Nearly every state has enacted some form of telehealth parity law, but these laws vary substantially in scope, and a critical distinction — between coverage parity and payment parity — means the practical protection a "parity law" actually provides differs enormously depending on exactly how a given state's law is written.
Coverage Parity Versus Payment Parity Is the Essential Distinction
Coverage parity laws require insurers to cover a telehealth visit for a service if they would cover the equivalent in-person visit, but do not specify what the insurer must actually pay for that covered telehealth visit — an insurer complying with coverage parity alone could still reimburse a telehealth visit at a meaningfully lower rate than the equivalent in-person visit. Payment parity laws go further, requiring the insurer to reimburse a covered telehealth visit at the same rate as the equivalent in-person visit. States vary considerably in which type of law, if either, they have enacted, which means "telehealth parity" in one state can mean something functionally quite different from "telehealth parity" in another.
Why Payment Parity Has Been More Contested Than Coverage Parity
Insurer industry groups have generally been more supportive of coverage parity requirements than payment parity requirements, arguing that telehealth visits may involve lower overhead costs for providers in some circumstances and that mandating identical payment removes an insurer's ability to negotiate rates reflecting those potential cost differences. Provider groups have countered that a telehealth visit still requires the same clinical expertise, time, and liability exposure as an in-person visit, and that lower payment rates create a direct financial disincentive against offering telehealth as an equally viable care option. This unresolved policy tension explains why payment parity laws have faced more legislative resistance and are less universally adopted than basic coverage parity requirements.
Sunset Provisions Add Another Layer of State-by-State Variation
Several states enacted their telehealth parity laws with sunset provisions or explicit pandemic-era time limits rather than permanent statutory requirements, meaning some state parity protections have already expired or face upcoming expiration deadlines requiring legislative renewal — adding yet another dimension of variability, since a practice must track not just whether a state has a parity law and what type, but also whether that law remains in effect or requires renewal to continue.
State Parity Laws Generally Apply Only to State-Regulated Insurance Plans
An important structural limitation of state telehealth parity laws is that they generally apply only to insurance plans subject to state regulation — fully insured commercial plans and Medicaid — while self-funded employer health plans, which cover a substantial share of Americans with employer-sponsored insurance, are regulated under federal ERISA law and are not bound by state telehealth parity requirements at all. This means a state's parity law, however protective on paper, does not guarantee telehealth payment parity for a meaningful share of insured patients whose employer happens to self-fund its health benefits.
Medicaid Telehealth Policy Follows Its Own Separate State-by-State Track
Beyond general parity laws, state Medicaid programs set their own specific telehealth coverage and payment policies, which have generally expanded considerably since the pandemic but still vary state by state in covered service types, allowed modalities (audio-only versus video), and payment rates — a further layer of state-specific variation that a multi-state telehealth practice serving Medicaid patients must track independently from both general parity law and Medicare policy.
Conclusion
Telehealth parity laws provide meaningfully different actual protection depending on whether a given state has enacted coverage parity, payment parity, or both, whether the law includes a sunset provision, and whether a specific patient's plan is even subject to state regulation at all. Multi-state telehealth practices navigating this variation rely on consistent diagnostic equipment standards to maintain uniform care quality regardless of the specific state payment framework in effect.
