So, telehealth. Over the past couple of decades, it's been a subject of much interest and some controversy in the United States. Before the COVID-19 pandemic, telehealth – or telemedicine, as some call it – was underused and underappreciated. While patients who actually used the technology tended to look favorably on it, many physicians either couldn't bear the red tape associated with it, or flat-out thought it was the catalyst for a race to the bottom when it came to quality.

But then COVID-19 changed everything. The pandemic served as the impetus for passage of the CARES Act and CMS 1135 Waiver, which in turn led to the federal government dropping licensing requirements and other barriers to utilizing telehealth. Patients with routine appointments could now be seen virtually, freeing up hospital space for emergent cases of COVID and avoiding relatively healthy people being exposed to the virus in a clinical setting.

This set of circumstances led to an ever-increasing acceptance of telehealth by the mainstream. In fact, in a 2022 survey administered by the American Medical Association, "74.4% of physicians surveyed reported that telehealth was used in their medical practices—nearly three times the share in 2018."

When any technology is adopted relatively overnight, there are bound to be bumps along the way. This is borne out by a 2024 JD Power telehealth satisfaction survey which found that telehealth user experience has varied significantly across various demographics. Despite this somewhat spotty record, however, most respondents praised the relative convenience of the technology.

This dynamic squares with most other articles I've read about the subject: although barriers persist, most people can at least agree that it's easier to hop on a telehealth call than taking the time to travel to a doctor's office.

Because I keep hearing about the ascendancy of telehealth, I wanted to get a better sense of who exactly is using it. The best data set I have access to is the Medicare Telehealth Trends data, so I'll be relying on it in this post as a proxy for how much telehealth has caught on among different demographic groups. The data set contains numbers for Medicare enrollees between 2020 and the second quarter of 2024.

But first, a few caveats.

Caveat #1: Because this is Medicare data, it has limited utility for this question. For instance, since Medicare is intended to insure mostly older Americans, we won't be able to get a feel for how most younger folks are using telehealth.

Caveat #2: Although the majority of Medicare beneficiaries are ages 65 and older (86%), 14% are younger and qualify for Medicare enrollment because of a long-term disability. Among this group, "(l)arger shares of Black (25%) and Hispanic (19%) beneficiaries are under age 65 compared to White beneficiaries (12%)" which makes comparing the general population to Medicare beneficiaries challenging.

Caveat #3: Medicare Part B and some Medicare Part A enrollees are eligible for telehealth services, but of those Part A beneficiaries who are permitted to use telehealth, most are enrolled in Medicare Advantage plans. For this reason, I'll be focusing only on Medicare Part B beneficiaries in this post.

Caveat #4: Since the latest data available in this data set only runs through Q2 of 2024, we can't get a full picture of current telehealth use.

With all that said, we'll look at trends over the past four years for how Medicare Part B enrollees have been utilizing telehealth services. Let's dive in.

Let's start at what might seem like an obvious place: age. As stated above, keeping in mind that there are some exceptions, the data for Part B beneficiaries necessarily skews to the older crowd. It's fair to assume that the older you get, the more touch points there would be with healthcare services and, thus, more telehealth consumption.

But surprisingly, this assumption is incorrect. As it turns out, Medicare Part B enrollees between 2020 and 2024 tended to use more telehealth services as they aged, but then the trend reversed when with the 75-84 year old cohort. Let's take a look at the data to see what I'm talking about here.

*Important note: all numbers are reflective of the years 2020 - Q2 of 2024

When graphed, it looks like this:

I may go into the reasons for this dropoff as age increases in another blog post, but my initial guess is that older folks tend to have more issues with technology and likely prefer to see doctors in person.

Now let's turn to differences by gender, again keeping in mind that these numbers are reflective of total telehealth use between 2020 and Q2 of 2024.

Between 2020 and Q2 of 2024, 2,424,715 more female than male Medicare Part B beneficiaries used telehealth. Personally, I don't find this very surprising given that, according to the Harvard Business School website, "At an individual level, studies have shown that women utilize more healthcare services" and are "76% more likely than men to have visited a doctor within the past year. At the family level, women control 80% of healthcare decisions…in the home."

Now here's where things get interesting. I've done a few things differently here to try to provide better context for what's going on: I've averaged telehealth use by race for the years 2020 - 2024, and added two additional new columns – one for numbers of each racial group enrolled in Medicare as of 2023, and then I averaged the mean number of enrollees in each racial category and the number enrolled in Medicare Part A and B as of 2023.

As it turns out, American Indian/Alaska Native enrollees top the list of average use of telehealth. Given all of the challenges facing that community, including lower overall access to high-speed internet, I was pleasantly surprised to find that they are relatively comfortable with using telehealth.

This is in keeping with research that shows that as of 2021, "Non-Hispanic White (39.2%) and non-Hispanic American Indian or Alaska Native (40.6%) adults were more likely to use telemedicine compared with Hispanic (32.8%), non-Hispanic Black (33.1%), and non-Hispanic Asian (33.0%) adults."