States

What Medicare pays, state by state

The same procedure code settles at a different number in every state. These pages show what providers billed and what Medicare allowed in each one.

61States and territories
250Procedures compared
14.7xWidest state gap

American Samoa carries the widest gap between billed and allowed, at 14.7x. Puerto Rico is the tightest at 1.7x. Medicare pays close to the same either way. The billed column is what changes.

Whose price this is

These are Medicare figures. The billed column is what providers asked for. The allowed column is what Medicare agreed to pay. Neither is what an uninsured patient gets charged, and neither is what a private insurer negotiates.

The gap between the two columns is the point. A hospital billing three times what Medicare allows tells you the billed number was never a price. It was an opening position.

Every state, ranked by billed against allowed

StateGapProcedures
American Samoa14.7x1
Armed Forces Central/South America7.2x71
Foreign Country5.1x109
Wisconsin4.9x247
Alaska4.2x229
Minnesota3.9x248
Armed Forces Europe3.9x106
Armed Forces Pacific3.8x117
New Hampshire3.5x239
Massachusetts3.5x247
Georgia3.5x247
New Jersey3.5x248
Nevada3.5x249
Texas3.4x250
Oregon3.4x248
New York3.4x248
Wyoming3.4x238
Louisiana3.3x248
Illinois3.3x249
California3.3x249
Colorado3.3x249
Tennessee3.2x248
North Carolina3.2x248
Kansas3.2x248
Ohio3.2x248
North Dakota3.2x245
Rhode Island3.1x244
Alabama3.1x250
Mississippi3.1x246
Arizona3.1x249
Missouri3.1x249
Nebraska3.1x245
Florida3.0x250
Washington3.0x248
New Mexico3.0x244
Iowa3.0x246
Oklahoma3.0x248
Connecticut3.0x247
South Carolina2.9x246
Utah2.9x248
Indiana2.9x248
Kentucky2.9x245
District of Columbia2.8x229
Virginia2.8x247
Hawaii2.8x242
West Virginia2.8x240
Arkansas2.8x248
Maine2.8x245
Maryland2.8x248
Michigan2.8x248
Pennsylvania2.8x247
Delaware2.7x239
South Dakota2.7x238
Montana2.7x234
Virgin Islands2.7x188
Idaho2.6x244
Vermont2.6x219
Northern Mariana Islands2.4x52
Guam2.3x179
Unknown2.0x91
Puerto Rico1.7x228

Source: CMS Medicare Physician & Other Practitioners, by Geography and Service. Weighted by service volume, non-drug codes.

What the gap does and does not mean

A wide gap is not a state overcharging Medicare. Medicare sets its own price and pays it.

It measures how far the sticker sits from the settlement. That matters to anyone without Medicare, because the sticker is where their bill starts.

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