AJMC September 15, 2022
Samantha Randall, BA, Erin L. Duffy, PhD, MPH, Sarah Green, BA, Erin Trish, PhD

Hospital price transparency data suggest that health insurance exchange (HIX) plans get lower negotiated rates than commercial group plans and higher negotiated rates than Medicare Advantage plans.

ABSTRACT

Objectives: This study investigates a sample of the pricing data released by hospitals under the price transparency law effective January 2021 to better understand the prices paid by health insurance exchange (HIX) plans relative to commercial group and Medicare Advantage plans.

Study Design: Cross-sectional analysis of hospital pricing data.

Methods: We compared allowed amounts for 25 common inpatient services and 56 common outpatient services across 22 hospital-insurer dyads, selected by the availability of plan-specific pricing data from the top 100 hospitals by bed counts and the top 100 hospitals by gross revenue based on 2017...

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Topics: ACA (Affordable Care Act), Health System / Hospital, Healthcare System, Insurance, Medicare Advantage, Payer, Pricing / Spending, Provider, Survey / Study, Trends
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