Telehealth Market

Medicare fee-for-service telemedicine visits fell 24 percent in the first 17 days after the program’s pandemic-era flexibilities expired on 30 September 2025, a figure cited in the Drug Enforcement Administration (DEA) telemedicine rule of 31 December 2025, and in Florida, Louisiana and New York the fall was nearly 40 percent or more. That patient reaction is the starting point for pricing the telehealth market. Douglas Insights sizes it at USD 48.65 billion in 2025, from 1.278 billion billable encounters at a blended USD 38.07 each, and projects USD 118.78 billion by 2035, a revenue CAGR (compound annual growth rate) of 9.34%. Encounters grow 7.35% a year and revenue per encounter 1.85%. The study belongs to our digital health research, and every figure was rebuilt under the Douglas Insights research methodology.

Which visits, monitored patients and software fees sit inside the telehealth boundary?

The telehealth market covers four revenue streams worth USD 48.65 billion in 2025: synchronous video and audio visits, remote patient monitoring, store-and-forward and asynchronous care, and telehealth platforms and software. Revenue is counted where a payer or a patient pays for remote clinical care, at realised value, across five regions.

One telehealth encounter is one billable remote contact: a video or telephone visit, an e-consult or photo review, or one remote patient monitoring (RPM) patient-month. Connected devices sold outright, general electronic health record software and in-person hybrid visits sit outside the count. Veterinary consults are excluded too; the Animal Telehealth Market report sizes them separately.

Telehealth buyers split into Medicare and public programmes, commercial insurers, employers and cash-pay consumers. Clinical demand concentrates in four areas: behavioural health, chronic disease management, primary and urgent care, and weight management. Prescription digital therapeutics are left to the Digital Medicine Market study.

Why are Medicare patients, GLP-1 subscribers and therapy clients keeping telehealth demand rising?

Telehealth encounter volume grows 7.35% a year to 2035, and four forces supply every point of it. Medicare coverage certainty adds 1.65 points, behavioural health and weight management programmes 2.10, chronic-disease monitoring 1.85 and Asian public programmes 1.75, all measured against the 1.278 billion encounters of 2025.

Medicare certainty is the first telehealth driver, worth 1.65 points. The Consolidated Appropriations Act, 2026, signed on 3 February 2026, extended home-based Medicare telehealth and audio-only visits to 31 December 2027, after a lapse from 1 October 2025 that Congress reversed in November 2025. Two years of statutory cover let health systems staff virtual clinics beyond a single quarter for the first time since 2020. The Physician Fee Schedule final rule for calendar year 2026, published on 5 November 2025, also made virtual direct supervision permanent and removed frequency limits on subsequent inpatient and nursing facility visits by telehealth.

Behavioural health and weight management add 2.10 points, the largest piece of the volume leg. Hims & Hers ended 2025 with 2,511 thousand subscribers, up 13% from 2,229 thousand, and revenue of USD 2.35 billion, up 59%, according to its full-year 2025 results. Teladoc Health’s BetterHelp therapy service averaged 0.386 million paying users in 2025, per its Form 8-K filing. Glucagon-like peptide-1 (GLP-1) obesity drugs turned weight care into a monthly telehealth subscription. Therapy became a weekly one.

Chronic-disease monitoring adds 1.85 points. The calendar year 2026 fee schedule created RPM codes 99445 and 99470 for months with fewer than 16 days of data transmission or under 20 minutes of interactive time, bringing patients who missed the old 16-day threshold into billing. Teladoc Health counted 1.188 million chronic care programme enrolments at the end of 2025. Inhaler sensors feed the same billing stream, as the Smart Inhalers Market report shows. Douglas Insights expects remote patient monitoring revenue to compound at 12.41% a year, the fastest of the four telehealth streams.

Asian public programmes add 1.75 points. India’s eSanjeevani service passed 50 crore (500 million) teleconsultations and runs around 2.5 to 3 lakh consultations a day through more than 1.42 lakh Ayushman Arogya Mandir spokes, All India Radio reported on 6 October 2026. At 2.75 lakh a day, eSanjeevani alone delivers about 100 million telehealth consultations a year, roughly 18% of the 548 million Asia Pacific encounters in our model.

What headwinds from licensure, DEA prescribing limits and visit-price deflation hold telehealth back?

