The rates Medicare pays hospitals are carefully calculated to cover the actual cost of care in an efficient healthcare facility. However, according to a new Center for Improving Value in Health Care report, Anthem, Cigna, United, and other commercial health insurers in Colorado are paying significantly more than Medicare.

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Kristin Paulson, president, and CEO of the Center for Improving Value in Health Care, said it would make sense for hospitals to charge commercial insurers a little more than Medicare to help expand services and shore up hospital bottom lines.

“But the data that we’ve just released demonstrates that hospitals are getting four, five, or sometimes even six times what Medicare pays. And that’s well beyond what we’d expect simply to strengthen a business’ bottom line or expand care,” she explained.

Using a new healthcare payment comparison tool, the Center found that while commercial insurers are paying more, overall payments compared to Medicare dropped by 4% between 2019 and 2022 across all facility types statewide. Paulson noted that programs—including the new Colorado Option plans, which are held to a percentage of Medicare rates—can help keep costs down.

Commercial plans operating through ConnectForHealthCO.com must spend 80% of consumer premium dollars on patient care; only 20% can go to administration costs and profits. But there are no incentives to challenge high prices. Paulson noted that if insurers collect $1 million in premiums, they can only take in $200,000 in profits. If costs double, insurers can increase premiums and profits.

“If they are covering the same people for the same services, they would have to charge $2 million in premiums, and they would be able to keep up to $400,000,” she continued. “So, the payers make money when prices go up as well.”

Paulson said Coloradans can help lower health costs by using the Center’s Shop for Care tool at civhc.org/shop-for-care, which compares procedure prices at different facilities.

“The more we’re paying for health care out of our own pocket, and through our health insurance companies, the more premiums will continue to rise. So as consumers, we need to be aware that these prices differences exist, and we need to look for opportunities to get lower-cost high-quality care,” she said.

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