What common medical visits cost in each state

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September 29, 2021
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What common medical visits cost in each state

In America’s patchwork of health care providers, determining what a medical visit might cost can be confusing at best, and life-altering at worst. The United States is the only developed country in the world that has its citizens begging strangers on GoFundMe to cover their chemotherapy costs. It’s a country in which patients can go to the hospital for a service recommended by their doctor without knowing the cost of that treatment.

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 that are looking to put a public option on the table for their residents. 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.

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 each state and the state-level factors that may influence these costs.

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Alabama

- Most common family practice visit costs
--- Medicare recipients: $99.34 for established patients ($85.95 for new patients)
--- Other insurance holders: $24.83 for established patients ($21.49 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $99.34 for established patients ($129.06 for new patients)
--- Other insurance holders: $24.83 for established patients ($32.26 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $99.34 for established patients ($85.95 for new patients)
--- Other insurance holders: $24.83 for established patients ($21.49 for new patients)

One of Alabama’s most serious medical issues sending patients to doctors and hospitals alike is prescription drug abuse. State legislature cracked down on so-called “doctor shopping” in 2021 with legislation that may decrease some of these case numbers. New legislation requires doctors to submit prescription information to a centralized database to prohibit abuse.

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Alaska

- Most common family practice visit costs
--- Medicare recipients: $135.85 for established patients ($116.69 for new patients)
--- Other insurance holders: $33.96 for established patients ($29.17 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $135.85 for established patients ($176.47 for new patients)
--- Other insurance holders: $33.96 for established patients ($44.12 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $135.85 for established patients ($116.69 for new patients)
--- Other insurance holders: $33.96 for established patients ($29.17 for new patients)

Alaskans may soon have expanded access to telemedicine, which could help drive down the cost of their visits, by lowering overhead for doctors’ offices and staff. However, the bill that state legislature passed to accommodate telehealth has another potentially less health-conscious provision: It would prohibit the state from mandating COVID-19 vaccines in order to access public spaces.

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Arizona

- Most common family practice visit costs
--- Medicare recipients: $102.07 for established patients ($88.34 for new patients)
--- Other insurance holders: $25.52 for established patients ($22.08 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $102.07 for established patients ($132.23 for new patients)
--- Other insurance holders: $25.52 for established patients ($33.06 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $102.07 for established patients ($88.34 for new patients)
--- Other insurance holders: $25.52 for established patients ($22.08 for new patients)

Arizonans looking for cost-saving advocacy from their representatives will need to look further than current Sen. Kyrsten Sinema. The Democrat has vocalized objections to lowering drug prices. Getting rid of this provision—which is currently in national legislation before Congress—could endanger a broader expansion of Medicare coverage.

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Arkansas

- Most common family practice visit costs
--- Medicare recipients: $95.61 for established patients ($82.31 for new patients)
--- Other insurance holders: $23.90 for established patients ($20.58 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $95.61 for established patients ($123.79 for new patients)
--- Other insurance holders: $23.90 for established patients ($30.95 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $95.61 for established patients ($82.31 for new patients)
--- Other insurance holders: $23.90 for established patients ($20.58 for new patients)

Arkansas has some of the highest rates of chronic disease in the country. Across the nation, 84% of health care costs come from the management of chronic disease, so it follows that Arkansas spends a considerable portion of its health care costs on such management. For Arkansan recipients of Medicaid whose chronic conditions have left them unable to work, a 2021 ruling by the Department of Health and Human Services offered a lifeline, waiving a work requirement put in place in 2018.

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California

- Most common family practice visit costs
--- Medicare recipients: $114.89 for established patients ($99.50 for new patients)
--- Other insurance holders: $28.72 for established patients ($24.88 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $114.89 for established patients ($147.83 for new patients)
--- Other insurance holders: $28.72 for established patients ($36.96 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $114.89 for established patients ($99.50 for new patients)
--- Other insurance holders: $28.72 for established patients ($24.88 for new patients)

Health care costs could soon change dramatically for California residents. A current bill is considering a single-payer health system. In such a system, out-of-pocket costs for patients would be outright banned.

