“What network do you belong to? asks the in-take clerk. “I’m on the Medicare network” replied the member. “That’s funny, there is no indication of that on your I.D. card” responds the now puzzled in-take clerk. “Well, our group plan is on the Medicare +20% network, it’s sometimes called a Reference Based Pricing plan. Since you take Medicare patients already, you’re really gonna like our plan!” says the member. “Cool” says the in-take clerk.
Medical bills paid by private insurance vs. Medicare: Comparison by state
Marissa Plescia and Andrew Cass – Thursday, May 5th, 2022
Private insurance plans in the U.S. paid 248 percent of what Medicare would have paid for the same medical services in 2020, the 2022 National Hospital Price Transparency Study by Rand found.
The study analyzed the average allowed amount paid by a commercial insurance plan compared to what Medicare would have paid for the same services by state. It includes inpatient and outpatient facilities, as well as inpatient and outpatient physician/professional services.
This data is included in a new dashboard called Sage Transparency, which was launched by the Employers’ Forum of Indiana.
Prices paid by commercial health insurance plans relative to Medicare by state:
Note: Data for Maryland is unavailable.
- South Carolina: 321 percent
- West Virginia: 317 percent
- Florida: 309 percent
- Wisconsin: 307 percent
- Wyoming: 305 percent
- Minnesota: 297 percent
- Indiana: 292 percent (tie)
- Arizona: 292 percent (tie)
- Kansas: 290 percent
- Georgia: 288 percent (tie)
- New Mexico: 288 percent (tie)
- Colorado: 288 percent (tie)
- California: 286 percent
- Delaware: 284 percent
- Nebraska: 282 percent
- Virginia: 279 percent
- Alaska: 278 percent (tie)
- Ohio: 278 percent (tie)
- Maine: 275 percent
- North Carolina: 266 percent
- New York: 263 percent
- Nevada: 260 percent
- Missouri: 255 percent
- Illinois: 253 percent
- Texas: 252 percent
- Idaho: 240 percent
- Montana: 239 percent
- Alabama: 235 percent (tie)
- Pennsylvania: 235 percent (tie)
- Louisiana: 230 percent
- Oregon: 221 percent
- Tennessee: 219 percent (tie)
- Connecticut: 219 percent (tie)
- South Dakota: 218 percent (tie)
- New Hampshire: 218 percent (tie)
- New Jersey: 217 percent
- Vermont: 215 percent
- Kentucky: 212 percent
- North Dakota: 211 percent
- Iowa: 198 percent (tie)
- Utah: 198 percent (tie)
- Oklahoma: 195 percent
- Rhode Island: 194 percent
- Mississippi: 193 percent (tie)
- Michigan: 193 percent (tie)
- Massachusetts: 179 percent
- Washington: 174 percent
- Arkansas: 149 percent
- Hawaii: 147 percent
