Telehealth parity laws address a question that sounds simple but has a complicated answer in practice: should a telehealth visit be covered and reimbursed the same way as an equivalent in-person visit? The answer depends heavily on which state and which payer are involved, since parity is not a single national standard but a patchwork of state-level rules layered on top of payer-specific policies.
Two different kinds of parity
Parity generally comes in two forms. Coverage parity requires that a payer cover a telehealth service if it would cover the equivalent in-person service. Payment parity goes further, requiring that the telehealth service be reimbursed at the same rate as the in-person equivalent. A state can have one without the other, and many do, so a service being "covered" under telehealth parity does not necessarily mean it is reimbursed at parity as well.
State variation is the norm
Most states have adopted some form of telehealth parity law, but the scope, the services covered, and whether the requirement applies to private payers, Medicaid, or both varies considerably. Some states apply parity broadly across specialties and modalities, while others limit it to specific services, patient populations, or delivery methods such as live video versus asynchronous store-and-forward care.
Telehealth parity is not one rule but two — coverage and payment — and a state or payer can offer either without the other.
Federal programs add another layer
Medicare telehealth policy operates on its own track, shaped by federal rulemaking and periodic legislative extensions, and does not automatically mirror state parity laws. A service treated at parity under a state's private-payer law may be reimbursed differently under Medicare or Medicaid, which typically follow their own separate coverage determinations.
Why this matters for practice planning
For physicians and practices building multi-state telehealth programs, parity status affects more than compliance — it shapes which services are financially viable to offer in a given state. Reviewing both the state parity law and the specific payer policies relevant to a patient population is generally more informative than relying on a state's parity law alone.
Because parity requirements differ by state, by payer, and by service type, and change over time, always confirm current requirements directly with the relevant state board or agency before making a compliance decision.