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Colorado

- Most common family practice visit costs
--- Medicare recipients: $106.33 for established patients ($92.05 for new patients)
--- Other insurance holders: $26.58 for established patients ($23.01 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $106.33 for established patients ($137.20 for new patients)
--- Other insurance holders: $26.58 for established patients ($34.30 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $106.33 for established patients ($92.05 for new patients)
--- Other insurance holders: $26.58 for established patients ($23.01 for new patients)

Colorado has some of the most expensive health care costs in the country. The state’s Health Care Task Force was established in part to address the sky-high costs for some hospital procedures, which were then found to be higher than those in 40 other states. The bipartisan commission found that a single-payer system would cover more Coloradans while also costing less than the existing structure.

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Connecticut

- Most common family practice visit costs
--- Medicare recipients: $112.10 for established patients ($97.18 for new patients)
--- Other insurance holders: $28.02 for established patients ($24.30 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $112.10 for established patients ($144.70 for new patients)
--- Other insurance holders: $28.02 for established patients ($36.17 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $112.10 for established patients ($97.18 for new patients)
--- Other insurance holders: $28.02 for established patients ($24.30 for new patients)

The rates which health insurers bill by are currently a subject of debate in Connecticut. Regulators have since declined to approve a request from insurers to bill higher rates. However, health care reform advocates say that approved rates are still far too high.

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Delaware

- Most common family practice visit costs
--- Medicare recipients: $105.98 for established patients ($91.85 for new patients)
--- Other insurance holders: $26.50 for established patients ($22.96 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $105.98 for established patients ($137.09 for new patients)
--- Other insurance holders: $26.50 for established patients ($34.27 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $105.98 for established patients ($91.85 for new patients)
--- Other insurance holders: $26.50 for established patients ($22.96 for new patients)

Delaware received nearly $11 million from the federal government in 2021 to help expand access to health care. A portion of high-cost claims, responsible for driving up prices for everyone, are reimbursed through this fund. In just its first two years, the plan has driven down premiums by 19%.

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Florida

- Most common family practice visit costs
--- Medicare recipients: $103.76 for established patients ($90.25 for new patients)
--- Other insurance holders: $25.94 for established patients ($22.56 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $103.76 for established patients ($135.26 for new patients)
--- Other insurance holders: $25.94 for established patients ($33.82 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $103.76 for established patients ($90.25 for new patients)
--- Other insurance holders: $25.94 for established patients ($22.56 for new patients)

Florida is currently experiencing one of the worst COVID-19 outbreaks in the nation, and soon, patients in the state will have to start covering the cost of their own care. Many insurers have indicated that they will no longer cover COVID-19 care for their patients, including Blue Cross Blue Shield (Florida Blue), the state’s largest provider.

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Georgia

- Most common family practice visit costs
--- Medicare recipients: $98.79 for established patients ($85.46 for new patients)
--- Other insurance holders: $24.70 for established patients ($21.36 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $98.79 for established patients ($128.38 for new patients)
--- Other insurance holders: $24.70 for established patients ($32.09 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $98.79 for established patients ($85.46 for new patients)
--- Other insurance holders: $24.70 for established patients ($21.36 for new patients)

Georgia is one of a minority of states that have resisted Medicaid expansion. These states, largely in the Republican South, have broadly declined to expand Medicaid on ideological grounds. Much of the state, including its leading newspaper, is calling on the government to use funds from the American Rescue Plan to expand coverage for a half-million Georgian families who make about $17,900 a year.

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Hawaii

- Most common family practice visit costs
--- Medicare recipients: $111.01 for established patients ($96.11 for new patients)
--- Other insurance holders: $27.75 for established patients ($24.03 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $111.01 for established patients ($142.73 for new patients)
--- Other insurance holders: $27.75 for established patients ($35.68 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $111.01 for established patients ($96.11 for new patients)
--- Other insurance holders: $27.75 for established patients ($24.03 for new patients)

Of all 50 states, Hawaii pays the least for employer-sponsored health insurance. This is due in part to the state laws that exist to protect Hawaiians. The state’s 1974 Prepaid Health Care Act requires employers to provide coverage for anyone working more than 20 hours per week, expanding access and lowering costs.

