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How Much Does Medicare Usually Pay for Healthcare?

Primary Listings

Average Medicare Payments for Hospital Outpatient Services

Average 2007 Medicare costs for outpatient procedures commonly performed in hospitals, listed by county and state, as well as US overall average Medicare payment. Check file of 61 Procedures that include scope of colon (colonoscopy), or shoulder, upper stomach-intestine scope, bladder exam, scope removal of tumors, stents; removal of damaged skin; rotator cuff repair; breast biopsy, prostate needle biopsy, other biopsy with scope procedures; cataract removal & lens insert, and post-cataract laser surgery; hemodialysis access; injection of lower back; breaking up kidney stones, wrist fracture surgery, hernia repair, nerve block injections and more. File of 20 procedures has x-ray, cardiac cath, scans, carpal tunnel, gall bladder, hernia repair. Preventive services file has vaccines and immunizations. Three files could contain any procedure. Shows volume and Medicare payment, but not original charges. Knowing the CPT code might help you find the right procedure. Not at all user-friendly, Excel format, but covers every state. Oct. 2008

Medicare Reimbursement for General Surgery

Covidien Reimbursement Guide for General Surgery shows what Medicare paid for hospital or ambulatory surgery center facility fees. Unfortunately, the year paid is not clear, possibly is 2011. Covidien is now part of Medtronic.

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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