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Key Points Question How does access to primary care in the Veterans Health Administration differ between veterans living in areas with optimal broadband internet service and veterans living in areas with suboptimal broadband internet service? Findings This cohort study of 6 995 545 veterans seen at 937 primary care clinics providing telemedicine and in-person clinical visits found that before the COVID-19 pandemic, broadband speed was not associated with the occurrence of primary care visits. After the onset of the pandemic, for patients living in census blocks with optimal vs inadequate broadband, video visits were twice as likely to occur (4.5 vs 2.2 per 100 patients per quarter), while in-person visits were less likely to occur (13.9 vs 16.3 per 100 patients per quarter); telephone visits were similar by broadband speed category. Meaning In this study, patients with optimal vs inadequate broadband availability had more video-based primary care visits and fewer in-person primary care visits after the onset of the pandemic, suggesting that broadband availability was associated with video-based telemedicine use.