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Idaho

- Most common family practice visit costs
--- Medicare recipients: $96.84 for established patients ($83.37 for new patients)
--- Other insurance holders: $24.21 for established patients ($20.84 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $96.84 for established patients ($125.19 for new patients)
--- Other insurance holders: $24.21 for established patients ($31.30 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $96.84 for established patients ($83.37 for new patients)
--- Other insurance holders: $24.21 for established patients ($20.84 for new patients)

A 2020 Idaho law was aimed to protect the rights of citizens who cannot afford the out-of-pocket medical costs they have been charged. The Idaho Patient Act requires providers to provide a list of care fees promptly and limits the tactics that debt collectors may employ to recoup overdue bills. Opponents to the law argued that it infringed upon the right of insurers to protect their “property”—patients’ money.

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Illinois

- Most common family practice visit costs
--- Medicare recipients: $101.50 for established patients ($88.06 for new patients)
--- Other insurance holders: $25.37 for established patients ($22.01 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $101.50 for established patients ($132.10 for new patients)
--- Other insurance holders: $25.37 for established patients ($33.03 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $101.50 for established patients ($88.06 for new patients)
--- Other insurance holders: $25.37 for established patients ($22.01 for new patients)

In 2021, Illinois state legislature passed a significant health care bill that will drive down costs for some state residents. The bill significantly expands the medical services available to low-income residents and increases funding for safety-net hospitals.

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Indiana

- Most common family practice visit costs
--- Medicare recipients: $98.12 for established patients ($84.54 for new patients)
--- Other insurance holders: $24.53 for established patients ($21.14 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $98.12 for established patients ($126.82 for new patients)
--- Other insurance holders: $24.53 for established patients ($31.70 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $98.12 for established patients ($84.54 for new patients)
--- Other insurance holders: $24.53 for established patients ($21.14 for new patients)

In 2020, a major health care transparency bill was signed in Indiana that required providers to publish lists of prices for their services. The purpose of such a requirement is to allow citizens to shop for the best price, thereby lowering their health care costs as much as possible.

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Iowa

- Most common family practice visit costs
--- Medicare recipients: $98.30 for established patients ($84.67 for new patients)
--- Other insurance holders: $24.57 for established patients ($21.17 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $98.30 for established patients ($126.95 for new patients)
--- Other insurance holders: $24.57 for established patients ($31.74 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $98.30 for established patients ($84.67 for new patients)
--- Other insurance holders: $24.57 for established patients ($21.17 for new patients)

Iowa passed two bills this year that aim to expand access to health care. One of the bills requires Iowa’s flagship state universities to provide expanded medical and dental services to student residents.

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Kansas

- Most common family practice visit costs
--- Medicare recipients: $98.47 for established patients ($84.86 for new patients)
--- Other insurance holders: $24.62 for established patients ($21.21 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $98.47 for established patients ($127.22 for new patients)
--- Other insurance holders: $24.62 for established patients ($31.81 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $98.47 for established patients ($84.86 for new patients)
--- Other insurance holders: $24.62 for established patients ($21.21 for new patients)

Kansas is one of 12 states that have declined to expand Medicaid access. Its current governor has since called upon Congress to create workarounds for states whose conservative legislatures will not green light Medicaid expansion. Such a program would allow eligible residents in non-expansion states to access full Medicaid coverage at no additional cost to the government.

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wutzkohphoto // Shutterstock

Kentucky

- Most common family practice visit costs
--- Medicare recipients: $98.06 for established patients ($84.75 for new patients)
--- Other insurance holders: $24.52 for established patients ($21.19 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $98.06 for established patients ($127.38 for new patients)
--- Other insurance holders: $24.52 for established patients ($31.84 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $98.06 for established patients ($84.75 for new patients)
--- Other insurance holders: $24.52 for established patients ($21.19 for new patients)

A new Kentucky bill up for consideration could allow providers to refuse to offer care. This so-called “rights of conscience” bill may also drive up prices. If some procedures become harder to obtain due to doctor refusal, the cost of such care could rise in response to such scarcity.

