Commercial insurance markups over Medicare prices vary widely by specialty
Nine specialties received commercial payments between 120% and 150% of Medicare rates, on average.
By Alan Goforth|October 20, 2021 at 10:19 AM
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Private insurers generally pay physicians substantially higher rates than Medicare does for the same service. This differential could have implications for debates over physician payment reforms, public option and single-payer policies, and Medicare payment reforms.
“Policy proposals to reduce commercial prices and curb health care spending by benchmarking private payment rates to Medicare prices could significantly affect physician payments, but the effects will likely vary considerably by specialty,” according to a new report from the Urban Institute.
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