Hospital payor mix by state
A hospital’s payor mix breaks down its sources of revenue – from commercial insurance plans to government programs such as Medicare and Medicaid – and provides insight into its financial performance and patient population.
In the Definitive Healthcare HospitalView product, payor mix is a proprietary calculation based on revenues, charges, discharges, and patient days that come from different medical insurance payors. The figure is aggregated from the most recent 12-month interval tracked in our database and updated from the October 2022 Medicare Cost Report release.
This Healthcare Insight reviews payor mix data tracked for more than 5,900 U.S. hospitals and compares the results by the state in which the hospital is located.
|State||Medicare||Medicaid||Private/Self Pay/Other||Explore dataset|
|District of Columbia||20.8%||31.3%||47.9%||Explore|
Which states have the highest Medicare payor mix?
Hospitals in Maryland and Delaware both have an estimated Medicare payor mix of more than 29% of hospital revenue. The aging population and increases in healthcare costs contribute to a higher Medicare payor mix. In addition, the state of Delaware has one of the highest populations of people over the age of 65.
Which states have the lowest Medicare payor mix?
Hawaii and Utah have the lowest percentage of their payor revenue coming from Medicare at 10.7% and 12.2%, respectively. Utah has a relatively younger population, and Hawaii’s low Medicare payor mix is balanced by its higher Medicaid payor mix.
Which states have the highest Medicaid payor mix?
The District of Columbia (DC) has the highest Medicaid payor mix at more than 30% followed by Kentucky at 25.4%. Both states are estimated to have a high percentage of their population enrolled in Medicaid or a Children’s Health Insurance Program (CHIP).
Which states have the lowest Medicaid payor mix?
South Dakota and Wyoming have the lowest percentage of Medicaid payor mix, at less than 6% of hospital revenue on average. Both are among the states with the lowest levels of Medicaid and CHIP enrollment.
Which states have the highest commercial payor mix?
Wisconsin has the highest commercial/private insurance payor mix, with more than 78% of their hospitals’ revenue coming from those sources. It is among ten states that have not adopted Medicaid expansion, possibly shifting more people to private insurance coverage. Hospitals in Utah, on average, have about 77% of their revenue coming from commercial and private insurance plans.
Which states have the lowest commercial payor mix?
The District of Columbia (DC) and Maryland have the lowest payor mix from commercial/private insurance at 47.9% and 53.3%, respectively. As noted above, these states have some of the highest Medicare and Medicaid payor mixes, which reduces their commercial payor mix.
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