During the height of the COVID-19 pandemic, telemedicine became a go-to solution for doctor visits. Now, insurers are banking on its lasting appeal by introducing health plans that prioritize virtual care—some even requiring video visits as the first step for primary care.
A Shift Toward Virtual-First Care
In some states, insurers are offering coverage that mandates online visits first for nonemergency primary care. Similar plans are being introduced for employers across multiple regions.
“These are true telehealth-first primary care replacements,” said an industry expert, noting that virtual-first plans have been launched as an addition to traditional Affordable Care Act (ACA) offerings.
These plans typically feature lower premiums and capitalize on the convenience of online consultations. However, some healthcare professionals worry about the potential downsides, such as missing subtle but critical health cues.
The Risks and Limitations of Virtual Care
Medical experts warn that virtual visits may overlook key diagnostic indicators. “There’s an instinct that comes with seeing a patient in person—like recognizing early signs of Parkinson’s or detecting a heart murmur,” one specialist noted. While telehealth is useful for follow-ups, it may be less effective for initial exams.
Patients enrolling in virtual-first plans are usually assigned an online primary care physician (PCP) who serves as their first point of contact. These physicians can refer patients to in-person specialists within the insurer’s network when needed. However, in some cases, patients may never meet their PCP in person.
How Virtual-First Plans Work
Most insurers offering these plans contract with third-party telehealth providers. Physicians, licensed across multiple states, conduct online visits and access medical records through integrated electronic systems. However, transferring patient data between different healthcare systems remains a challenge, even within traditional insurance models.
Recognizing the novelty of virtual-first plans, insurers are proactively reaching out to enrollees to ensure they understand the model. Reports indicate thousands of members have already joined, with plans to expand enrollment in the coming years.
Major Insurers Betting on Telehealth
Leading insurers have introduced their own telehealth-driven plans. While some emphasize virtual care, they don’t always require it.
Some plans allow patients to choose between online and in-person visits. “These aren’t virtual-only plans,” said a spokesperson for one insurer. “Patients can still opt for traditional providers.”
Unlike most insurers that rely on contracted telehealth providers, some companies employ their own in-house medical staff. Meanwhile, other telehealth providers have expanded to offer staffing for major insurers. Physicians working remotely are typically paid based on patient volume, with no cap on the number of patients they see.
Cost-Saving Strategy or Healthcare Limitation?
Virtual-first plans typically offer lower premiums and financial perks, such as no copays for online visits. They also promise near-instant access to medical professionals. Patients with serious conditions are assisted in arranging emergency care, while those needing lab tests, immunizations, or specialist visits are referred to in-network providers.
The model resembles a modernized HMO, offering insurers greater control over referrals and patient interactions. “It’s about managing care pathways and costs,” said an industry analyst.
However, these plans can restrict in-person care. Some require virtual doctors—who may never have physically examined the patient—to approve any in-person visits. Studies estimate that about 66% of primary care cases still require an in-person visit for accurate diagnosis and treatment.
To compensate, some insurers provide at-home medical kits, including blood pressure cuffs and thermometers. Online doctors may also guide patients through self-exams, such as checking for swollen lymph nodes or examining their own tonsils on camera. Nonetheless, these tools often lack the accuracy of in-office diagnostics.
Certain insurers mandate in-person visits for children’s wellness exams to ensure proper height, weight, and immunization tracking.
Navigating the Fine Print
Before choosing a virtual-first plan, experts advise consumers to carefully compare premiums, deductibles, and copays. While some plans eliminate copays for online visits, they may impose high out-of-pocket costs for in-person care.
For example, some virtual-first plans cover online primary care visits at no cost, but non-preventive in-person visits may require patients to meet a high annual deductible before coverage applies.
Other plans allow a limited number of in-person primary care visits per year with a copay, with additional visits subject to a deductible.
Virtual-first plans sold through ACA marketplaces or employers must comply with federal requirements, covering a broad range of services, including hospital care. However, experts warn against non-ACA-compliant plans, which might offer only virtual consultations without comprehensive medical coverage.
“Some plans may claim to offer access to online providers but little else,” cautioned a healthcare policy expert. “That’s not real major medical insurance.”
The Future of Virtual Healthcare
As insurers continue refining virtual-first models, the long-term impact remains uncertain. While the approach offers convenience and cost savings, it also raises questions about care quality, data accessibility, and the role of in-person visits.
For patients considering these plans, the key takeaway is clear: read the fine print, understand the limitations, and ensure the coverage meets your healthcare needs.