Health
Health care costs up to 300% higher for privately insured patients than those with Medicare, report reveals
Most Americans — more than 65% — have private health insurance, but a new report has revealed a potentially very expensive drawback.
Patients who have private (commercial) coverage may end up paying significantly more for their medical care compared to those who have public health insurance, such as Medicare, according to recent data from RAND Corp. in Washington, D.C.
As of 2022, employers and private insurance companies paid an average of 254% more for medical services than what Medicare programs would have paid.
HEALTH CARE COSTS UP TO 300% HIGHER FOR PRIVATELY INSURED PATIENTS THAN THOSE WITH MEDICARE
Several states — California, Florida, Georgia, New York, South Carolina, West Virginia, and Wisconsin — had medical costs that were more than 300% higher than Medicare prices, the report stated.
The researchers analyzed medical claims data from a “large population” of privately insured patients who were treated at over 4,000 hospitals across the country between 2020 and 2022.
Patients who have private coverage may end up paying significantly more for their medical care compared to those who have public health insurance, such as Medicare. (iStock)
The report also included the names and prices of each hospital.
“Calculating 4,000-plus U.S. hospitals’ overall relative prices has never been done before this study, because it’s so difficult to collect the requisite data and to get permissions to publish the hospital and health system names associated with each relative price,” said Brian Briscombe, a health care analyst at RAND and one of the study authors, to Fox News Digital.
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“This is real price transparency — naming the hospitals and presenting their overall relative prices in a way that anyone could understand.”
The report gives employers a tool they can use to become “better-informed purchasers” of health care services, Peter Hussey, director of RAND Health Care in Santa Monica, California, noted in a news release.
“Hospitals account for the largest share of health care spending in the U.S., so this report also provides valuable information that may aid policymakers interested in curbing health care costs,” Hussey also said in the release.
The researchers analyzed medical claims data from a “large population” of privately insured patients who were treated at more than 4,000 hospitals across the country between 2020 and 2022. (iStock)
The wide variance of prices across hospitals is the most important takeaway, according to Briscombe.
“Within a single city, you can find a hospital that (on average across all its services) charges privately insured patients about twice as much as Medicare charges for those same services — but down the street, another hospital charges three times what Medicare charges,” he told Fox News Digital.
The difference in prices cannot be explained by differences in quality, he added.
“This is real price transparency — naming the hospitals and presenting their overall relative prices in a way that anyone could understand.”
Dr. Brett Osborn, a Florida neurologist and longevity expert, was not involved in the RAND study but said the findings are “concerning.”
“Hospitals bill private insurers multiples of the Medicare allowable,” he told Fox News Digital.
“The elevated costs are passed onto patients, resulting in higher premiums and out-of-pocket expenses.”
As of 2022, employers and private insurance companies paid an average of 254% more for medical services than what Medicare programs would have paid, according to a new study. (iStock)
And these costs are on the rise, Osborn warned.
“People accept job offers because the employer offers health insurance — otherwise, for many, the premiums would be unaffordable,” he added.
Osborn emphasized the significant price variations among states.
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“Hospitals in some states charge less than 200% of Medicare rates, while others exceed 300%,” he said.
“Due to its size, Medicare can negotiate lower payments — but private insurers lack this leverage.”
“This discrepancy is due to some hospitals’ market power, making it hard for employers to avoid them. Due to its size, Medicare can negotiate lower payments — but private insurers lack this leverage.”
The doctor also called for greater price transparency from hospitals.
The new report published the names and pricing models of more than 4,000 U.S. hospitals. (iStock)
“Despite a federal rule for price transparency, only 24.5% of hospitals comply — highlighting the need for informed health care purchasing and policy changes to manage costs,” he said.
“The system is fundamentally flawed, designed to profit from illness rather than promote health,” Osborn continued.
“It clearly favors hospital systems, not the patients, reinforcing the harsh reality: There is money in the sick.”
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Dr. Marc Siegel, clinical professor of medicine at NYU Langone Medical Center and a Fox News medical contributor, said the issue of price variations is complex.
“Sometimes these are hidden costs, and sometimes hospitals and other health organizations know they can get away with charging private insurers more while obscuring prices from both the insurer and the patient to help compensate for the shrinking reimbursements from public insurances,” Siegel told Fox News Digital.
