Objectives Aims were to quantify the association of pre-COVID-19 pandemic telehealth use and separately: 1) likelihood of an emergency department (ED) visit, 2) likelihood of a telehealth visit in older people during the pandemic. Design A retrospective cohort study to measure odds ratios (ORs) of telehealth usage before the pandemic and likelihood of an ED visit and telehealth visit during the study period. Setting and Patients Adults 65 years of age and older (N = 39,214) in the University of California COVID Research Data Set (UC CORDS). Main Outcomes Primary outcome was occurrence of one or more ED visits. Secondary outcome was occurrence of one or more telehealth visits. Results A telehealth visit before the pandemic was associated with reduced likelihood of an ED visit with an OR of 0.33 (95% confidence interval [CI] 0.200.55). Pre-pandemic telehealth was associated with an increased likelihood of telehealth use during the pandemic with an OR of 4.66 (95% CI 3.52-6.18). Conclusion Older people who utilized telehealth before the pandemic were less likely to receive emergency care and were more likely to use telehealth during the pandemic. Approaches to enhance and measure telehealth access for older people are necessary.