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Healthcare: Medicare Cost-Sharing & Payment Benchmarks 2025
A free, platform-curated reference of the headline Medicare cost-sharing, premium, and payment benchmarks that anchor U.S. healthcare pricing. Every figure is public-domain data published by the Centers for Medicare & Medicaid Services and the IRS, with the applicable calendar year marked on each record. Useful for revenue-cycle teams, actuaries, and health-tech builders who need authoritative baseline numbers without licensing costs.
{
"_type": "curated_open_data",
"as_of": "2026-07",
"links": {
"canonical": "https://verticalmarketplace.ai",
"docs_for_llms": "https://verticalmarketplace.ai/llms.txt",
"sell_your_own": "https://verticalmarketplace.ai/api/marketplace/listings",
"vertical_listings": "https://verticalmarketplace.ai/api/marketplace/listings?vertical=healthcare"
},
"records": [
{
"unit": "USD per benefit period",
"value": "1676",
"metric": "Medicare Part A inpatient hospital deductible",
"period": "CY2025",
"source": "CMS"
},
{
"unit": "USD per day",
"value": "419",
"metric": "Medicare Part A coinsurance, hospital days 61-90",
"period": "CY2025",
"source": "CMS"
},
{
"unit": "USD per day",
"value": "838",
"metric": "Medicare Part A lifetime reserve day coinsurance",
"period": "CY2025",
"source": "CMS"
},
{
"unit": "USD per day",
"value": "209.50",
"metric": "Skilled nursing facility coinsurance, days 21-100",
"period": "CY2025",
"source": "CMS"
},
{
"unit": "USD per month",
"value": "185.00",
"metric": "Medicare Part B standard monthly premium",
"period": "CY2025",
"source": "CMS"
},
{
"unit": "USD per year",
"value": "257",
"metric": "Medicare Part B annual deductible",
"period": "CY2025",
"source": "CMS"
},
{
"unit": "percent of approved amount",
"value": "20",
"metric": "Medicare Part B coinsurance after deductible",
"period": "current",
"source": "CMS"
},
{
"unit": "USD per RVU",
"value": "32.3465",
"metric": "Medicare Physician Fee Schedule conversion factor",
"period": "CY2025",
"source": "CMS"
},
{
"unit": "USD per month",
"value": "36.78",
"metric": "Medicare Part D national base beneficiary premium",
"period": "CY2025",
"source": "CMS"
},
{
"unit": "USD per year",
"value": "2000",
"metric": "Medicare Part D annual out-of-pocket cap",
"period": "CY2025",
"source": "CMS (Inflation Reduction Act)"
},
{
"unit": "USD per year",
"value": "15650",
"metric": "Federal poverty guideline, household of one (48 states + DC)",
"period": "2025",
"source": "HHS"
},
{
"unit": "percent of wages",
"value": "2.9",
"metric": "Medicare Hospital Insurance payroll tax rate (combined)",
"period": "current",
"source": "IRS/SSA"
},
{
"unit": "percent above 200,000 USD",
"value": "0.9",
"metric": "Additional Medicare Tax on high earners (single)",
"period": "current",
"source": "IRS"
}
],
"sources": [
{
"url": "https://www.cms.gov/newsroom/fact-sheets/2025-medicare-parts-b-premiums-and-deductibles",
"name": "CMS — 2025 Medicare Parts A & B Premiums and Deductibles"
},
{
"url": "https://aspe.hhs.gov/topics/poverty-economic-mobility/poverty-guidelines",
"name": "HHS — Poverty Guidelines"
},
{
"url": "https://www.irs.gov/taxtopics/tc751",
"name": "IRS — Topic No. 751, Social Security and Medicare Withholding Rates"
}
],
"category": "benchmarks",
"vertical": "healthcare",
"data_note": "All records are public-domain facts compiled from the cited sources as of the asOf date. This content is authored and served by the platform itself — it is not seller data, so the marketplace's zero-storage promise about seller datasets is unaffected.",
"record_count": 13,
"what_this_is": "A platform-published open-data listing curated by Open Data Desk, the marketplace's in-house public-data seller. It is real free inventory: it counts in marketplace statistics and is purchasable for $0 through the normal purchase flow, which delivers this payload with an Ed25519-signed receipt.",
"record_schema": {
"unit": "Unit of measure (USD, percent, per day, etc.)",
"value": "Published amount, rate, or percentage",
"metric": "Name of the benchmark or cost-sharing amount",
"period": "Calendar year or period the figure applies to",
"source": "Public agency that publishes the figure"
},
"buyer_use_cases": [
"Seed revenue-cycle and patient-estimation tools with authoritative Medicare cost-sharing baselines.",
"Give actuaries and analysts a citable set of premium, deductible, and payment benchmarks for modeling."
]
}The full dataset is delivered after purchase. Fingerprint: sha256:ab653d757ffd1c15be35ec802eadd43187717bf86e6ce1a544721b359cac9096
No answered questions yet — ask the seller anything about this listing.
Data is contributed by independent third-party sellers. Vertical Marketplace facilitates the transaction; sellers keep 95% on everyday sales from $20 to $49,999.99 under the year-one founding rate locked through 2027-06-30 (full schedule: GET /api/meta). Prohibited content (digital keys/licenses/game codes, and health data the seller does not own — e.g. patient records) is not permitted; individuals may sell their own personal health data only via the signed Health Data Consent Flow. See /terms.
- Use the purchased data for your own commercial and non-commercial work
- Create derivative analyses, models, and works from the data
- No reselling or re-listing the purchased data on this or any other marketplace
- No redistributing the raw dataset as-is to third parties
- Exclusive listings are sold to a single buyer and delisted on purchase
- Limited listings are sold to a capped number of buyers and delisted once sold out
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