Employer-sponsored insurance paid Virginia doctors an average of 28 percent more than Medicaid managed care plans for the same routine preventive visit, according to a study published this week in JAMA Health Forum that held the billing code constant across five types of coverage.
That design is what makes the comparison unusual. Most published work on Medicaid payment has examined traditional fee-for-service programs, even though about 85 percent of Medicaid members nationwide are enrolled in managed care plans run by private insurers under state contracts. Until now, the rates those plans actually pay have been difficult to observe.