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Louisiana

- Most common family practice visit costs
--- Medicare recipients: $100.09 for established patients ($86.89 for new patients)
--- Other insurance holders: $25.02 for established patients ($21.72 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $100.09 for established patients ($130.62 for new patients)
--- Other insurance holders: $25.02 for established patients ($32.66 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $100.09 for established patients ($86.89 for new patients)
--- Other insurance holders: $25.02 for established patients ($21.72 for new patients)

A law passed in 2019 made one kind of procedure more affordable for Louisiana residents. Act 461 requires insurers to cover breast cancer screenings for those who have had bilateral mastectomies and have been declared cancer-free. The requirement also applies to Medicaid recipients.

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Maine

- Most common family practice visit costs
--- Medicare recipients: $98.76 for established patients ($85.25 for new patients)
--- Other insurance holders: $24.69 for established patients ($21.31 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $98.76 for established patients ($127.90 for new patients)
--- Other insurance holders: $24.69 for established patients ($31.98 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $98.76 for established patients ($85.25 for new patients)
--- Other insurance holders: $24.69 for established patients ($21.31 for new patients)

Maine is moving toward universal health care for all residents. The state’s Health Coverage, Insurance and Financial Services committee voted “ought to pass” by a wide margin on a bill that would cover all health care costs for everyone in the state, including dental and vision care alongside addiction and mental health treatment.

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Maryland

- Most common family practice visit costs
--- Medicare recipients: $107.58 for established patients ($93.34 for new patients)
--- Other insurance holders: $26.89 for established patients ($23.34 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $107.58 for established patients ($139.30 for new patients)
--- Other insurance holders: $26.89 for established patients ($34.82 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $107.58 for established patients ($93.34 for new patients)
--- Other insurance holders: $26.89 for established patients ($23.34 for new patients)

Maryland policymakers and health care advocates are currently looking to expand coverage and lower costs for one type of oft-neglected medical care. A task force has been established to expand coverage of dental services, the costs of which are rarely covered by insurers.

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Massachusetts

- Most common family practice visit costs
--- Medicare recipients: $108.63 for established patients ($94.07 for new patients)
--- Other insurance holders: $27.16 for established patients ($23.52 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $108.63 for established patients ($140.29 for new patients)
--- Other insurance holders: $27.16 for established patients ($35.07 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $108.63 for established patients ($94.07 for new patients)
--- Other insurance holders: $27.16 for established patients ($23.52 for new patients)

The current governor of Massachusetts is looking to make major health care reforms soon. Public officials in the state have flagged rising costs of care, and Gov. Charlie Baker has indicated that he will make reining in such costs a major focus in the coming year.

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Michigan

- Most common family practice visit costs
--- Medicare recipients: $100.66 for established patients ($87.16 for new patients)
--- Other insurance holders: $25.16 for established patients ($21.79 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $100.66 for established patients ($130.74 for new patients)
--- Other insurance holders: $25.16 for established patients ($32.69 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $100.66 for established patients ($87.16 for new patients)
--- Other insurance holders: $25.16 for established patients ($21.79 for new patients)

In 2021, Michigan unveiled a bipartisan health care bill intended to lower costs and expand access to care. A significant change proposed in the bill would limit the ability of drug companies to influence doctors through expensive gifts and sponsored trips to prescribe their medications to patients.

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Minnesota

- Most common family practice visit costs
--- Medicare recipients: $103.05 for established patients ($88.84 for new patients)
--- Other insurance holders: $25.76 for established patients ($22.21 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $103.05 for established patients ($132.53 for new patients)
--- Other insurance holders: $25.76 for established patients ($33.13 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $103.05 for established patients ($88.84 for new patients)
--- Other insurance holders: $25.76 for established patients ($22.21 for new patients)

In 2021, Minnesota passed several reforms aiming to lower health care costs. One such measure is the expansion of telehealth, which, along with continuing the state’s reinsurance policy, has enabled Minnesotans to enjoy some of the lowest health care costs in the country.

