For Many Specialties, Commercial-to-Medicare Markup Is Modest

Only a small number of physician specialties paid commercial health insurance plans over 150% more than Medicare payment rates for healthcare services, according to a recent Urban Institute study based on data from FAIR Health’s private health insurance claims database from March 2019 to February 2020. Anesthesia received the highest markup, at 330% of Medicare rates. Meanwhile, many specialties, such as cardiology, cardiovascular surgery, general surgery and orthopedics, received modest commercial payment rates that were 130% to 150% above Medicare rates.

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Jinghong Chen Reporter

Jinghong produces infographics and data stories on health insurance and specialty pharmacy for AIS Health. She graduated from Missouri School of Journalism with a focus on data journalism and international reporting. Before joining AIS in 2018, she worked at WBEZ, Al Jazeera English and The New York Times Chinese.

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