Three telehealth headwinds remove 2.10 points of encounter growth in the slower case, cutting the volume leg from 7.35% to 5.25%. Prescribing limits take 0.85 points, the 2028 Medicare cliff and licensure 0.70, and the clinical ceiling on remote care 0.55. Visit-price deflation separately trims the price leg by 0.65 points.

Controlled-substance prescribing is the sharpest telehealth headwind, at 0.85 points. The DEA and Substance Abuse and Mental Health Services Administration (SAMHSA) fourth temporary extension keeps pandemic-era telemedicine prescribing open only from 1 January 2026 to 31 December 2026. The same rule cites an estimate that more than 7 million of 44.6 million controlled-substance prescriptions written across 258 organisations in 2024, about 16 percent, were issued without a prior in-person evaluation. Without a further extension or a special registration, those patients face a clinic visit before their first prescription.

The Medicare cliff and licensure take 0.70 points. Under the 2026 appropriations law, home-based Medicare telehealth runs to 31 December 2027, and Congress must act again to avoid a lapse on 1 January 2028. State licensure adds friction every year: a clinician must hold a licence where the patient sits, so each state line narrows the pool a telehealth vendor can route a visit to.

The clinical ceiling takes 0.55 points. Examinations, imaging and procedures still need a room, and roughly one in four Medicare telemedicine visits did not happen during the autumn lapse. Price deflation removes 0.65 points from the price leg in the slower case, as cash-pay telehealth visits compete down to USD 25 to 45 and insurers audit audio-only claims.

How did the autumn Medicare lapse show which telehealth visits patients will not give up?

Telehealth proved sticky but not fixed: Medicare fee-for-service visits fell 24 percent in 17 days once coverage lapsed on 1 October 2025, so about three in four continued, per the DEA and SAMHSA rule. Patients kept the visits that replace a long trip, such as behavioural health follow-ups, and dropped the ones a nearby clinic absorbs.

The base of willing telehealth patients is broad. The National Center for Health Statistics found that 37.0% of US adults used telemedicine in the past 12 months in 2021, rising to 43.3% among adults aged 65 and over and 42.0% among women (NCHS data brief 445). Older adults, the Medicare population, are the heaviest users. That is why a lapse in Medicare cover bites harder than any commercial price change.

European patients show the same habit inside public systems. In England, 67.4% of the 40.4 million general practice appointments in October 2025 were face to face, so 32.6% used other modes, chiefly telephone (NHS England appointments data). Douglas Insights puts Europe’s 2025 telehealth encounters at 238 million, priced near USD 31.80 each because national systems pay remote GP contacts inside capitation rather than per visit.

Which region turns the most telehealth encounters into revenue, and where does growth run fastest?

North America earns 60.10% of 2025 telehealth revenue, USD 29.24 billion, from 392 million encounters at about USD 74.60 each. Asia Pacific grows fastest at 11.84% a year on public teleconsultation volume, and the Middle East and Africa is the wildcard at 10.14%, with country tables in the Excel model.

North America reaches USD 65.57 billion by 2035 at 8.41% a year. Medicare and commercial insurers pay per visit and per monitored month, so its 392 million telehealth encounters earn more than the other four regions combined.

Asia Pacific is the fastest-growing telehealth region at 11.84%, rising from USD 9.26 billion to USD 28.35 billion, because public programmes such as eSanjeevani and hospital-run internet clinics in China add encounters faster than anywhere else. Its 548 million encounters carry only about USD 16.90 each.

Europe holds 15.55% of telehealth revenue, USD 7.57 billion, and compounds at 9.07% to USD 18.03 billion as national systems keep about a third of primary care contacts remote. Latin America holds 3.43%, USD 1.67 billion, growing 10.24% to USD 4.43 billion on private insurer apps.

The Middle East and Africa is the telehealth wildcard: USD 910.5 million in 2025, 1.87% of revenue, growing 10.14% a year to USD 2.39 billion. Gulf insurer mandates and mobile-first African clinics pull in opposite price directions, which is why the range around this region is widest.

Which telehealth service type makes the money: video visits, monitored patient-months or software?

Synchronous video and audio visits make the most money, 47.3% of 2025 telehealth revenue or USD 23.01 billion, because every payer reimburses a visit. Remote patient monitoring is the fastest-growing stream at 12.41% a year, as monthly chronic-care codes widen to patients who transmit fewer readings.

