey survey of over 600 employers in May 2020 reported that 91% planned to continue or expand their use of telehealth post-crisis.

This rapid transition from in-person to virtual care brought telemedicine into the mainstream for many providers and patients who previously were not utilizing it or did not think it could effectively replace in-person visits. Out of necessity, telehealth became a lifeline for accessing non-emergency care during lockdowns while avoiding infection risks.

The experience convinced doubters that many types of appointments can be safely and effectively managed remotely using video chat and remote monitoring devices. Common uses included consultations for minor illnesses, follow-up visits, prescription renewals, mental health therapy, and chronic disease management. Telemedicine also allowed high-risk patients who were shielding to still receive ongoing care without in-person exposure.

Beyond the pandemic, experts anticipate telehealth will continue growing as providers, insurers, employers and patients recognize its convenience and outcomes. However, to fully realize its transformational potential within healthcare delivery, telemedicine needs appropriate alignment and integration with health insurance programs.

Part 2: Aligning Telemedicine with Insurance

For telemedicine to truly thrive post-pandemic, access to virtual care needs to become more financially viable and routine for patients. This requires active collaboration between telehealth providers and insurers to appropriately cover telehealth in both public and private plans. Some key considerations include:

  • Reimbursing Telehealth on Par with In-Person Care
    Perhaps the biggest barrier pre-COVID was that many public and private insurance programs either did not cover telemedicine services or reimbursed them at substantially lower rates than comparable in-person visits. This disincentivized use of telehealth.
  • In response to COVID, CMS and many commercial insurers took emergency measures to cover telehealth on parity with in-office visits and waive cost-sharing for patients. Continuing some version of this equitable coverage and payment policy on a permanent basis is crucial to incentivizing wider integration and utilization of telemedicine as a standard option for care delivery.
  • Expanding the Pool of Covered Virtual Services
    Historically, insurance coverage of telehealth has been limited to only select specialist consultations like psychiatry or dermatology. The pandemic proved many routine primary care, follow-up, and chronic disease management appointments can effectively take place virtually. Some insurers are now signaling they will consider covering a much broader range of telehealth services. Extending this could help reduce travel burdens for patients and improve access in underserved areas.
  • Leveraging Remote Patient Monitoring Technologies
    New mobile health/remote monitoring devices and apps present opportunities to better manage chronic conditions between appointments. For example, glucose meters, blood pressure cuffs, scales, and activity trackers that automatically transmit data to providers. Insurance reimbursement of these technologies and the time providers spend reviewing the information could enable proactive, preventative, and lower-cost care through remote surveillance. High-risk and high-cost patients may benefit most.
  • Educating Consumers About Telehealth Options
    For telehealth to fully take hold, patients need to understand what virtual care services are covered under their plans and how to access appointments. Insurance outreach programs can help promote available telehealth benefits, eligible providers, cost-sharing rules and resources for connecting with virtual visits. Consumer education paired with streamlined digital systems may encourage higher engagement in remote care delivery models, improving health outcomes and lowering costs across the system over time.
  • Evaluating Outcomes and Cost Savings
    As telehealth scales up, payers should study its impact on key metrics like patient satisfaction, clinical outcomes, utilization rates across settings, and overall medical costs – both short and long-term. Ongoing analysis shows promise to strengthen the case for covering additional telehealth services by demonstrating care quality and efficiency. It may also reveal opportunities for payer-provider partnerships or alternative reimbursement models aligned with value-based goals.
Telemedicine and Health Insurance: The Future of Healthcare Access
Telemedicine and Health Insurance: The Future of Healthcare Access

Part 3: Expanding Telehealth’s Reach Through Insurance

By thoughtfully integrating telemedicine with health insurance programs, virtual care can help address some of the biggest challenges plaguing America’s healthcare system today around cost, access and health equity. Here are some areas primed for meaningful impact:

  • Improving Access in Rural/Underserved Areas
    Transportation barriers, provider shortages and long travel times are unfortunately all too common for people living in remote or sparsely populated parts of the country. Telehealth promises a solution by connecting patients to specialists, behavioral health professionals or other services they may not have near their community. By covering virtual care through insurance, access improves significantly in these underserved areas.
  • Expanding Options for the Uninsured or Underinsured
    An estimated 27.5 million Americans remained without health insurance even after the Affordable Care Act. Many others face high deductibles and co-pays that deter needed care access. Telemedicine provides an affordable approach to obtaining consultations, prescriptions, screening exams and ongoing management for conditions. By integrating with subsidized community health centers, public health networks and safety net clinics – telehealth can help fill coverage gaps cost-effectively.
  • Supporting the Needs of Vulnerable Groups
    Certain communities face unique healthcare access barriers due to social vulnerabilities arising from age, disability status, low income or health conditions. Tailored telehealth programs addressing needs of seniors, veterans, pregnant women, mental health patients and chronically-ill citizens under Medicaid or Medicare can help overcome obstacles to care like mobility issues, psychological barriers or transportation limitations. When beneficiaries understand virtual options covered by their public benefits, it expands choice and independence.
  • Containing Healthcare Spending Pressures
    Soaring medical costs are unsustainable for individuals, employers and taxpayers financing the delivery system. By reducing unnecessary in-person visits, avoiding expensive emergency department usage for primary care needs through 24/7 virtual access points, and more effectively monitoring at-risk patients – telehealth shows promise to generate sizable cost offsets across settings. Insurance arrangements help maximize these savings potential by properly incentivizing value and outcomes over volume alone.
  • Improving Care Experience and Outcomes Efficiency
    Telehealth, in tandem with virtual chronic disease monitoring programs, online therapy, and accessible scheduling, encourages patient engagement and proactivity. Digital interactions, supported by insurance, not only enhance preventive and wellness measures but also strengthen existing clinical relationships. This holistic approach has the potential to positively impact health metrics, including medication adherence, hospitalization rates, and overall health status in the long term.

