Healthcare Cost Research & Analysis

Our research team analyzes publicly available healthcare data to uncover pricing trends, regional disparities, and cost-saving opportunities. All findings are based on government data sources and independent analysis.

📊 Our Research Approach

We analyze data from CMS Public Use Files, state insurance department rate filings, and hospital price transparency data (mandated since January 2021). Our methodology prioritizes:

  • • Transparency: All data sources are cited and publicly accessible
  • • Statistical rigor: We use percentile ranges rather than simple averages
  • • Regular updates: Analysis refreshed during Open Enrollment periods

Featured Research

Data AnalysisJanuary 2026

MRI Pricing Variation Across 10 States: Hospital vs. Independent Imaging Centers

Our analysis of cash-pay MRI prices across California, Texas, Florida, New York, Pennsylvania, Illinois, Ohio, Georgia, Michigan, and North Carolina reveals significant pricing disparities between facility types. Key findings show that hospital-based MRIs cost an average of 2.4x more than independent imaging centers for identical scans.

Key Findings:

$2,847

Avg. Hospital MRI Cost

$1,180

Avg. Imaging Center Cost

58%

Potential Savings

State-by-State Breakdown:

StateHospital Avg.Imaging Center Avg.Difference
California$3,200$1,400-56%
New York$3,100$1,500-52%
Texas$2,600$1,200-54%
Florida$2,400$1,100-54%
Pennsylvania$2,500$1,150-54%

Source: USHealthCosts.com analysis of hospital price transparency data and direct facility surveys, 2025-2026.

Market AnalysisDecember 2025

2026 ACA Marketplace Premium Trends: State-by-State Analysis

Analysis of 2026 ACA marketplace premiums across our 10 covered states reveals a 3.2% average premium decrease compared to 2025, continuing the trend of stabilizing individual market premiums following enhanced subsidy provisions.

Premium Trends by Tier (40-year-old, Non-Smoker):

$312

Bronze Avg.

↓ 2.8%

$478

Silver Avg.

↓ 3.4%

$562

Gold Avg.

↓ 3.1%

$698

Platinum Avg.

↓ 2.9%

Key Insights:

  • • Most affordable: Ohio and Texas continue to have the lowest average premiums
  • • Most expensive: New York and California have highest premiums (but also strongest subsidies)
  • • Best value: Silver plans with CSR in all 10 states offer effective 80-94% actuarial value
  • • Competition factor: States with 4+ carriers average 8% lower premiums than single-carrier counties

Source: USHealthCosts.com analysis of CMS 2026 QHP Landscape Files and state insurance department filings.

Policy AnalysisNovember 2025

The Medicaid Coverage Gap: Impact on 2.2 Million Americans in Non-Expansion States

Three of our covered states (Texas, Florida, Georgia) have not expanded Medicaid, leaving approximately 2.2 million adults in a "coverage gap" where they earn too much for traditional Medicaid but too little to qualify for ACA marketplace subsidies.

Coverage Gap by State:

771,000

Texas

438,000

Florida

267,000

Georgia

Alternatives for Those in the Gap:

  • • Federally Qualified Health Centers (sliding-scale fees)
  • • Hospital charity care programs
  • • Free and charitable clinics
  • • State-specific programs (e.g., Texas Women's Health Program)

Source: Kaiser Family Foundation coverage gap estimates, 2025. USHealthCosts.com state-level analysis.

Cost AnalysisOctober 2025

Emergency Room vs. Urgent Care: True Cost Comparison Across 10 States

Our analysis of ER and urgent care pricing for common conditions reveals that emergency rooms charge 8-12x more than urgent care centers for treating identical non-emergency conditions like minor fractures, UTIs, and respiratory infections.

Average Costs by Condition (Uninsured):

ConditionER AverageUrgent Care Avg.Savings
Sprained Ankle$1,498$165$1,333
Urinary Tract Infection$1,082$125$957
Upper Respiratory Infection$987$115$872
Minor Laceration (stitches)$1,734$195$1,539
Ear Infection$892$105$787

Note: ER costs include facility fee; excludes physician billing. Urgent care costs are all-inclusive.

⚠️ When to Use the ER

Emergency rooms are essential for true emergencies: chest pain, difficulty breathing, severe bleeding, stroke symptoms, major trauma, or loss of consciousness. For non-life-threatening conditions, urgent care provides equivalent treatment at a fraction of the cost.

Our Data Sources

Government Sources

  • • CMS Public Use Files (QHP Landscape, Marketplace enrollment)
  • • State Insurance Department Rate Filings
  • • Hospital Price Transparency Files (CMS mandate)
  • • HHS Federal Poverty Level Guidelines

Research Organizations

  • • Kaiser Family Foundation Health Policy Research
  • • Health Care Cost Institute (HCCI)
  • • Commonwealth Fund Healthcare Studies
  • • Urban Institute Health Policy Center

Request Custom Research

Have a healthcare cost question you'd like us to research? We consider community suggestions for future analyses. Topics with significant public interest may become featured research articles.

Submit research suggestions: research@ushealthcosts.com