What private insurers paid hospitals vs. Medicare rates, by state


Prices paid to hospitals for services provided to privately insured patients compared to Medicare rates varied widely among states in 2017, according to a new Rand Corp. study.

The study conducted by Rand and the Employers' Forum of Indiana, an employer-led healthcare coalition, examined the prices paid by private health plans to hospitals relative to Medicare at 1,598 hospitals in 25 states. Researchers looked at healthcare insurance claims for more than 4 million people, using data from self-insured employers, two state all- payer claims databases and records from health insurance plans.

Relative prices represent the negotiated allowed amounts paid per service, including amounts from the insurer and the patient, with adjustments based on the intensity of services, compared to the amounts that would have been paid for the same services provided by the same facilities by Medicare.

Here are the relative prices in 2017 by state, from highest to lowest:

Indiana: 311 percent

Wyoming: 307 percent

Maine: 283 percent

Wisconsin: 279 percent

Montana: 277 percent

Colorado: 269 percent

Texas: 244 percent

Georgia: 243 percent

Ohio: 241 percent

Washington: 237 percent

New Hampshire: 236 percent

Louisiana: 235 percent

North Carolina: 234 percent

New Mexico: 229 percent

Florida: 229 percent

Massachusetts: 228 percent

Illinois: 225 percent

Missouri: 221 percent

Kansas: 219 percent

Vermont: 217 percent

Tennessee: 208 percent

Kentucky: 186 percent

New York: 178 percent

Pennsylvania: 169 percent

Michigan: 156 percent

After the release of the study, the American Hospital Association expressed concerns about the analysis, including the sample size used. Read the statement here

Read more about the study here.


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