Medicare & Medicaid in Pennsylvania (PA)
2026 healthcare costs, coverage, and spending data for Pennsylvania.
$12,687
Spending/Capita
3,282,320
Medicare Enrollees
4,459,760
Medicaid Enrollees
3.6%
Uninsured Rate
Medicare Premiums in Pennsylvania
Part B Premium
$478/mo
Part D Premium (Avg)
$82/mo
Medigap Premium (Avg)
$136/mo
Medicaid Expansion: Yes - Pennsylvania expanded Medicaid under the ACA
Procedure Costs in Pennsylvania
Hospital
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Kidney Transplant | $161,213 | $128,970 | $32,243 |
| Liver Transplant | $139,782 | $111,826 | $27,956 |
| Heart Valve Replacement | $93,136 | $74,509 | $18,627 |
| Coronary Artery Bypass Graft (CABG) | $79,506 | $63,605 | $15,901 |
| Spinal Fusion | $40,978 | $32,782 | $8,196 |
| Total Hip Replacement | $39,319 | $31,455 | $7,864 |
| Defibrillator Implantation (ICD) | $35,762 | $28,610 | $7,152 |
| Laminectomy | $32,172 | $25,738 | $6,434 |
| Total Knee Replacement | $30,155 | $24,124 | $6,031 |
| Pacemaker Implantation | $24,931 | $19,945 | $4,986 |
| Lumbar Disc Surgery | $24,927 | $19,942 | $4,985 |
| Sepsis Treatment | $24,136 | $19,309 | $4,827 |
| Mastectomy | $23,856 | $19,085 | $4,771 |
| Cardiac Catheterization with Stent | $21,448 | $17,159 | $4,290 |
| Hip Fracture Repair | $21,334 | $17,068 | $4,267 |
Outpatient
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| TURP (Prostate) | $8,504 | $6,803 | $1,701 |
| Lithotripsy (Kidney Stones) | $6,944 | $5,555 | $1,389 |
| Bunionectomy | $6,919 | $5,535 | $1,384 |
| Septoplasty | $6,857 | $5,486 | $1,371 |
| Endoscopic Sinus Surgery | $6,684 | $5,347 | $1,337 |
| Arthroscopic Knee Surgery | $6,489 | $5,191 | $1,298 |
| Tonsillectomy | $6,136 | $4,908 | $1,227 |
| Nasal Polyp Removal | $5,368 | $4,295 | $1,074 |
| Dialysis Access Surgery | $5,310 | $4,248 | $1,062 |
| Hemorrhoid Surgery | $4,682 | $3,746 | $936 |
| Pilonidal Cyst Surgery | $4,651 | $3,721 | $930 |
| Varicose Vein Treatment | $3,627 | $2,901 | $725 |
| Trigger Finger Release | $3,545 | $2,836 | $709 |
| Breast Biopsy | $3,153 | $2,523 | $631 |
| Adenoidectomy | $3,088 | $2,470 | $618 |
Imaging
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| PET Scan | $4,075 | $3,260 | $815 |
| Nuclear Stress Test | $1,954 | $1,563 | $391 |
| MRI Brain | $1,844 | $1,476 | $369 |
| CT Scan Abdomen/Pelvis | $1,380 | $1,104 | $276 |
| MRI Shoulder | $1,288 | $1,030 | $258 |
| MRI Spine (Lumbar) | $1,267 | $1,014 | $253 |
| CT Angiography | $1,253 | $1,002 | $251 |
| MRI Hip | $1,081 | $865 | $216 |
| MRI Spine (Cervical) | $1,063 | $851 | $213 |
| CT Scan Chest | $1,047 | $838 | $209 |
| MRI Knee | $1,031 | $825 | $206 |
| CT Colonography (Virtual) | $942 | $754 | $188 |
| Bone Scan | $904 | $723 | $181 |
| CT Scan Head | $853 | $683 | $171 |
| Echocardiogram | $628 | $503 | $126 |
Physician/Office
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Sleep Study Consultation | $424 | $339 | $85 |
| Allergy Testing | $367 | $294 | $73 |
| Mammogram (Screening) | $304 | $304 | $0 |
| Psychiatry Visit | $295 | $236 | $59 |
| Mental Health Counseling | $233 | $186 | $47 |
| Shingles Vaccination | $228 | $228 | $0 |
| Office Visit (New Patient) | $221 | $177 | $44 |
| Annual Wellness Visit | $216 | $216 | $0 |
| Wound Care Visit | $191 | $153 | $38 |
| Physical Therapy Session | $184 | $148 | $37 |
| Office Visit (Established Patient) | $181 | $145 | $36 |
| Speech Therapy Session | $168 | $134 | $34 |
| Occupational Therapy Session | $164 | $132 | $33 |
| Skin Cancer Screening | $159 | $127 | $32 |
| Bone Density Test (DEXA Scan) | $157 | $126 | $31 |
Laboratory
| Procedure | Avg Cost | Medicare Pays | You Pay |
|---|---|---|---|
| Blood Type and Crossmatch | $58 | $47 | $12 |
| BNP (Heart Failure Marker) | $56 | $45 | $11 |
| Blood Culture | $53 | $42 | $11 |
| Comprehensive Metabolic Panel | $45 | $36 | $9 |
| Thyroid Panel (TSH) | $44 | $35 | $9 |
| Vitamin D Level | $42 | $34 | $8 |
| PSA (Prostate-Specific Antigen) | $40 | $32 | $8 |
| Lipid Panel | $38 | $30 | $8 |
| B12 Level | $37 | $30 | $7 |
| Urine Drug Screen | $36 | $29 | $7 |
| Glucose Tolerance Test | $36 | $29 | $7 |
| Liver Function Panel | $36 | $29 | $7 |
| Pap Smear Lab Processing | $36 | $28 | $7 |
| Complete Blood Count (CBC) | $33 | $26 | $7 |
| Troponin Level | $33 | $26 | $7 |
Compare Pennsylvania With Other States
Frequently Asked Questions
How much does Medicare spend per person in Pennsylvania?
In 2026, the average Medicare spending per beneficiary in Pennsylvania is $12,687.
How many people are enrolled in Medicare in Pennsylvania?
Pennsylvania has approximately 3,282,320 Medicare beneficiaries.
Did Pennsylvania expand Medicaid?
Yes, Pennsylvania expanded Medicaid under the Affordable Care Act.
What is the uninsured rate in Pennsylvania?
The uninsured rate in Pennsylvania is 3.6%.
What is the average Medigap premium in Pennsylvania?
The average Medigap (Medicare Supplement) premium in Pennsylvania is $136 per month.