If you have ever gotten a surprise bill after a telehealth visit, you know how confusing virtual care billing can be.

The rules depend on who insures you, what state you are in, and sometimes what type of visit you are having. This guide breaks down what is actually included — and what is not.

Medicare: What Is Included for Telehealth

What is now permanent

Medicare has significantly expanded telehealth benefits since the pandemic-era emergency provisions. Several key changes have been made permanent:

No geographic restrictions — You can receive telehealth from home, whether you live in a major city or a rural area. The old requirement that patients had to be at a medical facility in a rural area is gone for most services.
Mental health parity — Virtual psychiatry and therapy visits are reimbursed at the same rate as in-person. Medicare removed the requirement for an initial in-person visit before telehealth mental health care for established patients.
Audio-only visits — Phone-only appointments are reimbursed for behavioral health services when video is not feasible. This is especially important for patients without reliable internet access.
FQHCs and Rural Health Clinics — Federally Qualified Health Centers and Rural Health Clinics can now serve as telehealth providers, expanding access in underserved areas.

What You Will Pay with Medicare

Standard Part B cost-sharing applies to telehealth: you pay 20% of the Medicare-approved amount after meeting your annual deductible.

Medicare Advantage plans may have lower or even $0 copays for virtual visits — check your specific plan summary of benefits.

Watch the renewal cycle

Important: Medicare telehealth benefits are subject to congressional renewal for certain services. Check CMS.gov for the most current list of eligible telehealth services.

Medicaid: It Varies by State

What is reimbursed where

Every state provides some form of telehealth reimbursement under Medicaid, but the details differ significantly:

Live video visits — Reimbursed in all 50 states and DC
Store-and-forward (sending photos or records for review later) — Available in roughly 30 states
Remote patient monitoring — Available in roughly 35 states
Audio-only visits — Available in roughly 40 states, but often restricted to behavioral health

Why payment parity matters

Payment parity — whether Medicaid pays the same rate for telehealth as in-person visits — is mandated in about half the states.

In states without parity, providers may receive 10 to 30 percent less for telehealth, which can limit how many providers offer virtual Medicaid appointments.

Where to look up your state

For your state specific Medicaid telehealth policies, contact your state Medicaid office or check the Medicaid.gov website.

Private Insurance: Employer and Marketplace Plans

The trend is broader inclusion

Most employer-sponsored and marketplace plans now include telehealth benefits. The trend has been toward broader inclusion, but the specifics depend on your plan and your state laws.

Three things to know

Key points:

The majority of states have laws requiring private insurers to include telehealth in some form
About half of states require payment parity — meaning insurers must reimburse telehealth at the same rate as in-person visits
Telehealth for specialties beyond primary care and mental health (like dermatology, cardiology, endocrinology) is expanding but not universal

What Major Insurers Typically Include

Insurer	Primary Care	Mental Health	Specialty Care	Notes
Aetna	Yes	Yes	Select specialties	Teladoc partnership
Blue Cross Blue Shield	Yes	Yes	Varies by state plan	Differs by affiliate
Cigna / Evernorth	Yes	Yes	Yes	MDLive integration
UnitedHealthcare	Yes	Yes	Yes	Optum virtual care
Kaiser Permanente	Yes	Yes	In-network only	Integrated system

Note: This table reflects general trends. Your specific plan may differ. Always verify with your insurer before booking.

HSA and FSA: Yes, Telehealth Counts

Eligible expenses

Telehealth copays, coinsurance, and self-pay fees are all eligible expenses under Health Savings Accounts (HSA) and Flexible Spending Accounts (FSA).

HDHP + HSA: pre-deductible telehealth

If you have a high-deductible health plan (HDHP) paired with an HSA, some plans allow pre-deductible telehealth — meaning you can get a virtual visit before meeting your deductible without it affecting your HSA eligibility.

The Cross-State Problem

Two things must both be true

This catches a lot of people off guard. Even if your insurance includes telehealth, two things must be true for the visit to work:

The provider must be licensed in your state — where you physically are during the visit
The provider must be in your insurance network

What happens when you travel

If you travel to another state, your regular telehealth provider might not be able to see you. The choosing an online doctor guide explains how to verify licensure across states.

You can search for providers by specialty on NPI Telehealth and verify they are properly registered before worrying about insurance.

What Is Usually NOT Included

Common exclusions

Cosmetic consultations (elective dermatology, plastic surgery consults)
Services from providers outside your insurance network
Platform subscription fees (some telehealth companies charge monthly fees separately from visit copays)
International telehealth — most US insurance will not reimburse visits with providers outside the country
Services from providers not licensed in your state

How to Check Your Benefits Before Booking

Four steps, ten minutes

Call your insurer — Use the member services number on the back of your insurance card. Ask specifically: Does my plan include telehealth visits? What is my copay? Which platforms or providers are in-network?
Read your Summary of Benefits — Look for sections labeled telehealth, virtual visit, telemedicine, or digital health. The copay is sometimes different from in-person visits (often lower).
Verify the provider — Use NPI Telehealth to confirm the provider is NPI-registered. Then check they are in-network with your specific plan.
Ask about cost upfront — Before the visit starts, confirm your expected out-of-pocket cost. A good platform will show this during booking.

Frequently Asked Questions

Does insurance pay for therapy apps like BetterHelp or Talkspace?

It depends on the platform and your plan. Some platforms have started accepting insurance directly, while others remain self-pay only.

Check directly with both the platform and your insurer. Our mental health telehealth review lists which platforms accept insurance.

Can my employer plan restrict which telehealth platform I use?

Yes. Many employer plans partner with specific telehealth providers (like Teladoc or MDLive) and offer lower copays for those platforms.

You can usually still use other in-network providers, but your cost-sharing may be higher.

What if my insurance denies a telehealth claim?

First, check if the denial is due to the provider being out-of-network or not licensed in your state.

If the service should be reimbursed, file an appeal with your insurer. Your state insurance commissioner office can help if the insurer is not following state telehealth laws.

Is there a limit on how many telehealth visits insurance pays for per year?

Most plans do not have a specific limit on telehealth visits, but they may have overall visit limits for certain specialties (like a cap on therapy sessions per year).

The telehealth modality itself is rarely the limiting factor.

Stay Informed

Where the rules actually live

Telehealth reimbursement rules change frequently as states pass new laws and federal policies evolve.

The most reliable sources for current information are CMS.gov for Medicare, your state Medicaid office for Medicaid, and your plan member portal for private insurance.

One last rule of thumb

When in doubt, call your insurer before the visit — not after.

Telehealth Insurance Coverage: 2026 Update