Differences across studies may be due to a number of factors, including the representativeness of hospitals, physicians, and insurers used in the analysis, the data collection period, and the characteristics of the markets examined by each study, with some studies focusing on highly consolidated health care markets where providers have stronger negotiating leverage over insurers. For physician services, private insurance paid 143% of Medicare rates, on average, ranging from 118% to 179% of Medicare rates across studies.Īcross all studies, payments from private insurers are much higher than Medicare payments for both hospital and physician services, although the magnitude of the difference varies ( ES Figure 1).The difference between private and Medicare rates was greater for outpatient than inpatient hospital services, which averaged 264% and 189% of Medicare rates overall, respectively.Private insurers paid nearly double Medicare rates for all hospital services (199% of Medicare rates, on average), ranging from 141% to 259% of Medicare rates across the reviewed studies.To inform both discussions, this issue brief reviews the findings of 19 recent studies comparing Medicare and private health insurance payment rates for hospital care and physician services. overcomes the immediate public health emergency, attention will likely return to underlying questions regarding provider payments, as well as their impact on health expenditures and out-of-pocket costs. While supporters point to potential coverage gains and reductions in national health spending, critics contend that bringing private insurer payments closer to Medicare rates could threaten providers’ financial viability. Prior to the outbreak, national and state-level policymakers were already debating several proposals that would build on Medicare’s payment structure – including Medicare-for-All and various public option proposals – to establish standardized rates for hospitals, physicians, and other health care providers. However, some have raised concerns that even these increased Medicare rates may not be sufficient. The Trump administration has signaled that it will use some of these funds to reimburse hospitals for treating uninsured COVID-19 patients at Medicare payment rates, which the CARES act also increased by 20% for COVID-19 treatment during the crisis. In response, Congress has passed the Coronavirus Aid, Relief, and Economic Security (CARES) Act, which allocates $100 billion in assistance for hospitals and other health care providers. health care system will be tested as it never has been before.

With millions expected to be hospitalized during the COVID-19 pandemic, the U.S.

Medicare hospital compare quality