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Mississippi

- Most common family practice visit costs
--- Medicare recipients: $96.18 for established patients ($82.96 for new patients)
--- Other insurance holders: $24.04 for established patients ($20.74 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $96.18 for established patients ($124.83 for new patients)
--- Other insurance holders: $24.04 for established patients ($31.21 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $96.18 for established patients ($82.96 for new patients)
--- Other insurance holders: $24.04 for established patients ($20.74 for new patients)

The state of Mississippi claims that it cannot afford to expand Medicare. Economists have pushed back, publishing a report showing that the expansion would pay for itself and the state would incur no new costs. As it stands, Mississippi’s inaction has left many residents uninsured or underinsured.

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Missouri

 Jr.- Most common family practice visit costs
--- Medicare recipients: $97.26 for established patients ($84.04 for new patients)
--- Other insurance holders: $24.32 for established patients ($21.01 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $97.26 for established patients ($126.41 for new patients)
--- Other insurance holders: $24.32 for established patients ($31.60 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $97.26 for established patients ($84.04 for new patients)
--- Other insurance holders: $24.32 for established patients ($21.01 for new patients)

Missouri state representative Rasheen Aldridge Jr., who is disabled, is currently fighting to expand access to affordable care for Missourians with disabilities. “If I didn’t have health care it would be really tough for me to have the prosthetic I have,” Aldridge told state newspapers. As it stands, insurers in the state do not always cover visits and treatments related to disabilities.

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Montana

- Most common family practice visit costs
--- Medicare recipients: $104.87 for established patients ($90.90 for new patients)
--- Other insurance holders: $26.22 for established patients ($22.73 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $104.87 for established patients ($135.79 for new patients)
--- Other insurance holders: $26.22 for established patients ($33.95 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $104.87 for established patients ($90.90 for new patients)
--- Other insurance holders: $26.22 for established patients ($22.73 for new patients)

Montana lawmakers cut funding for Medicaid in 2021. Under new changes in the law, Medicaid recipients may not be able to keep their coverage for a full year regardless of potential changes in income. If a resident’s income level increases, they may be required to find new insurance.

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Nebraska

- Most common family practice visit costs
--- Medicare recipients: $97.60 for established patients ($83.92 for new patients)
--- Other insurance holders: $24.40 for established patients ($20.98 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $97.60 for established patients ($125.79 for new patients)
--- Other insurance holders: $24.40 for established patients ($31.45 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $97.60 for established patients ($83.92 for new patients)
--- Other insurance holders: $24.40 for established patients ($20.98 for new patients)

Nebraska passed a bill in 2021 to permanently expand access to telehealth services. Studies have shown that access to telehealth can reduce the cost of providing health care by up to $1,500 per visit.

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Nevada

- Most common family practice visit costs
--- Medicare recipients: $106.60 for established patients ($92.70 for new patients)
--- Other insurance holders: $26.65 for established patients ($23.17 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $106.60 for established patients ($138.56 for new patients)
--- Other insurance holders: $26.65 for established patients ($34.64 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $106.60 for established patients ($92.70 for new patients)
--- Other insurance holders: $26.65 for established patients ($23.17 for new patients)

In 2021, Nevada became the second state in the nation to adopt a public health insurance option. The bill is projected to lower the costs of premiums by 15% over four years.

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New Hampshire

- Most common family practice visit costs
--- Medicare recipients: $106.44 for established patients ($92.26 for new patients)
--- Other insurance holders: $26.61 for established patients ($23.06 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $106.44 for established patients ($137.58 for new patients)
--- Other insurance holders: $26.61 for established patients ($34.39 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $106.44 for established patients ($92.26 for new patients)
--- Other insurance holders: $26.61 for established patients ($23.06 for new patients)

In 2021, New Hampshire appropriated $1.6 million to help residents of the state find affordable health care. The New Hampshire Navigator’s health care program will help residents explore the marketplace of insurance options to find the best plans for themselves and their families.

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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.

