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Hospital Prices Have Risen Much Faster for Private Insurance Than Medicare Since 2019

Hospitals account for nearly one-third of US health spending and 40% of spending growth from 2022-2024. Analysis shows hospital prices paid by private insurers have risen faster than Medicare rates since 2019, a trend with implications for affordability.

Hospital prices paid by private insurers rose 30% from 2019-2026, compared to a 21% increase in Medicare payment rates. The disparate growth widened an existing gap between what Medicare and private plans pay for hospital services.

What Are the Recent Trends in Employer-Based Health Coverage?

Policy Changes Bring Renewed Focus on High-Deductible Health Plans

Health Insurer Financial Performance in 2024

Examining Short-Term Limited-Duration Health Plans

Health Care Affordability

BTD Health Policy in 2026

Health Policy in 2026

President and CEO Dr. Drew Altman forecasts eight things to look for in health policy in 2026. “First and foremost,” he writes, “is the role health care affordability will play in the midterms.” And, he notes: “The average cost of a family policy for employers could approach $30,000 and cost sharing and deductibles will rise again after plateauing for several years.”

View all of Drew’s Beyond the Data Columns

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  • For ACA Enrollees, How Much Premiums Rise Next Year is Mostly up to Congress

    Policy Watch

    Most customers with coverage through Affordable Care Act's marketplaces will face big premium increases next year if Congress doesn’t extend the temporary enhanced tax credits included in the American Rescue Plan Act (ARPA) of 2021. If the outcome isn’t clear by summer, fall open enrollment could be a mess.

  • Employer Coverage of Travel Costs for Out-of-State Abortion

    Policy Watch

    This Policy Watch gives an overview of employers offering to cover travel expenses for workers who need to go out of state for an abortion in the context of increasing restrictions on abortion around the country. We discuss who is offering these benefits, the implications for workers, and some of the legal and political concerns for employers.

  • Analysis: The Vast Majority of Physicians Accept New Patients, Including Patients With Medicare and Private Insurance

    News Release

    Despite occasional anecdotal reports of people having trouble finding a doctor who takes their insurance, KFF researchers find in a new analysis that the vast majority of non-pediatric office-based physicians accept new Medicare patients, as well as new private insurance patients. Eighty-nine percent of such physicians accepted new Medicare patients in 2019, and 91 percent accepted new private insurance patients, according to the analysis, which uses data from the federal 2019 National Electronic Health Records…

  • Most Office-Based Physicians Accept New Patients, Including Patients With Medicare and Private Insurance

    Issue Brief

    This brief examines the share of non-pediatric office-based physicians accepting new patients with Medicare or private insurance and how these rates have changed over time and vary by physician specialties, geographic areas, and physician and practice characteristics across Medicare and private insurance. This analysis further examines the extent to which non-pediatric physicians are opting out of Medicare, by specialty and state.

  • Out-of-pocket spending on insulin among people with private insurance

    Issue Brief

    This analysis of insurance claims data finds that Congressional proposals to set a $35 per month cap on what people pay out of pocket for insulin would provide financial relief to at least 1 out of 5 insulin users with different types of private health insurance.

  • Many Privately Insured People with Diabetes Could Save Money if Congress Caps Insulin Costs

    News Release

    Several legislative proposals in Congress propose a $35 per month cap on what people with health insurance would have to pay out of pocket for insulin, a life-saving hormone taken regularly by many people with diabetes to maintain their health. Such a cap could provide financial relief to at least 1 out of 5 insulin users with different types of private health insurance, a new KFF analysis of insurance claims data finds. In the large…

  • No Surprises Act Quiz

    Feature

    A new federal law provides new consumer protections against "surprise" medical bills beginning this year. Test your knowledge about its provisions with this 12-question quiz.

  • Half of Admissions in the Large Group Market Are Paid Above 150% of Medicare Rates, Excluding Maternity Admissions

    Issue Brief

    This analysis looks at in-network payment rates for inpatient hospital stays, other than maternity/newborn admissions, among large employer plans relative to Medicare payment rates. We find that a cap of 150% of Medicare rates would affect 52% of in-network admissions and 36% of in-network spending, while a cap of 300% of Medicare rates would affect 13% of in-network admissions and 13% of in-network spending, with variation across types of admissions.