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

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.