U.S. health plan rates can vary sharply by county, study shows
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One of the first studies of publicly available insurer price data found generally higher rates for office visits and medical procedures in the Upper Midwest and Southeast, and the lowest costs in the Central U.S. and Florida.
Why it matters: The findings published in JAMA Health Forum could help shine a light on regional price variations and whether higher costs translate to more value in markets.
- That, in turn, could help employers, providers and patients make more informed choices and manage health care costs.
Context: Since July 1, 2022, insurers in the commercial market have had to release their in-network negotiated rates for all covered items and services.
- More than half of the U.S. population receives health insurance from private health plans, and prices are negotiated with providers instead of set administratively, like in Medicare.
- Insurers seem to be complying with the requirement, experts say. But the data files tend to be inaccessible and cumbersome, making it difficult to glean useful information.
Details: The researchers looked at Humana's negotiated rates for seven procedures, including colonoscopies, patient office visits and high-severity emergency department visits, as of October 2022.
- The rate Humana paid providers for office visits ranged from $69 to $114 across the country, according to the study.
- Higher-priced counties often bordered lower-priced ones, the researchers found.
Zoom out: Overall, the prices commercial health insurers pay to hospitals and physicians have been rising quickly, congressional scorekeepers found last year.
- This underlying cost growth has inflated consumers' health insurance costs.
What's next: Future research could dig into why prices vary for the same services, and if the trend holds across other insurers.
- It's not clear whether prices align with value or if they are driven by consolidation or anticompetitive contracting that could merit regulatory responses, the study said.
