Healthcare Insights
Breaking down U.S. hospital payor mixes
Understanding a hospital’s payor mix gives insight into the organization’s financial health and performance.
This Healthcare Insight reviews payor mix data for more than 5,700 U.S. hospitals and compares the results by hospital type, size, and location.
What is payor mix in healthcare?
Payor mix data represents the breakdown of revenues, charges, discharges, and patient days from different medical insurance payors. In the Definitive Healthcare HospitalView product, the proprietary calculation is based on a facility’s charge and revenue measures from the Medicare Cost Report.
What is the difference between payer and payor?
For the U.S. healthcare market, the terms “payor” and “payer” are often used interchangeably and have the same general meaning. The American Medical Association (AMA) recognizes “payor” as the preferable spelling.
Payor mix classifications
Payor mix breaks down into the following classifications: Medicare, Medicaid, and commercial/private/self-pay/other. Specifically, these payor mix categories are defined as:
Medicare: charges from beneficiaries who are 65 and older, or certain people under 65 with a disability, end-stage renal disease, amyotrophic lateral sclerosis, etc., and are part of the Medicare program.
Medicaid: charges from beneficiaries who are part of state Medicaid programs (also includes Medicaid Managed Care charges).
Commercial/private/self-pay/other: charges from any patients who have health insurance through their employer or marketplaces, those who do not have insurance or choose to self-pay, Medicare Advantage patients, and all other patients.
How is hospital payor mix calculated?
Using hospital revenue and charge data, we can estimate the allocation of revenue sources to derive individual hospital payor mixes. For example, if we know a hospital’s total patient revenue is $100 million, its Medicare revenue is approximately $25 million, and its Medicaid revenue is approximately $10 million, we could calculate a 25% Medicare, 10% Medicaid, and 65% commercial/private/self-pay payor mix.
What is the payor mix breakdown?
Results in the following analysis are aggregated from the most recent complete 12-month interval tracked in our database. The most recent full calendar year of data available for all hospitals at the time of publishing is for 2024.
Commercial, private, and self-pay represent the largest payor group for U.S. hospitals with net patient revenue of more than $924 billion, or 71% of average payor mix.
Total net patient revenue for Medicare was more than $188 billion in 2024, or 15% of payor mix. Medicaid’s total net revenue was more than $194 billion or 15% of payor mix distribution.
In addition to revenue allocation, payor mix can also be analyzed by the percentage of patient days. For example, since Medicare patients represent an older population, patient cases might be more complex or patient comorbidities may lead to longer hospital stays.
Payor mix by total patient days breaks down as follows:
- Commercial/private/self-pay/other: 69%
- Medicare: 23%
- Medicaid: 8%
| | Total net revenue (in billions) | Average percent of payor mix | Average percent of total days | Explore dataset |
|---|---|---|---|---|
| Medicare | $188B | 14.40% | 8.20% | Explore |
| Medicaid | $194B | 14.80% | 22.70% | Explore |
| Commercial/private/self/other | $924B | 70.70% | 69.00% | Explore |
Fig. 1 Data is from the Definitive Healthcare HospitalView product and sourced from the Medicare Cost Report. Accessed August 2026.
How has hospital payor mix breakdown changed year-to-year?
Medicaid enrollment increased with the expansion of the Affordable Care Act (ACA) and during the COVID-19 pandemic. In addition, the country faces an aging population. While these factors suggest growing Medicare and Medicaid reliance, hospital data reveals a counterintuitive trend: the share of hospital patient days attributed to Medicare and Medicaid has steadily declined year over year for more than a decade.
Between 2014 and 2024, the percentage of Medicare patient days fell from 34% to 23%, while Medicaid patient days dropped from 13% to 8%. Conversely, commercial/private/self-pay patient days at U.S. hospitals expanded, rising from 53% in 2014 to 69% in 2024.
In addition to rising healthcare costs, this could also reflect the increase in Medicare Advantage enrollment, which are Medicare Part C plans offered by commercial/private payors approved by Medicare. At the same time, the continued shift from inpatient to outpatient care has reduced the number of hospital days generated by many patients.
Average percentage of payor days 2014-2024
Fig. 2 - Data is from the Definitive Healthcare HospitalView product and sourced from the Medicare Cost Report. Accessed August 2026.
What is the payor mix breakdown by hospital bed size?
Smaller hospitals have a higher share of Medicare patient days, while larger hospitals have a greater share of commercial/private/self-pay/other. Among hospitals with 25 or fewer beds, 40.3% of patient days are attributed to Medicare, compared with 20.9% among hospitals with more than 250 beds.
The reverse pattern appears for commercial/private/self-pay/other patient days. These account for 70.6% of patient days at hospitals with more than 250 beds, compared with 52.7% at hospitals with 25 or fewer beds. Medicaid represents a smaller and relatively consistent share of patient days across hospital sizes, ranging from 7.0% to 8.5%.
Overall, Medicare days generally decrease as hospital bed count increases, while commercial, self-pay and other days increase. Differences in hospital service areas, patient demographics, facility specialties and insurance coverage may contribute to the variation in payor mix across hospital sizes.
Average percentage of payor days by hospital bed size, 2024
Fig. 3 - Data is from the Definitive Healthcare HospitalView product and sourced from the Medicare Cost Report. Accessed August 2026.
What is the payor mix breakdown by hospital type?
The highest percentage of Medicaid and commercial/private/self-pay patient days are at psychiatric hospitals and children’s hospitals, respectively. Rehabilitation hospitals have more than half of their patient days coming from private payors, while critical access hospitals had about half from this same group.
Average percentage of payor days by hospital type, 2024
Fig. 4 - Data is from the Definitive Healthcare HospitalView product and sourced from the Medicare Cost Report. Accessed August 2026.
What is the payor mix breakdown by hospital location?
Payor mix varies somewhat by hospital location, although commercial/private/self-pay/other accounts for the largest share of patient days across every region. The Southeast has the highest percentage at 71.4%, closely followed by the Southwest at 71.2%, while the Northeast has the lowest share among U.S. regions at 65.1%.
The Northeast has the highest percentage of Medicare patient days at 26.3%, followed by the Midwest at 24.0%. The Southwest has the lowest Medicare share among U.S. regions at 19.2%. This is consistent with the analysis above showing that smaller hospitals tend to have a higher percentage of Medicare days.
Medicaid patient days are highest in the West and Southwest, at 10.4% and 9.6%, respectively. The Northeast follows at 8.6%. The Midwest and Southeast have the lowest Medicaid shares, at 6.6% and 6.9%. U.S. territories are a notable outlier, with Medicaid accounting for 27.9% of patient days and Medicare just 8.7%.
Overall, the regional differences are relatively modest among the 50 states, with commercial/private/self-pay/other representing roughly two-thirds to more than 70% of patient days in every U.S. region. The more pronounced differences in Medicare and Medicaid shares likely reflect a combination of hospital characteristics, population demographics, and insurance coverage patterns.
Average percentage of payor days by region, 2024
Fig. 5 - Data is from the Definitive Healthcare HospitalView product and sourced from the Medicare Cost Report. Accessed August 2026.
Why does payor mix matter for commercialization?
Payor mix provides healthcare companies with a way to understand the coverage and reimbursement environment across potential hospital customers, helping commercial teams segment accounts and tailor their market strategies. The mix of Medicare, Medicaid, commercial insurance, and self-pay patients can influence whether a product is covered, who ultimately pays for it, and how readily a hospital may be able to adopt it.
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