Healthcare Insights
Hospital payor mix by state
A hospital’s payor mix breaks down its sources of revenue – from commercial insurance plans to government programs such as Medicare and Medicaid – and provides insight into its financial performance and patient population.
In the Definitive Healthcare HospitalView product, payor mix is a proprietary calculation based on revenues, charges, discharges, and patient days that come from different medical insurance payors. The figure is aggregated from the most recent 12-month interval tracked in our database and updated from the October 2024 Medicare Cost Report release.
This Healthcare Insight reviews payor mix data tracked for more than 5,900 U.S. hospitals and compares the results by the state in which the hospital is located.
| State | Medicare | Medicaid | Private/Self-Pay/Other | Explore dataset |
|---|---|---|---|---|
| Alabama | 28.40% | 18.90% | 55.50% | Explore |
| Alaska | 40.50% | 30.00% | 29.40% | Explore |
| Arizona | 26.30% | 18.90% | 58.50% | Explore |
| Arkansas | 37.40% | 10.70% | 53.00% | Explore |
| California | 28.30% | 9.90% | 63.70% | Explore |
| Colorado | 29.30% | 21.60% | 50.10% | Explore |
| Connecticut | 22.90% | 22.30% | 55.30% | Explore |
| Delaware | 34.90% | 13.70% | 57.70% | Explore |
| District of Columbia | 23.90% | 8.50% | 67.60% | Explore |
| Florida | 31.10% | 5.40% | 65.00% | Explore |
| Georgia | 27.00% | 7.10% | 66.40% | Explore |
| Hawaii | 24.90% | 18.40% | 61.50% | Explore |
| Idaho | 38.80% | 16.60% | 45.50% | Explore |
| Illinois | 36.00% | 4.60% | 59.70% | Explore |
| Indiana | 30.00% | 5.10% | 65.10% | Explore |
| Iowa | 50.10% | 6.60% | 45.30% | Explore |
| Kansas | 51.60% | 7.20% | 43.80% | Explore |
| Kentucky | 28.80% | 4.00% | 67.20% | Explore |
| Louisiana | 35.00% | 9.40% | 58.60% | Explore |
| Maine | 27.40% | 19.20% | 53.30% | Explore |
| Maryland | 37.00% | 9.50% | 55.10% | Explore |
| Massachusetts | 32.40% | 15.00% | 53.90% | Explore |
| Michigan | 27.30% | 4.90% | 68.30% | Explore |
| Minnesota | 36.50% | 9.60% | 54.40% | Explore |
| Mississippi | 48.00% | 12.50% | 40.90% | Explore |
| Missouri | 30.70% | 10.10% | 60.00% | Explore |
| Montana | 32.00% | 26.40% | 43.30% | Explore |
| Nebraska | 55.50% | 6.30% | 39.80% | Explore |
| Nevada | 35.20% | 11.30% | 54.50% | Explore |
| New Hampshire | 38.00% | 6.30% | 55.50% | Explore |
| New Jersey | 33.20% | 4.90% | 63.60% | Explore |
| New Mexico | 28.70% | 5.20% | 67.30% | Explore |
| New York | 25.40% | 8.80% | 66.10% | Explore |
| North Carolina | 26.20% | 5.10% | 68.80% | Explore |
| North Dakota | 48.80% | 12.20% | 40.50% | Explore |
| Ohio | 27.10% | 4.10% | 69.10% | Explore |
| Oklahoma | 42.80% | 20.10% | 37.80% | Explore |
| Oregon | 32.10% | 8.20% | 59.80% | Explore |
| Pennsylvania | 28.20% | 3.20% | 70.30% | Explore |
| Rhode Island | 21.80% | 4.10% | 74.30% | Explore |
| South Carolina | 32.60% | 5.90% | 62.40% | Explore |
| South Dakota | 59.00% | 9.90% | 31.80% | Explore |
| Tennessee | 29.80% | 9.00% | 64.90% | Explore |
| Texas | 32.60% | 3.80% | 65.50% | Explore |
| Utah | 21.80% | 15.40% | 64.10% | Explore |
| Vermont | 39.50% | 14.60% | 47.60% | Explore |
| Virginia | 32.50% | 5.10% | 63.20% | Explore |
| Washington | 31.60% | 8.50% | 60.30% | Explore |
| West Virginia | 35.10% | 4.40% | 60.60% | Explore |
| Wisconsin | 34.00% | 6.60% | 59.70% | Explore |
| Wyoming | 48.60% | 11.20% | 41.30% | Explore |
Fig. 1 Analysis of data from the Definitive Healthcare HospitalView product and is aggregated from the most recent 12-month interval tracked in our database. Accessed December 2024.
Which states have the highest Medicare payor mix?
Hospitals in South Dakota both have an estimated Medicare payor mix of more than 59% of hospital revenue. Nebraska, Kansas, and Iowa fall just behind, with Medicare payor mixes averaging above 50%. The aging population and increases in healthcare costs contribute to a higher Medicare payor mix.
Which states have the lowest Medicare payor mix?
Rhode Island and Utah have the lowest percentage of their payor revenue coming from Medicare at 21.8% each. Utah has a relatively younger population, and Rhode Island’s low Medicare payor mix is balanced by its higher private/self-pay payor mix.
Which states have the highest Medicaid payor mix?
Alaska has the highest Medicaid payor mix at nearly 30% followed by Virginia and Montana at 26.9% and 26.4% respectively. Virginia is estimated to have a particularly high percentage of its population enrolled in Medicaid or a Children’s Health Insurance Program (CHIP).
Which states have the lowest Medicaid payor mix?
Texas and Pennsylvania have the lowest percentage of Medicaid payor mix, at less than 4% of hospital revenue on average. Interestingly, both are among the states with the lowest levels of Medicaid and CHIP enrollment.
Which states have the highest commercial payor mix?
Rhode Island has the highest commercial/private insurance payor mix, with more than 74% of their hospitals’ revenue coming from those sources. Hospitals in Pennsylvania, on average, have about 70% of their revenue coming from commercial and private insurance plans.
Which states have the lowest commercial payor mix?
Alaska and South Dakota have the lowest payor mix from commercial/private insurance at 29.4% and 31.8%, respectively. As noted above, these states have some of the highest Medicare and Medicaid payor mixes, which reduces their commercial payor mix.
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