Forty-one states and the District of Columbia mandate coverage parity, which requires private insurers to cover telehealth similarly to in-person care. These state laws often specify insurers cover telehealth “in the same manner” or “to the same extent” as in-person services and prohibit insurers from denying coverage solely because a service is delivered through telehealth. Additionally, coverage parity laws typically clarify insurers are not required to cover virtual health services they do not cover in-person, and that they can apply the same level of cost-sharing to telehealth as they would for in-person care.
Some states set limits on what private insurers are required to cover. For example:
Washington applies telehealth coverage requirements only to services recognized as an essential health benefit under the Affordable Care Act.
South Dakota authorizes private insurers to establish criteria a provider must meet to demonstrate a certain service or treatment can be safely and effectively delivered via telehealth.
Two states with private insurance laws—Florida and Michigan—do not explicitly require coverage parity. Rather, these states give insurers more authority over the extent of coverage they provide for telehealth.
While most private insurance laws require coverage parity, fewer state laws stipulate what insurers must pay for telehealth. Twenty-two states mandate payment parity, which requires private insurance reimbursements for telehealth to reflect what the insurer would pay for in-person services. Some state laws require reimbursements for telehealth to be “the same amount” or “at the same rate” as in-person services. Certain policy experts maintain this statutory language provides a stricter standard for private insurers and ensures reimbursement rates are truly equivalent to in-person care.
Other payment parity laws specify private insurers must reimburse “on the same basis” as in-person care, which some argue may better account for potential cost savings achieved through telehealth—such as lower facility and administrative fees.
Some states—including California, Georgia and Washington—require payment parity, but also authorize insurers and providers to voluntarily differentiate reimbursements via contract negotiations.
Several other states have established requirements for private insurance reimbursements, but they do not constitute full payment parity for all services delivered through telehealth. For example:
Some states limit payment parity to certain types of services and specialties. Iowa, Massachusetts and Nebraska mandate payment parity for telemental health or behavioral health services. Massachusetts also temporarily extended payment parity requirements to primary care and chronic disease management services until January 2023. Rhode Island established payment parity for primary care, dietitian and behavioral health services.
At least six states—Florida, Kansas, Nebraska, North Dakota, Tennessee and West Virginia—have statutory language fully deferring to reimbursement rates determined through provider-insurer contract negotiations rather than requiring payment parity.
Louisiana requires private health insurers to reimburse providers at originating sites—or where the patient is located when using telehealth—for at least 75% of the in-person rate.
Other Private Insurance Requirements
Beyond coverage and payment parity, states have enacted legislation enhancing private insurance coverage for telehealth in other ways.
According to Foley and Lardner LLP, 30 states provide cost-sharing protections for health plan enrollees using telehealth, which often ensures patients do not face higher copayments, coinsurance or deductibles for telehealth visits compared to in-person care.
Coverage for different modalities
Foley also identified 27 states that require private insurance coverage for store-and-forward technologies, and 17 states that mandate coverage for remote patient monitoring.
Limiting coverage exclusions
Some states prohibit insurers from establishing additional criteria as a condition for telehealth coverage. For example, Colorado enacted legislation in 2020 prohibiting health insurers from requiring a previously established provider-patient relationship, or from imposing additional certification, location or training requirements prior to covering telehealth. The legislation also prevents insurers from establishing specific requirements or limitations on telehealth technologies in compliance with the Health Insurance Portability and Accountability Act.
A note about this brief: Although the COVID-19 pandemic ushered in a wave of private insurance coverage requirements, many of these actions are temporary. State counts listed throughout this brief only include permanent laws and regulations. Please refer to the Telehealth, COVID-19 and Looking Ahead brief for more information.