Primary Care Access and the Role of Telemedicine for Traditional Medicare Beneficiaries.

Importance: Primary care improves population health, yet access is a challenge in the US. It is unclear how primary care use, access, and access disparities have changed since widespread adoption of telemedicine during the pandemic. Objective: To quantify trends in primary care use and determine the role of telemedicine in primary care access and access disparities for traditional Medicare beneficiaries. Design, Setting, and Participants: Serial cross-sectional study using 2017-2023 100% claims and administrative data for traditional Medicare beneficiaries continuously enrolled and alive for the given year. Data were analyzed from October 2024 to July 2025. Main Outcomes and Measures: Primary care visits per beneficiary, primary care access (defined as ≥1 virtual or in-person primary care visit in the year), and primary care continuity (Bice-Boxerman Index). Results: Among 258 324 127 person-years from 2017 to 2023, primary care visit rates decreased from 2.54 per person-year in 2017 to 2.27 per person-year in 2023, and access dropped from 61.9% to 59.8%. In 2023, virtual visits comprised 7% of primary care visits and 14% of beneficiaries who accessed primary care used telemedicine to do so. Disparities in access by race, geography, and income increased slightly from 2019 to 2023, and beneficiaries in historically underserved groups by race, geography, and income who accessed primary care were more likely than others to use telemedicine to do so. Primary care continuity decreased from 0.72 in 2019 to 0.65 in 2023; in 2023, continuity was slightly higher for those using telemedicine for primary care than for those who were not. Conclusions and Relevance: This serial cross-sectional study found that across all traditional Medicare beneficiaries, primary care visit rates and access decreased, with virtual visits comprising a small share of previously in-person visits. Access disparities widened while those in underserved groups were more likely than others to use telemedicine for this access. Results suggest that telemedicine plays a small but potentially important role in primary care access.