Synchronous video and audio visits hold USD 23.01 billion because they are the one telehealth format every payer reimburses. They grow slowest, at 7.08%, to USD 45.61 billion, since price competition caps the visit fee.

Remote patient monitoring holds 22.6%, USD 11.00 billion, and climbs at 12.41% to USD 35.42 billion. Each enrolled patient bills monthly, so telehealth monitoring revenue compounds with enrolment rather than with visits.

Telehealth platforms and software take 19.4%, USD 9.44 billion, from licence and per-member fees that health systems and insurers pay for the virtual front door. They grow 9.38% to USD 23.14 billion.

Store-and-forward and asynchronous care holds 10.7%, USD 5.21 billion, from photo dermatology, e-consults and message-based subscription programmes. It grows 10.27% to USD 13.84 billion because cash-pay consumers prefer a form to a video call.

Douglas Insights calculates that monitoring lifts its share of telehealth revenue from 22.6% to about 30% by 2035. Mix, not visit inflation, explains the price leg.

How much do payers and cash-pay consumers spend per telehealth encounter or monitored patient-month?

A telehealth encounter earned a blended USD 38.07 in 2025, rising to USD 45.73 by 2035 at 1.85% a year. The blend hides a wide ladder: about USD 74.60 per North American encounter, USD 31.80 in Europe and USD 16.90 in Asia Pacific, where public teleconsultations are nearly free at the point of use.

Disclosed revenues give two cash-pay telehealth anchors. Hims & Hers earned about USD 82.55 per average subscriber per month in 2025, a Douglas Insights calculation from USD 2.35 billion of revenue and the mean of 2,229 thousand and 2,511 thousand subscribers (company results). BetterHelp earned about USD 205.18 per paying user per month, from USD 950.4 million of revenue and 0.386 million paying users (Teladoc Health 8-K).

Douglas Insights price bands for 2025 run from USD 25 to 45 for a cash-pay asynchronous telehealth visit, USD 60 to 110 for an insured North American video visit and USD 45 to 110 for an RPM patient-month. A public teleconsultation in India or China costs the system under USD 5.

The price leg rises 1.85% a year even though insured visit fees stay roughly flat. Monitored patient-months and subscriptions, each worth more than a single telehealth visit, gain share.

Which DEA and Medicare rules decide what a telehealth clinician can bill and prescribe?

Three telehealth rules govern billing and prescribing through 2027: Medicare home-based coverage runs to 31 December 2027, DEA telemedicine prescribing flexibilities run to 31 December 2026, and the Physician Fee Schedule resets payment every January. Each covers a different decision: where the patient sits, what can be prescribed and what the visit pays.

The Consolidated Appropriations Act, 2026 (H.R. 7148) set the Medicare telehealth date. The DEA and SAMHSA extension, effective 1 January 2026, set the prescribing date and is the fourth temporary extension since 2023. The calendar year 2026 fee schedule rule set the RPM codes and the permanent virtual supervision policy. The 2023 proposals drew 38,369 public comments, a sign of how contested the prescribing question remains for telehealth.

Douglas Exclusive: the reimbursement cliff calendar

The reimbursement cliff calendar is a Douglas Insights model, built from 6 dated federal actions and 7 inputs from our telehealth encounter model, that puts a revenue figure on each US deadline. Its rows are drawn from the DEA and SAMHSA rule, the 2026 appropriations law and the 2026 fee schedule rule; the exposure values are our estimates, not official figures.

The telehealth cliff calendar counts, for each deadline, the revenue riding on the rule and the share that would vanish in a lapse. For Medicare, our model puts 15.8% of North American telehealth revenue, USD 5.89 billion in 2028, on the home-based waiver, and applies the 24% loss observed in the autumn 2025 lapse to reach USD 1.41 billion at risk. For DEA prescribing, it puts 7.1% of 2027 North American revenue, USD 2.44 billion, on controlled-substance programmes and applies the 16% share issued without an in-person evaluation, giving USD 390.4 million.

The finding: the Medicare cliff on 1 January 2028 is 3.6 times the DEA cliff in revenue at risk, yet it equals only 2.22% of global telehealth revenue that year. Telehealth survives either cliff; US behavioural health operators carry most of the pain.

Which telehealth vendors, from Teladoc Health to Doctolib, win the employer, payer and cash-pay channels?

