Chronic Illness and Telehealth Use in the United States (2020-2024)

Background/Purpose: The Covid-19 pandemic changed healthcare delivery in many ways. The increased use of telehealth and virtual medical care was one important change with the potential to improve accessibility. For example, Medicare Fee-for-Service telehealth visits increased almost 63-fold between 2019 and 2020 (ASPE, 2021). With Medicare funded telehealth services under threat and only covered through September 2025, research on who is most impacted by telehealth expansion is sorely needed. This study analyzes telehealth use among US adults with chronic illnesses since 2020, trends over the past four years, and key sociodemographic predictors of use.

Method: We use the 2020-2024 waves of the National Health Interview Survey, a nationally representative dataset that monitors US population health, to examine patterns in telehealth use among people with chronic illnesses and how health insurance and sociodemographic factors influenced their use of telehealth (NCHS, 2024). We use multivariate logistic regression models to estimate predicted probabilities of telehealth use, defined as a virtual visit in the past year, during the Covid-19 pandemic and today, by several chronic health conditions. Further analysis will examine changes in telehealth use by chronic illness over this 4-year period and interaction effects between chronic health conditions and sociodemographic factors over time. Note that preliminary analysis was conducted through 2023, but 2024 NHIS data will be available for analysis before SSWR 2026.

Results: Telehealth use among NHIS respondents peaked in 2021, with 39 percent of respondents reporting a virtual medical appointment in the past year. Telehealth use declined to 27 percent in 2023, but remained significantly higher than pre-pandemic levels. Predicted probabilities show significantly higher telehealth use among respondents with a chronic health condition. Highest utilization was reported for respondents with kidney disease (64 percent), immunocompromise (63 percent), and lung disease such as COPD or asthma (59 percent). Reductions in telehealth use were smallest for respondents with these conditions. Finally, respondents with chronic health conditions living in poverty were more likely to use telehealth than respondents with higher incomes, while respondents with chronic health conditions and no health insurance were significantly less likely to use telehealth compared to those with insurance.

Conclusion: Adults with chronic health conditions were significantly more likely to use telehealth than those without. While telehealth used declined between 2021 and 2023, it remained high, with about a third of adults overall and more than half of adults with chronic health conditions using telehealth at least once over the past year. Respondents with conditions requiring frequent health visits—such as immunocompromise, kidney disease, and lung disease—were most likely to use telehealth. Finally, our results suggest economically vulnerable adults with chronic health conditions were more likely to use telehealth, while those without health insurance were much less likely to access telehealth in addition to other health services. Policy efforts to increase telehealth accessibility for Americans with chronic health conditions must focus on expanding health insurance coverage. Our findings lend evidence to policy efforts to continue Medicare coverage for telehealth and also continued coverage for Medicaid and private health insurance.