“At the same time, more out-of-pocket costs are transferred to the consumer in terms of copays and deductibles, as middlemen take the profits.”
“The system is fundamentally flawed, designed to profit from illness rather than promote health.”
With the lack of price transparency, there is no way to introduce competition, Siegel said, as the true costs and prices are hidden.
The study did have some limitations, the researchers acknowledged.
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“We didn’t have sufficient claims data to publish all U.S. hospitals’ relative prices,” Briscombe told Fox News Digital.
“Some states in the U.S. don’t have All Payor Claims Databases (APCDs), so we have to collect claims from one data contributor at a time – usually from employers that operate in that location and whose employees and dependents use those hospitals.”
“Despite a federal rule for price transparency, only 24.5% of hospitals comply, highlighting the need for informed health care purchasing and policy changes to manage costs,” according to a doctor who spoke with Fox News Digital. (iStock)
Overall, he said, the researchers had a “sufficiently large sample of data” to estimate the overall relative price of each hospital and health system included in the report, Briscombe said, “but it would be nice to have even more claims data in order to publish the relative prices for all U.S. hospitals.”
Fox News Digital reached out to the Centers for Medicare & Medicaid Services and the American Hospital Association requesting comment.
For more Health articles, visit www.foxnews.com/health.
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Aging is often depicted as a steady decline, but new research suggests that many older adults actually improve over time.
Using more than a decade of data from a large, representative study of older Americans, Yale University researchers found that nearly half of adults 65 and older showed improvement in cognitive function, physical function or both.
The improvements were consistent across the study population, and were linked to the participants’ mindset about aging, according to a press release.
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“In contrast to a predominant belief or stereotype that age is a time of continuous and inevitable decline, we found evidence that a meaningful number of older persons actually show improvement over 12 years in cognitive and/or physical health,” lead author Becca Levy, a professor of social and behavioral sciences at Yale, told Fox News Digital.
The research, which was published in the journal Geriatrics, relied on data from the Health and Retirement Study, a federally supported, long-running survey of older Americans.
The results were consistent across the study population, rather than being limited to a small group of high performers. (iStock)
Researchers tracked changes in cognition using global performance tests and measured physical function based on walking speed, which was seen as a “vital sign” because of its strong links to disability, hospitalization and mortality.
Over a 12-year period, 45% of participants improved either mentally or physically. About 32% showed cognitive gains, while 28% improved physically, according to the study.
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“If you average everyone together, you see decline,” Levy said. “But when you look at individual trajectories, you uncover a very different story. A meaningful percentage of the older participants … got better.”
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A participant’s beliefs about aging appeared to influence the results, as those with more positive age beliefs were significantly more likely to show improvements in both cognition and walking speed.
Over a 12-year period, 45% of participants improved either mentally or physically, researchers found. (iStock)
This remained true even after accounting for factors such as age, sex, education, chronic disease, depression and the length of follow-up. Improvements were seen even among participants who started with “normal” levels of function, not just those recovering from injuries or illness.
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“Individuals who have taken in more positive age beliefs … tend to have a lower stress response and lower stress biomarkers,” Levy said. Because age beliefs are modifiable, she noted, there could be a capacity for improvements later in life.
The study did have some limitations, the researchers acknowledged. It didn’t look at how muscles or brain cells change and adapt, which could help explain why people improved.
“Individuals who have taken in more positive age beliefs … tend to have a lower stress response and lower stress biomarkers,” the researcher said. (iStock)
Future studies should examine improvement patterns for other types of cognition, such as spatial memory, they added.
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“In addition, although our participants were drawn from a nationally representative sample, it would be useful to examine patterns of improvement in additional cohorts that have a greater representation of different ethnic minority groups,” the researchers noted in the study.
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The authors said they hope the findings will debunk the myth that continuous physical and cognitive decline is inevitable.
“We found evidence that there could be psychological pathways, behavioral pathways and physiological pathways [by which age beliefs impact health],” said Levy. “It’s common, and it should be included in our understanding of the aging process.”
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Scientists and physicians agree that there’s been a general decline in male fertility — but they aren’t sure why.
