Four things to know:
1. Using 2022 price information disclosed by hospitals, researchers studied the ratio of commercial-to-Medicare Advantage prices negotiated by the same payer, in the same hospital and for the same services. Most major insurers operate in both the commercial and Medicare Advantage markets.
2. The median commercial-to-Medicare Advantage price ratio in the same hospital varied, from 1.8 for surgery and medicine services to 2.2 for laboratory tests and emergency department visits and 2.4 for imaging services, according to the study.
3. Higher ratios were associated with health system-affiliated, nonprofit and teaching hospitals, as well as with large national payers.
4. The findings highlight the differences in financial incentives and regulatory policies in the commercial and Medicare Advantage markets. Because payers respond to differing incentives by obtaining different negotiated prices across markets, policy and practice efforts that alter incentives for insurers could lower commercial prices, according to researchers.
Click here for more details on the study.
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