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New Mexico

- Most common family practice visit costs
--- Medicare recipients: $100.67 for established patients ($87.31 for new patients)
--- Other insurance holders: $25.17 for established patients ($21.83 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $100.67 for established patients ($131.09 for new patients)
--- Other insurance holders: $25.17 for established patients ($32.77 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $100.67 for established patients ($87.31 for new patients)
--- Other insurance holders: $25.17 for established patients ($21.83 for new patients)

New Mexico enacted health care legislation in 2021 that will significantly expand access and lower costs. SB 317 prohibits copays and other cost-sharing measures for patients seeking behavioral health treatments and establishes the Health Care Affordability Fund, which aims to lower costs for middle- and lower-income residents of New Mexico.

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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.

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North Carolina

- Most common family practice visit costs
--- Medicare recipients: $100.83 for established patients ($87.21 for new patients)
--- Other insurance holders: $25.21 for established patients ($21.80 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $100.83 for established patients ($130.68 for new patients)
--- Other insurance holders: $25.21 for established patients ($32.67 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $100.83 for established patients ($87.21 for new patients)
--- Other insurance holders: $25.21 for established patients ($21.80 for new patients)

North Carolina lawmakers moved to crack down on surprise medical billing in 2021, a move which could lower health care costs for some residents. SB 505 requires providers to notify patients when an out-of-network charge is levied.

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North Dakota

- Most common family practice visit costs
--- Medicare recipients: $102.74 for established patients ($88.62 for new patients)
--- Other insurance holders: $25.68 for established patients ($22.15 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $102.74 for established patients ($132.29 for new patients)
--- Other insurance holders: $25.68 for established patients ($33.07 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $102.74 for established patients ($88.62 for new patients)
--- Other insurance holders: $25.68 for established patients ($22.15 for new patients)

Patients in North Dakota may struggle to access care. Rural residents have complained of the difficulty of finding providers in their area, likely due to the state’s large size and the remoteness of much of its population.

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Ohio

- Most common family practice visit costs
--- Medicare recipients: $101.20 for established patients ($87.73 for new patients)
--- Other insurance holders: $25.30 for established patients ($21.93 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $101.20 for established patients ($131.59 for new patients)
--- Other insurance holders: $25.30 for established patients ($32.90 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $101.20 for established patients ($87.73 for new patients)
--- Other insurance holders: $25.30 for established patients ($21.93 for new patients)

One of the most contentious issues facing Ohioans who are looking to access reliable and affordable health care is the so-called “right to refusal” law. This provision allows providers to opt out of providing care based on ethical or religious objections, which could cause an issue for LGBTQ+ patients looking to access care in the state.

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Oklahoma

- Most common family practice visit costs
--- Medicare recipients: $98.46 for established patients ($85.07 for new patients)
--- Other insurance holders: $24.61 for established patients ($21.27 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $98.46 for established patients ($127.77 for new patients)
--- Other insurance holders: $24.61 for established patients ($31.94 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $98.46 for established patients ($85.07 for new patients)
--- Other insurance holders: $24.61 for established patients ($21.27 for new patients)

Budgeting for health care is set to become less opaque for Oklahomans. In 2021, the state senate passed a measure that would require health care providers to annually publish the costs of their most common medical procedures, helping residents decide which provider to visit and how to budget for their care.

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Oregon

- Most common family practice visit costs
--- Medicare recipients: $100.62 for established patients ($86.82 for new patients)
--- Other insurance holders: $25.16 for established patients ($21.71 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $100.62 for established patients ($129.94 for new patients)
--- Other insurance holders: $25.16 for established patients ($32.48 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $100.62 for established patients ($86.82 for new patients)
--- Other insurance holders: $25.16 for established patients ($21.71 for new patients)

In 2021, Oregon passed legislation intended to keep health care costs competitive. HB 3262 limits mergers and consolidations between insurers, theoretically making it more likely that a robust network of providers will compete against one another to lower prices.

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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.