Part 4: Examples of Promising Telehealth-Insurance Models

As telemedicine increasingly becomes integrated with health insurance programs, new collaboration and payment models are emerging with potential for driving innovation and greater value. Here are a few examples offering lessons:

  • Direct Contracting with Employers/Payers
    Teladoc pioneered this approach, signing contracts directly with employers to provide 24/7 general medical telehealth services to covered employees and dependents, often at flat per-member rates. Revenue stability appealing to both employers seeking lower costs and Teladoc able to scale nationally. Similar direct-to-payer deals now growing as well.
  • Capitated & Shared Savings Integrated Models
    Health systems like Intermountain and Ascension launching telehealth subsidiaries able to take on greater financial risk through value-based contracts. For example, Primary 360 uses telehealth tools in combination with in-person care to better coordinate and manage chronically ill patients enrolled under capitated payments. Upside/downside incentives prioritize quality.
  • Provider-Insurer Joint Ventures
    Sanford Health partnered with philanthropic insurer Cambia Health to launchVirtualCare, a joint telehealth platform covering both urban and rural populations across multiple states. Program generates claims data to guide service expansions, quality improvement efforts and long-term cost modeling strategies.


FAQ 1: Will telemedicine replace in-person doctor visits?

While telemedicine offers convenient virtual access, it is not meant to fully replace all in-person visits. Certain procedures, exams, and conditions still require seeing a provider physically. However, telehealth can handle many routine visits like medication checks, minor illnesses, post-op follow ups, etc. The ideal future incorporates both telemedicine and traditional care seamlessly to maximize benefits.

FAQ 2: How does telemedicine work with my existing health insurance?

Most major insurance plans now cover telehealth to some degree, either from in-network providers virtually or via telehealth vendors. Costs are often comparable to office visits. Prior to your telemedicine appointment, verify benefits, contact your insurer for coverage details, eligible providers, cost-sharing information, and access instructions. Plans are also working to better integrate telehealth into their networks and administration systems.

FAQ 3: What kinds of medical conditions can be treated via telemedicine?

Telehealth manages minor illnesses, mental health counseling, preventative consultations, post-surgery follow-ups, chronic condition medication, dermatology, and more for easy accessibility. The types of remote treatment are expanding as technology improves and insurers recognize the benefits. Safety oversight remains crucial to determine clinical appropriateness of telehealth services versus in-person visits.

FAQ 4: Is my medical information kept private during a telemedicine visit?

HIPAA privacy rules apply fully to virtual visits just as with in-person care. Telemedicine platforms must adhere to stringent security standards and robust encryption measures to safeguard personal health data. By offering virtual monitoring, online therapy, and seamless scheduling, telehealth not only enhances patient engagement but also promotes proactive care, reinforces prevention, and improves overall health metrics. With proper precautions by all parties, telehealth can be securely conducted.

FAQ 5: What equipment do I need for a telemedicine visit?

Basic requirements include a smartphone, tablet or computer with a microphone, speaker or headphones, and webcam. Many doctors can conduct full medical visits using just these consumer devices. To address specific health concerns, additional connected devices such as blood pressure cuffs, pulse oximeters, glucometers, etc., may be necessary. However, traditional telehealth appointments seamlessly utilize existing consumer technology found in most households.

FAQ 6: How can I access telemedicine if I don’t have internet at home?

Explore affordable internet alternatives like mobile hotspots and public WiFi, and inquire about low-cost broadband programs to overcome financial barriers to access. Additionally, consider offline telehealth solutions, including secure messaging and stored/forwarded video visits, especially when collaborating with local community health centers to reach disconnected populations. Persistence and community support can help overcome the digital divide barrier.


In conclusion, telemedicine’s integration with health insurance holds tremendous promise to expand access to high-quality, convenient healthcare for all citizens. Virtual care boosts accessibility, cuts costs, and improves health outcomes, particularly in chronic illness management, advancing through technology & insurance collaboration. Innovative approaches in health and insurance hold promise to reshape healthcare delivery and financing sustainably, addressing privacy and access gaps.


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