U.S. Health Care Price Index Shows Cash-Pay Prices Hold Steady as Millions of Americans Risk Losing Medicaid Coverage

With the end of Public Health Emergency, U.S. sees a 10% decrease in COVID-19 screenings while cash-pay prices for healthcare remain steady

NEW YORK, MAY 8 2023 – The April U.S. Health Care Price Index found prices for the top cash-pay healthcare services - from mental health to dermatology services - remained stable, and the price of COVID-19 screenings decreased 9.7% from a national average of $45.80 in March to $41.57 in April.

With the Public Health Emergency (PHE) ending on May 11, the price of cash-pay healthcare services in April are an indication of what millions of Americans could pay as many are at risk of losing Medicaid coverage.

APRIL USHPI FINDINGS
Nationally, the average price for a primary care telehealth visit increased by 3.2% from March to April 2023 ($41.50 to $42.85). However, the price of a prescription refill (-0.4%) and a mental health consult (+0.46%) remained relatively flat. The largest increase in price was a 5.16% increase for a UTI visit from March to April ($40 to $42.12).

END OF THE PHE AND THE CASH-PAY MARKET
This week, the federal government will end a Medicaid waiver that provided states additional funding in exchange for pausing Medicaid eligibility reviews and removing people from the program. It’s estimated between five and 14 million people are at risk of losing their healthcare coverage and entering the cash-pay healthcare market.

Additionally, the almost 10% decrease in the price of a COVID-19 screening in April could be impactful for millions of Americans as free coverage for OTC and laboratory tests for people on private insurance and laboratory tests for Medicare beneficiaries will end.

CASH PRICE IN TOP FIVE STATES IMPACTED BY MEDICAID REDETERMINATIONS
The following is a breakdown of the top five states most affected by the upcoming Medicaid redeterminations and what they can expect to pay for cash-pay healthcare services based on the April USHPI:

#1: Texas 1.8 million Texans are expected to lose Medicaid coverage. The average April cash-pay prices in Texas:

• Mental Health Consult: $38.72
• Prescription Refill Appointment: $36.76
• Telehealth Visit: $37.80
  
  #2: Florida 1.4 million Floridians are expected to lose Medicaid coverage. The average April cash-pay prices in Florida:
• Mental Health Consult: $39.52
• Prescription Refill Appointment: $36.59
• Telehealth Visit: $40.95
  
  #3: Indiana Over 565,000 people are expected to lose Medicaid coverage. The average April cash-pay prices in Indiana:
• Mental Health Consult: $49.22
• Prescription Refill Appointment: $43.43
• Telehealth Visit: $45.12
  
  #4: Virginia Over 479,000 Virginians are expected to lose Medicaid coverage. The average April cash-pay prices in Virginia:
• Mental Health Consult: $47.20
• Prescription Refill Appointment: $40.90
• Telehealth Visit: $43.20
  
  #5: Colorado It’s estimated that 394,000 people, or over 25%, of Colorado’s Medicaid enrollees will be removed from the program once Medicaid reviews begin again. Average April cash-pay prices in Colorado:
• Mental Health Consult: $40.22
• Prescription Refill Appointment: $37.31
• Telehealth Visit: $39.88
  
  ABOUT USHPI
  The USHPI, the first national resource to publicly document the price of cash-pay medical care in America, features pricing data for routine medical services in all 50 states – from primary care and mental health to women's health and more. In addition to regional and state comparisons, the USHPI tracks price variance and market trends on a monthly basis. The entire USHPI database of monthly cash prices can be found here: https://sesamecare.com/compare/ushpi.
  
  

WHAT IS THE CASH PRICE OF MEDICAL CARE?
Simply put, the cash price is what a doctor or health care provider charges a consumer when a third-party payer - like insurance or a government entity - is not involved in the transaction. This could be because a patient does not have insurance, has a high-deductible health plan or chooses to pay their provider directly, without involving a middleman.

WHAT IS THE METHODOLOGY USED TO COLLECT THE DATA?
The data comes from Sesame, one of the largest cash-pay health care marketplaces in the United States. It covers the thousands of healthcare providers resident in the marketplace that charge cash prices for their services. Sesame analyzed thousands of primary care and specialty care appointments made on its platform, leveraging pricing data for patient appointments that occurred during April 2023.