Introduction: Disparities in dermatologic care access exist across sociodemographic factors, with racial minorities and uninsured individuals less likely to receive care. Teledermatology expanded during COVID-19, yet national disparities remain understudied. Methods: We conducted a repeated cross-sectional analysis of the 2020-2022 Medical Expenditure Panel Survey, including individuals with at least one dermatology visit. Multivariate logistic regression assessed associations between sociodemographic factors and teledermatology use, with two-part models examining spending. Results: Among 5,280 respondents (representing 68,315,000 patients), visits in 2021 (adjusted odds ratio [aOR] = 2.725, p = 0.003) had higher odds of teledermatology use, as did Black (aOR = 6.467, p < 0.001), Hispanic (aOR = 5.520, p = 0.012), and non-Black, non-White, non-Hispanic race patients (aOR = 3.416, p = 0.002). Patients with a bachelor's degree (aOR = 5.470, p = 0.019) also had increased odds. Medicaid was associated with lower out-of-pocket costs. Discussion: Teledermatology use grew, benefiting racial minorities, but educational barriers persist. Targeted interventions are needed to enhance access.