Aim <p>This study investigated demographic disparities and temporal trends in telehealth utilization among Medicare beneficiaries in the United States from 2020 to 2024, with emphasis on differences by geography, gender, age group, and enrollment status.</p> Subject and methods <p>A retrospective secondary analysis was conducted using the Centers for Medicare &amp; Medicaid Services (CMS) Medicare Telehealth Trends dataset, covering January 2020 to September 2024. The study population comprised Medicare Part B beneficiaries eligible for telehealth services. Key variables included telehealth utilization percentage, gender, rural–urban commuting area (RUCA) classification, age group, and enrollment figures. Nonparametric statistical tests (Mann–Whitney <i>U</i>, Kruskal–Wallis, Dunn’s post hoc, and Wilcoxon signed-rank) were employed owing to non-normal data distribution. Temporal trends were visualized across the study period.</p> Results <p>Analysis of over 32 million records showed a mean telehealth utilization rate of 21.66% (SD 13.49%). Utilization was significantly higher among urban compared to rural residents and among women compared to men (<i>p</i> &lt; 0.001). Statistically significant differences were observed across age groups (χ²(7) = 1283.16, <i>p</i> &lt; 0.001), with the 0–64 age group reporting the highest usage. Telehealth peaked at 47.3% in Q2 2020 and then stabilized between 13 and 16% thereafter. A significant discrepancy was found between telehealth-eligible individuals and overall enrollment (<i>p</i> &lt; 0.001).</p> Conclusion <p>Telehealth utilization among Medicare beneficiaries displayed significant demographic and geographic disparities. These findings highlight the importance of equity-driven digital health policies aimed at reducing barriers and promoting inclusive access to virtual care.</p>