What common medical visits cost in Pennsylvania - and how they compare to nearby states

In the patchwork of health care providers in the United States, determining what a medical visit might cost can be confusing at best and life-altering at worst. The vast majority of patients who arrive at the hospital for a service recommended by their doctor do so without knowing the cost of that treatment. The price tag on most medical visits is so high for the uninsured, a full one-third of all money raised on GoFundMe is for health care costs.

A raft of legislation in nearly every state is set on tackling some of these endemic issues, with energy aimed squarely at lowering costs and expanding access. Some of this legislation is grand in scope, notably in states like New York where legislators are looking to put a public option on the table for residents there. Other states are taking a narrower approach, requiring providers to release price lists so patients are aware of what their care will cost.

Stacker analyzed cost data released on June 8, 2021, from the Centers for Medicare & Medicaid Services, common provider data from Verywell Health, and state zip codes from Simplemaps to find the average out-of-pocket cost for three typical medical visits in each state.

Pennsylvania

- Most common family practice visit costs
--- Medicare recipients: $101.62 for established patients ($87.96 for new patients)
--- Other insurance holders: $25.41 for established patients ($21.99 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $101.62 for established patients ($131.75 for new patients)
--- Other insurance holders: $25.41 for established patients ($32.94 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $101.62 for established patients ($87.96 for new patients)
--- Other insurance holders: $25.41 for established patients ($21.99 for new patients)

Pennsylvania lawmakers are moving forward with legislation that will make one facet of health care more affordable. A new bill aims to lower the cost of prescription drugs, which one in five state residents say they choose not to fill due to cost.

Some trends held steady across most states. For family practice and pediatric visits, new patients often pay less than established patients. For internal medicine visits, new patients frequently pay more than established patients. Both of these trends exist regardless of insurance type.

Transparency is increasingly paramount in American health care. Keep reading for a look at what common medical visits cost in neighboring states and the state-level factors that may influence these costs.

New Jersey

- Most common family practice visit costs
--- Medicare recipients: $116.86 for established patients ($101.41 for new patients)
--- Other insurance holders: $29.22 for established patients ($25.35 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $116.86 for established patients ($150.57 for new patients)
--- Other insurance holders: $29.22 for established patients ($37.64 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $116.86 for established patients ($101.41 for new patients)
--- Other insurance holders: $29.22 for established patients ($25.35 for new patients)

A major law protecting New Jersey residents from surprise billing will go into effect in 2022. The No Surprises Act will prohibit providers from billing unanticipated care costs from doctors and specialists who are out-of-network on an individual patient's insurance plan.

New York

- Most common family practice visit costs
--- Medicare recipients: $101.86 for established patients ($88.06 for new patients)
--- Other insurance holders: $25.46 for established patients ($22.02 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $101.86 for established patients ($131.79 for new patients)
--- Other insurance holders: $25.46 for established patients ($32.95 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $101.86 for established patients ($88.06 for new patients)
--- Other insurance holders: $25.46 for established patients ($22.02 for new patients)

A proposed New York Health Act, currently under consideration by lawmakers, could establish a robust single-payer system. All services requiring medical attention would be covered at zero cost to patients, eliminating the copayments and premiums that prohibit some residents from seeking care.