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How Much Does Medicare Usually Pay for Healthcare?

Primary Listings

Average Medicare Payments for Hospital Outpatient Services

Average 2014 Medicare costs for certain outpatient procedures commonly performed in hospitals, listed by county and state, as well as US overall average Medicare payment. Files are detailed and complicated, not user-friendly.

Other Helpful Listings

Fact Sheet: Underpayment by Medicare & Medicaid (2014)

Analysis by the American Hospital Association shows that Medicare and Medicaid under-pay the true cost of hospital care by about $51 billion. This cost ends up being borne by other payors and commercial insurance. Using 2014 data, it is estimated Medicare pays 89 cents on the dollar, and Medicaid pays 90. January 2016 report

Healthcare Expenses for Seniors (MEPS 2011 data)

Special report on Health Care Expenditures for the Elderly Age 65 and over, shows median annual expenditures were $4206. Average expenses for those with expense were $9863 in 2011. Medicare paid over 62% (up considerably from 10 years ago); private insurance paid 16%; out-of-pocket amount declined to 12%. 96% of seniors had some healthcare expense, most often office-based care and prescribed medicines. Medications took up 22% of the total, averaging $76 per purchase. For seniors, the inpatient room rate averaged $3199 per day (sticker shock); ER visit was $884 on average; office visit was $228. MEPS Statistical Brief #429, Jan. 2014

Pennsylvania Total Hip and Knee Replacements FY 2013 (pdf)

June 2015 report by PHC4 shows volume and readmission rates by hospitals in Penn. Average PA hospital charges also shown, with 2013 prices (excluding surgeon fee) at $52,912 and $55,493 for knees and hip replacements, respectively. Separately, consumers can find surgeon volume and what Medicare paid (less than 25% of the average charge)

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