Background The COVID-19 pandemic has become a serious public health concern for older adults and amplified the value of deploying telehealth solutions. The purpose of this study was to investigate telehealth offered by providers among U.S. Medicare beneficiaries aged 65 years and older during the COVID-19 pandemic. Methods This cross-sectional study analyzed Medicare beneficiaries aged 65 years and older using data from the Medicare Current Beneficiary Survey, Winter 2021 COVID-19 Supplement ($$n=9,185$$ n = 9 , 185 ). We identified variables that were associated with telehealth offered by primary care physicians and beneficiaries’ access to the Internet through a multivariate classification analysis utilizing Random Forest machine learning techniques. Findings For study participants interviewed by telephone, 81.06% of primary care providers provided telehealth services, and 84.62% of the Medicare beneficiaries had access to the Internet. The survey response rates for each outcome were 74.86% and 99.55% respectively. The two outcomes were positively correlated ($$\chi ^2=268.58,\,p<.001$$ χ 2 = 268.58 , p < . 001 ). The Our machine learning model predicted the outcomes accurately utilizing 44 variables. Residing area and race/ethnicity were most informative for predicting telehealth coverage, and Medicare-Medicaid dual eligibility and income were most informative for predicting Internet access. Other strong correlates included age, ability to access basic needs and certain mental and physical health conditions. Interactions were found among statuses of residing area, age, Medicare Advantage and heart conditions that intensified the disparity of outcomes. Conclusions We found that telehealth offered by providers likely increased during the COVID-19 pandemic for older beneficiaries, providing important access to care for certain subgroups. Policymakers must continue to identify effective means of delivering telehealth services, modernize the framework of regulatory, accreditation and reimbursement, and address disparities in access to telehealth with a particular focus on underserved communities.

BackgroundThe coronavirus disease 2019 (COVID-19) public health emergency has amplified the potential value of deploying telehealth solutions. Less is known about how trends in access to care through telehealth changed over time.ObjectivesTo investigate trends in forgone care and telehealth coverage among Medicare beneficiaries during the COVID-19 pandemic.MethodsA cross-sectional study design was used to analyze the outcomes of 31,907 Medicare beneficiaries using data from three waves of survey data from the Medicare Current Beneficiary Survey COVID-19 Supplement (Summer 2020, Fall 2020, and Winter 2021). We identified informative variables through a multivariate classification analysis utilizing Random Forest machine learning techniques.FindingsThe rate of reported forgone medical care because of COVID-19 decreased largely (22.89–3.31%) with a small increase in telehealth coverage (56.24–61.84%) from the week of June 7, 2020, to the week of April 4 to 25, 2021. Overall, there were 21.97% of respondents did not know whether their primary care providers offered telehealth services; the rates of forgone care and telehealth coverage were 11.68 and 59.52% (11.73 and 81.18% from yes and no responses). Our machine learning model predicted the outcomes accurately utilizing 43 variables. Informative factors included Medicare beneficiaries' age, Medicare-Medicaid dual eligibility, ability to access basic needs, certain mental and physical health conditions, and interview date.ConclusionsThis cross-sectional survey study found proliferation and utilization of telehealth services in certain subgroups during the COVID-19 pandemic, providing important access to care. There is a need to confront traditional barriers to the proliferation of telehealth. Policymakers must continue to identify effective means of maintaining continuity of care and growth of telehealth services.