Our Methodology

At USHealthCosts.com, we believe in complete transparency about how we gather and present healthcare cost data. This page provides a detailed explanation of our research methodology, data sources, and the limitations of our estimates.

Methodology Summary

  • Data Sources: CMS public files, state insurance filings, hospital transparency data, KFF research
  • Update Frequency: Annually during Open Enrollment + major policy changes
  • Price Ranges: 25th percentile (Low), Median (Average), 75th percentile (High)
  • Coverage: 10 states representing ~55% of U.S. population

Primary Data Sources

We aggregate data from publicly available, authoritative sources. No proprietary or purchased data is used. Our primary sources include:

Centers for Medicare & Medicaid Services (CMS)

CMS provides the official data for ACA marketplace plans, including plan-level premium information, metal tier classifications, and enrollment statistics.

Source: CMS.gov Marketplace Data

State Insurance Department Rate Filings

Insurance carriers must file their proposed rates with state insurance departments. These public filings provide detailed premium information by age band, rating area, and plan type.

Source: Individual state insurance department websites (varies by state)

Hospital Price Transparency Data

Since January 2021, hospitals are required by federal law to publish their prices for common services. We analyze machine-readable files from hospitals to determine cash pay and negotiated rates for medical procedures.

Source: Hospital machine-readable pricing files (per CMS price transparency rule)

Kaiser Family Foundation (KFF) Research

KFF is a non-partisan health policy research organization that provides rigorous analysis of health insurance markets, subsidy eligibility, and premium trends. We reference their research for trend analysis and validation.

Source: KFF.org

Federal Poverty Level (FPL) Guidelines

The Department of Health and Human Services publishes annual FPL guidelines used to determine subsidy eligibility. We update our subsidy calculations each year when new FPL figures are released.

Source: HHS.gov Poverty Guidelines

How We Calculate Price Ranges

Healthcare costs vary dramatically based on provider, location, and insurance status. Instead of providing a single "average" which can be misleading, we focus on ranges (Low, Average, High) to help you understand realistic cost variation.

Low (25th Percentile)

Represents the lower end of typical prices—what you might find at competitive imaging centers, community clinics, or in areas with robust provider competition.

Average (Median)

The median or mean cost across the state. This is what a "typical" patient might expect to pay in most situations.

High (75th Percentile)

Represents higher-end pricing—hospital-based facilities, specialty providers, or less competitive markets like rural areas.

Important: These figures are estimates for educational purposes. Your actual cost will depend on your specific provider, insurance plan, negotiated rates, and medical needs. Always request a written estimate before receiving care.

Health Insurance Premium Methodology

For health insurance premium estimates, we analyze marketplace plan data with the following approach:

  • Age Standardization: Unless otherwise noted, premiums are shown for a 30-year-old non-smoker. Premiums increase with age (up to 3x higher for a 64-year-old under ACA age rating rules).
  • Metal Tier Mapping: Low = Bronze plans (60% actuarial value), Average = Silver plans (70% AV), High = Gold/Platinum plans (80-90% AV).
  • Before-Subsidy Prices: All premium figures are shown before subsidies are applied. Many consumers qualify for significant premium tax credits that reduce out-of-pocket costs.
  • State Averages: We average across rating areas within each state to provide statewide estimates. Actual premiums vary by county and zip code.

Medical Procedure Cost Methodology

For medical procedure costs (MRI, CT scan, ER visits, etc.), we analyze hospital price transparency data:

  • Cash/Self-Pay Prices: We focus on self-pay or "cash pay" rates—what an uninsured patient would be charged. These are often different from (and sometimes lower than) billed charges.
  • CPT Code Matching: Medical procedures are identified by CPT (Current Procedural Terminology) codes. We map common procedure names to their CPT codes for consistency.
  • Facility Type: Prices vary significantly between hospital-based facilities and independent imaging/surgical centers. We note this distinction where relevant.
  • Excluding Extremes: We exclude outlier prices (top/bottom 5%) that may reflect data errors or unusual circumstances.

Update Schedule & Data Currency

Healthcare costs change frequently. We maintain the following update schedule:

Insurance Premiums

Updated annually during Open Enrollment (November-January) when new plan year data is available from CMS.

Medical Procedure Costs

Reviewed quarterly as hospitals update their price transparency files. Major updates occur semi-annually.

FPL & Subsidy Information

Updated when HHS releases new Federal Poverty Level guidelines (typically January/February each year).

Policy Changes

We monitor CMS announcements and update affected content within 30 days of significant policy changes.

Limitations & Caveats

We believe in being transparent about the limitations of our data:

  • Estimates, Not Quotes: Our figures are educational estimates, not price guarantees. Always verify specific costs with your insurance carrier or healthcare provider.
  • Geographic Variation: Even within a state, costs can vary significantly by county and zip code. Our state-level averages may not reflect local market conditions in your area.
  • Individual Factors: Your actual costs depend on age, health status, plan selection, provider network, and whether you qualify for subsidies or cost-sharing reductions.
  • Data Lag: There is typically a 3-6 month lag between when data is collected and when it reflects current market conditions.
  • Incomplete Hospital Data: Despite federal requirements, not all hospitals have fully compliant price transparency data, which may affect our medical cost estimates.

Questions About Our Methodology?

We welcome questions and feedback about our research methodology. If you have concerns about specific data points or want to understand our process in more detail:

Email: data@ushealthcosts.com

Learn more about our team on the Editorial Team page or review our Editorial Policy.