Teladoc Health leads telehealth with a 5.2% share of 2025 revenue, on Douglas Insights estimates built from its USD 2.53 billion of reported revenue. Hims & Hers follows at 4.8%, so the top two hold 10.0%; health systems, insurers and national programmes deliver most other encounters themselves.

Teladoc Health reported USD 2.53 billion of 2025 revenue, down 2%, with Integrated Care up 3% to USD 1.58 billion, BetterHelp down 9% to USD 950.4 million, 17.1 million visits and 101.8 million US Integrated Care members (Form 8-K). Its 17.1 million visits equal 1.34% of global telehealth encounters, which shows how fragmented delivery is.

Hims & Hers built its telehealth position on cash-pay subscriptions, growing revenue 59% to USD 2.35 billion in 2025 (results release). A DEA lapse on 31 December 2026 matters less to it than to therapy-led rivals, since weight and dermatology prescriptions are mostly not controlled substances.

Amwell sells telehealth software to health systems and health plans, so its revenue sits in the platforms stream. Doctolib turned a booking network used by European practices into a video-consultation rail. Included Health pairs employer navigation with virtual care, and JD Health links consultations to pharmacy fulfilment in China.

What would a permanent Medicare fix, or a 2028 telehealth cliff, do to the 2035 forecast?

The base case reaches USD 118.78 billion in 2035 with 7.35% encounter growth and 1.85% price growth. A slower case at 5.25% and 1.2% lands at USD 91.44 billion, and a faster case at 8.9% and 2.4%, with Medicare telehealth made permanent, reaches USD 144.67 billion.

Encounter growth is the dial that matters for telehealth. One extra point on the 7.35% leg adds about USD 11.54 billion to the 2035 value, and one point less removes about USD 10.61 billion.

The slower case is what the 30 September 2025 lapse previewed: a 24 percent fall in Medicare fee-for-service visits in 17 days (Federal Register), repeated as a permanent loss after 1 January 2028 and combined with a DEA lapse. The faster case assumes Congress makes home-based telehealth permanent before the 31 December 2027 deadline set by the 2026 appropriations law.

Outside forecasts of telehealth growth span 11.3% to 24.8% a year. Our 9.34% sits below that whole range because Douglas Insights counts only billed remote care and leaves out devices and in-person hybrid revenue.

How does the methodology turn 1.278 billion telehealth encounters into USD 48.65 billion?

The methodology multiplies 1.278 billion billable telehealth encounters by a blended USD 38.07 to reach USD 48.65 billion for 2025. Five regional builds sum to that total within 0.01%. Direct encounter evidence covers 3 countries, the United States, England and India, and the other markets are scaled from them.

Regional receipts: North America 392 million encounters at USD 74.60, Europe 238 million at USD 31.80, Asia Pacific 548 million at USD 16.90, Latin America 61 million at USD 27.39, and the Middle East and Africa 39 million at USD 23.35. Together they give USD 48.65 billion against the global receipt.

Four cross-checks hold the telehealth build in place. Teladoc Health’s 17.1 million visits equal 1.34% of encounters; Teladoc Health and Hims & Hers revenue equals 10.0% of value; eSanjeevani’s roughly 100 million yearly consultations equal about 18% of Asia Pacific volume; and the 24% Medicare drop calibrates the cliff calendar. The model draws on 8 primary documents linked on this page.

AI drafting and automated checks are used to prepare this telehealth report, and the Douglas Insights research desk owns the sources, the model and the final approval, as set out in our editorial standards.

Sources

1. DEA and SAMHSA, Federal Register Fourth Temporary Extension of COVID-19 Telemedicine Flexibilities for Prescription of Controlled Medications (2025)
2. US Government Publishing Office Consolidated Appropriations Act, 2026 (H.R. 7148, enrolled) (2026)
3. CMS, Federal Register CY 2026 Physician Fee Schedule final rule (2025)
4. Teladoc Health, SEC EDGAR Teladoc Health fourth quarter and full year 2025 results (Form 8-K) (2026)
5. Hims and Hers Health Hims and Hers Health fourth quarter and full year 2025 results (2026)
6. National Center for Health Statistics Telemedicine Use Among Adults: United States, 2021 (Data Brief 445) (2022)
7. NHS England Appointments in General Practice, October 2025 (2025)
8. All India Radio News eSanjeevani achieves milestone of 50 crore teleconsultations (2026)