Social media buzz has pointed to a few environmental exposures as potential factors, including cellphones and electric vehicles.
But the reality is “more complicated” than that, according to experts who recently spoke to National Geographic.
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Although it’s not clear whether the decline is at a stage where it should be considered a crisis, numbers show that overall fertility — demographically measured by the number of babies born compared to women of child-bearing age — has decreased.
Scientists and physicians agree that there’s been a general decline in male fertility. (iStock)
Dr. Alex Robles of the Columbia University Fertility Center in New York confirmed that clinical practitioners are “certainly seeing more couples where the male factor contributes to infertility.”
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“At least one-third of couples we evaluate have some male component,” he told Fox News Digital.
A 2017 meta-analysis published in Oxford Journals: Human Reproduction Update found that sperm counts in Western countries have declined by almost 60% globally since 1973. The 2023 update confirmed these same results.
Urologists can track declining fertility in sperm quality, while demographic data uses the number of babies born compared to women of child-bearing age as a benchmark, according to National Geographic. (iStock)
Lead study author and epidemiologist Hagai Levine warned that this trend could lead to human extinction if it isn’t addressed.
“This is the canary in the coal mine,” Levine, public health physician at the Hebrew University-Hadassah Braun School of Public Health, told National Geographic. “It signifies that something is very wrong with our current environment, as lower sperm counts predict morbidity and mortality.”
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These findings have been contradicted by other studies, however. A 2025 Cleveland Clinic analysis of studies from the last 53 years found sperm counts to be steady.
“There is no evidence to suggest that this decline is the cause of a precipitous decline in the ability to cause pregnancies,” primary study author Scott Lundy, a reproductive urologist at Cleveland Clinic, told National Geographic. “Most men, even with a modest decline in sperm counts, will still have no issues conceiving.”
Potential factors of decline
Multiple lifestyle factors can lead to a decline in male fertility, Robles noted, including obesity, smoking and diet, as well as environmental exposures and delayed parenthood.
National Geographic also reported that heavy drinking and marijuana use directly contribute to declining fertility and that quitting these habits, while also exercising and losing weight, can help.
Smoking of any kind can contribute to a decline in fertility, according to experts. (iStock)
Systemic inflammation, infection and disease can also have a “big, profound effect on the current status of fertility,” Lundy told National Geographic.
Those who are getting over a fever from an infection, like the flu or COVID, will have a “drastically lower” sperm count for three months, he said.
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Male infertility can also be a marker of overall health, according to Robles. “Poor semen parameters are associated with other medical conditions and may signal underlying metabolic, hormonal or environmental issues,” he told Fox News Digital.
Experts recommend seeing a doctor to discuss fertility concerns instead of relying on the internet. (iStock)
Allan Pacey, deputy dean of the Faculty of Biology, Medicine and Health at the University of Manchester, told National Geographic that the decline could be caused by increased use of contraception, as well as men waiting longer to have children or choosing not to have them at all.
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Microplastics have also been raised on social media as a potential culprit, but the effects are unclear, according to experts.
There is some evidence of endocrine-disrupting chemicals — which are substances found in reusable plastics and some disposable products — altering male fertility, Lundy revealed to National Geographic.
Myths busted
Concerns have circulated on social media that keeping a cellphone in a front pocket could harm male fertility. While Lundy said such an effect is biologically possible, there is currently no scientific evidence supporting the claim.
Another common myth is that infertility is mostly a women’s issue, Robles noted, but male factors contribute to about one-third to one-half of all cases.
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The claim that taking supplements can boost sperm counts is another common myth, he said, adding that it’s not backed by strong scientific evidence.
“Men should focus on factors that we know matter: maintaining a healthy weight, avoiding tobacco, limiting alcohol and managing chronic health conditions,” Robles advised.
One common myth is that infertility is mostly a women’s issue, but male factors contribute to about one-third to one-half of all cases. (iStock)
Experts recommend seeing a urologist to address fertility concerns. Robles said his approach begins with an evaluation, semen analysis, hormonal testing and medical history, while also exploring lifestyle factors.
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In addition to traditional treatment options, Robles said his fertility center also uses advanced tools that incorporate AI and robotics.
“Technologies like this are expanding options for patients who previously had very limited paths to biological parenthood,” he said.
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