Telehealth Transformation in Medicare Mental Health Care Post-COVID

Telehealth has significantly transformed mental health care delivery for Medicare fee-for-service beneficiaries since the COVID-19 pandemic. Prior to the pandemic, telehealth was a small part of outpatient visits, making up only 2.1%. By 2023, this figure surged to 42.9%, as detailed in a JAMA Network Open research letter published in January 2026.

Researchers from RAND and Brown University's School of Public Health examined claims data from nearly 9.6 million Medicare beneficiaries who attended outpatient mental health visits from January 2019 to December 2023. The study tracked claims rates and expenditures through phases: before, during, and after the pandemic. Conditions like depression, anxiety, and PTSD, which represent 75% of mental health issues in this group, were a key focus.

The study focused on fee-for-service Medicare beneficiaries, a segment less often analyzed compared to those with commercial insurance. During the pandemic's acute phase, telehealth constituted 54.4% of mental health claims, later stabilizing at 42.9%, still higher than pre-pandemic levels. This pattern was observed across all studied diagnostic categories.

While visit frequency slightly increased during the pandemic, the shift to telehealth primarily replaced in-person visits rather than adding to total service utilization. However, outpatient mental health spending rose—monthly spending averaged $71,109 per 10,000 beneficiaries pre-pandemic, then climbed to $91,003 during, and $87,792 post-pandemic. This spending increase has implications for payers and telehealth reimbursement reviews.

The study's findings have fueled discussions on maintaining telehealth flexibilities birthed during the pandemic. Previously, Medicare enforced strict telehealth regulations. Emergency waivers lifted these restrictions, reflecting their acceptance among beneficiaries and providers. Current extensions remain until 2026, awaiting long-term regulatory decisions.

Behavioral health professionals should consider telehealth's persistent role and offer flexible hybrid services. Although the study did not include Medicare Advantage enrollees, nor examine clinical outcomes, it highlights telehealth's enduring presence in outpatient care. As policy makers deliberate on telehealth's future, its profound integration into care delivery will be crucial. The full study is available in JAMA Network Open.