Cash price or insurance: how to compare

If you haven’t met your deductible, you pay your plan’s negotiated rate in full. At some hospitals that rate is higher than the hospital’s own cash price; at others it’s far lower. The only way to know is to compare the two numbers for the same hospital and code.

The two numbers

• Cash price (the file calls it “discounted cash price”): what the hospital says it charges a patient who pays without insurance.
• Your plan’s rate (the “negotiated rate”): what your insurer agreed to pay that hospital for that code. Until your deductible is met, that is what you pay. After it, you pay your coinsurance share of it.

An example from the data

For a abdomen and pelvis CT in McAllen, the cash price runs from $348 at Knapp Medical Center to $37,077 at South Texas Health System Edinburg, while the median employer-plan rate in the area is $1,260. See every hospital.

Questions to ask before choosing

1. Does a cash payment count toward my deductible? Usually not, unless your insurer agrees to count it. If you expect a lot of care this year, that matters.
2. How much of my deductible is left? If it is already met, your share is your coinsurance (often 10–30%) of the plan rate, which is usually less than any cash price.
3. Is the hospital in network for my exact plan? Out-of-network rates can be much higher. Your insurer’s member line or app can confirm.
4. What else will be billed? The hospital price is the facility part. The radiologist, anesthesia or pathology bill separately, under insurance or cash.

Your plan’s rate at each hospital is in its price file, but files name plans differently. Your plan’s price finds your plan in each file and puts it next to the cash price.