ACA Marketplace Insurers Pay Lower Rates Than Off-Marketplace, Small-Group Plans
-
Dec 06, 2024
Affordable Care Act (ACA) marketplace nongroup insurers paid providers significantly less than employer small-group insurers paid for professional services, outpatient hospital services and inpatient hospital services in 2021, according to a recent Health Affairs study.
Using 2021 claims data from CMS, the researchers estimated prices for three market segments: nongroup plans sold on the ACA marketplaces, nongroup plans sold off the marketplaces and small-group employer plans. They found that overall, ACA marketplace prices were 152% of Medicare prices, whereas the prices paid by small-group insurers were 179% of Medicare prices. Weighted average price ratios — also known as price indices — relative to Medicare payment rates were highest for outpatient services, followed by inpatient and professional services.
Read more
© 2025 MMIT
The Latest
Meet Our Reporters
Meet Our Reporters