What common medical visits cost in Texas – and how they compare to nearby states

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What common medical visits cost in Texas – 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.

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.

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 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.

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.