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Rhode Island

- Most common family practice visit costs
--- Medicare recipients: $108.29 for established patients ($93.88 for new patients)
--- Other insurance holders: $27.07 for established patients ($23.47 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $108.29 for established patients ($140.08 for new patients)
--- Other insurance holders: $27.07 for established patients ($35.02 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $108.29 for established patients ($93.88 for new patients)
--- Other insurance holders: $27.07 for established patients ($23.47 for new patients)

Some Rhode Islanders may soon be experiencing a version of universal health care. A proposed law, called “RIte track,” provides free universal health insurance for all children in the state regardless of their immigration status.

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South Carolina

- Most common family practice visit costs
--- Medicare recipients: $99.16 for established patients ($85.63 for new patients)
--- Other insurance holders: $24.79 for established patients ($21.41 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $99.16 for established patients ($128.46 for new patients)
--- Other insurance holders: $24.79 for established patients ($32.12 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $99.16 for established patients ($85.63 for new patients)
--- Other insurance holders: $24.79 for established patients ($21.41 for new patients)

Rural residents in South Carolina have long had difficulty accessing care. Some clinics that serve rural areas do so on a sliding-scale model, which boosts their popularity, making it even more difficult for patients to secure an open appointment in the busy clinic.

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South Dakota

- Most common family practice visit costs
--- Medicare recipients: $102.41 for established patients ($88.26 for new patients)
--- Other insurance holders: $25.60 for established patients ($22.07 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $102.41 for established patients ($131.75 for new patients)
--- Other insurance holders: $25.60 for established patients ($32.94 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $102.41 for established patients ($88.26 for new patients)
--- Other insurance holders: $25.60 for established patients ($22.07 for new patients)

South Dakota is one of the 12 states that have declined to expand Medicaid access, and not everyone in the state is happy about it. A cohort of the state’s health care systems has come together to lobby for a major expansion of Medicaid in the state, aiming to expand access and lower costs.

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Tennessee

- Most common family practice visit costs
--- Medicare recipients: $97.85 for established patients ($84.32 for new patients)
--- Other insurance holders: $24.46 for established patients ($21.08 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $97.85 for established patients ($126.53 for new patients)
--- Other insurance holders: $24.46 for established patients ($31.63 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $97.85 for established patients ($84.32 for new patients)
--- Other insurance holders: $24.46 for established patients ($21.08 for new patients)

Using federal grants to pay for Medicaid for residents has long been a contentious issue in Tennessee. In 2019, the state legislature even enacted a bill requiring the governor to seek permission before converting federal funds into a block grant that would pay for Medicaid expansion.

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Texas

- Most common family practice visit costs
--- Medicare recipients: $101.20 for established patients ($87.36 for new patients)
--- Other insurance holders: $25.30 for established patients ($21.84 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $101.20 for established patients ($130.71 for new patients)
--- Other insurance holders: $25.30 for established patients ($32.68 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $101.20 for established patients ($87.36 for new patients)
--- Other insurance holders: $25.30 for established patients ($21.84 for new patients)

In a rare show of bipartisan unity, Republicans and Democrats in Texas worked together in 2021 to put forward a bill focusing on two cost-saving priorities. The first is lowering prescription drug prices. The second would expand telehealth services to all residents in the state, regardless of whether they have public or private health care coverage.

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Utah

- Most common family practice visit costs
--- Medicare recipients: $100.33 for established patients ($86.74 for new patients)
--- Other insurance holders: $25.08 for established patients ($21.69 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $100.33 for established patients ($130.04 for new patients)
--- Other insurance holders: $25.08 for established patients ($32.51 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $100.33 for established patients ($86.74 for new patients)
--- Other insurance holders: $25.08 for established patients ($21.69 for new patients)

Utah passed a major health care law in 2021 aimed at reining in lifesaving medical expenses. HB 54 requires providers to provide emergency care at in-network rates, meaning that Utah residents experiencing acute health crises like heart attacks and gunshot wounds will not have to wonder en route to the hospital if they can afford to save their own lives.

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Vermont

- Most common family practice visit costs
--- Medicare recipients: $103.32 for established patients ($89.24 for new patients)
--- Other insurance holders: $25.83 for established patients ($22.31 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $103.32 for established patients ($133.23 for new patients)
--- Other insurance holders: $25.83 for established patients ($33.31 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $103.32 for established patients ($89.24 for new patients)
--- Other insurance holders: $25.83 for established patients ($22.31 for new patients)

A new piece of legislation in Vermont aims to make health care access more equitable among the state’s residents. Act 33 establishes a commission that will study health care costs and access for the state’s historically disadvantaged groups, particularly people of color, members of the LGBTQ+ community, and people with disabilities.

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Virginia

- Most common family practice visit costs
--- Medicare recipients: $104.32 for established patients ($90.36 for new patients)
--- Other insurance holders: $26.08 for established patients ($22.59 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $104.32 for established patients ($135.00 for new patients)
--- Other insurance holders: $26.08 for established patients ($33.75 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $104.32 for established patients ($90.36 for new patients)
--- Other insurance holders: $26.08 for established patients ($22.59 for new patients)

In 2020, the Virginia General Assembly passed legislation that prohibited surprise medical billing. Unexpected out-of-network costs will no longer be allowed after patients receive care; instead, insurers will have to negotiate with providers and agree to pay a reasonable commercial rate.

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Washington

- Most common family practice visit costs
--- Medicare recipients: $104.62 for established patients ($90.52 for new patients)
--- Other insurance holders: $26.16 for established patients ($22.63 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $104.62 for established patients ($135.10 for new patients)
--- Other insurance holders: $26.16 for established patients ($33.77 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $104.62 for established patients ($90.52 for new patients)
--- Other insurance holders: $26.16 for established patients ($22.63 for new patients)

In 2021, Washington passed a law that aims to lower premiums and expand access to health care throughout the state. The Cascade Care 2.0 bill establishes a premium assistance program to help people afford to purchase insurance on the state’s exchange.

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West Virginia

- Most common family practice visit costs
--- Medicare recipients: $98.99 for established patients ($85.85 for new patients)
--- Other insurance holders: $24.75 for established patients ($21.46 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $98.99 for established patients ($129.13 for new patients)
--- Other insurance holders: $24.75 for established patients ($32.28 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $98.99 for established patients ($85.85 for new patients)
--- Other insurance holders: $24.75 for established patients ($21.46 for new patients)

West Virginia has a much higher Medicaid rate than many other states. One-third of West Virginians use Medicaid due to the state’s high number of lower-income households and the program’s expansion in the state following the passage of the Affordable Care Act.

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Wisconsin

- Most common family practice visit costs
--- Medicare recipients: $99.46 for established patients ($85.61 for new patients)
--- Other insurance holders: $24.86 for established patients ($21.40 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $99.46 for established patients ($128.12 for new patients)
--- Other insurance holders: $24.86 for established patients ($32.03 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $99.46 for established patients ($85.61 for new patients)
--- Other insurance holders: $24.86 for established patients ($21.40 for new patients)

In 2021, Republicans in Wisconsin blocked the state from accepting $1 billion in federal funds to expand Medicaid. Legislators could have appropriated that money from the federal Coronavirus Aid, Relief, and Economic Security Act, but declined, concerned that money would dry up and require the state to spend more to keep people insured via the public option.

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Wyoming

- Most common family practice visit costs
--- Medicare recipients: $104.34 for established patients ($90.34 for new patients)
--- Other insurance holders: $26.08 for established patients ($22.58 for new patients)
- Most common internal medicine visit costs
--- Medicare recipients: $104.34 for established patients ($134.92 for new patients)
--- Other insurance holders: $26.08 for established patients ($33.73 for new patients)
- Most common pediatric medicine visit costs
--- Medicare recipients: $104.34 for established patients ($90.34 for new patients)
--- Other insurance holders: $26.08 for established patients ($22.58 for new patients)

The Wyoming House of Representatives passed a Medicaid expansion bill in 2021 that allows people whose income is at or below 138% of the federal poverty level to access coverage, reaching those who don’t qualify for Medicaid or premium subsidies under the Affordable Care Act.

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