Moab and Grand County · Hospital bills
Why Does My Moab Hospital Bill Cost More on Medicare?
If you had an outpatient test or procedure at Moab Regional Hospital and your share looked bigger than you expected, you're not imagining it. Small rural hospitals like ours are paid under a different Medicare rule, and that rule changes how your 20% is figured. Here's how it works and which coverage absorbs it.
The short answer
- Moab Regional is a critical access hospital. So are San Juan Hospital in Monticello and Blue Mountain Hospital in Blanding.
- For outpatient care there, your 20% is usually based on the hospital's charges, not Medicare's lower rate.
- No ceiling. Elsewhere, one outpatient service's coinsurance is capped at $1,736 in 2026. Here it isn't.
- A Medigap plan pays it. With no supplement, you're billed directly. Advantage plans use their own copays and network.
Two rules that make the difference
Congress created critical access hospitals so towns like Moab would keep a hospital at all. They have 25 beds or fewer, and Medicare pays them based on their actual costs instead of the fixed rates big hospitals get. CMS's hospital data lists Moab Regional Hospital as one, and the hospital calls itself "a 17-bed not-for-profit Critical Access Hospital."
That payment system is good for keeping the doors open. It also changes your side of the bill in two ways:
- The 20% is figured on charges. MedPAC, the commission that advises Congress on Medicare, wrote in June 2025: "For most outpatient services, CAH coinsurance is set at 20 percent of charges." Charges are a hospital's list prices. They're almost always higher than what Medicare actually pays.
- The usual ceiling doesn't apply. Medicare.gov's outpatient page says that in most cases the copayment for one service "can't be more than the Part A deductible," then adds: at a critical access hospital, "your copayment may be higher and may exceed the Part A deductible." CMS's booklet for these hospitals confirms it doesn't limit the 20% by the inpatient deductible.
| Original Medicare, 2026 | Moab Regional (critical access) | A large hospital, like St. Mary's in Grand Junction |
|---|---|---|
| What the 20% is figured on | The hospital's charges (its list price) | Medicare's approved payment rate |
| Ceiling on one outpatient service | None | The Part A deductible, $1,736 in 2026 |
| Inpatient stay (admitted) | Part A deductible, $1,736 | Part A deductible, $1,736 |
| Who covers the 20% | Medigap, Medicaid or retiree coverage, if you have it | Same |
Sources: Medicare.gov, CMS MLN006400, MedPAC, CMS 2026 figures. Critical access hospitals are limited to 25 beds, so a regional hospital the size of St. Mary's is paid under the standard outpatient system.
Notice the third row. If you're admitted as an inpatient, the Part A deductible is the same everywhere. This is an outpatient issue: emergency room visits where you go home, imaging, outpatient surgery, infusions and injections.
How big the difference gets
Here's a made-up example to show the math, not a Moab Regional price. Say an outpatient procedure carries a hospital charge of $20,000. At a critical access hospital, 20% of that is $4,000. At a large hospital, your coinsurance would be 20% of Medicare's approved amount, and it couldn't go above $1,736 in 2026 no matter what.
The real-world numbers are just as striking:
- In 2022, patient cost sharing averaged 52% of all Medicare payments for outpatient care at critical access hospitals, according to MedPAC. For some services it equaled 100%.
- About 200,000 outpatient line items that year had coinsurance above the cap that applies at other hospitals. The most common were orthopedic surgeries, like knee replacements, and Part B drug injections. A cap would have cut those bills by about $2,000 per line item on average.
- The HHS Inspector General found in 2014 that for 10 common outpatient services, patients at these hospitals paid 2 to 6 times the coinsurance they'd have paid at other hospitals.
None of this is something Moab Regional chose. It's how federal law pays every critical access hospital in the country. CMS encourages these hospitals to help patients understand their charges ahead of time, so ask for an estimate before anything planned.
Not sure what your coverage does with that 20%?
We'll look at your plan and show you what a Moab Regional outpatient bill would cost you under it, compared with a Medigap plan or one of the Grand County plans we offer. Free, by phone or at our Moab office, no pressure.
Book a call →Who actually pays the 20%
MedPAC estimates that about 84% of rural people on Original Medicare have some supplemental coverage, such as Medigap, Medicaid or a retiree plan. The other 16% are "directly billed 20 percent of charges." Which group you're in decides how much this rule matters to you.
- Medigap. The 20% is Part B coinsurance, and every standard Medigap plan pays at least part of it, per Medicare.gov's Medigap chart. Plans A, B, C, D, F, G, M and N pay it in full. Plan N adds small copays for office and ER visits, and Plans K and L pay 50% and 75%. With Plan G, a big outpatient bill at Moab Regional costs you the $283 Part B deductible once a year, and that's it. MedPAC does note that supplement premiums can run higher in states with many critical access hospitals, since insurers pay these bills too.
- Medicare Advantage. Your plan's copays apply instead of 20% of charges, and the plan's yearly out-of-pocket maximum caps the total. CMS's 2027 landscape lists 12 general Advantage plans in Grand County, six from UnitedHealthcare and six from Humana, with in-network maximums from $4,900 to $9,150. Check whether Moab Regional is in the plan's network for 2027 before you choose. Open enrollment ends December 7.
- Original Medicare alone. This is the group the rule hits hardest. If that's you, ask for an estimate before any planned outpatient service, and ask the hospital about financial assistance if a bill is already in hand.
What this means if you're choosing coverage in southeast Utah
For most of Grand and San Juan counties, the closest hospital is a critical access hospital. That's Moab Regional for Moab and Castle Valley families, and San Juan Hospital or Blue Mountain Hospital for Monticello and Blanding. So the rule isn't an occasional surprise here. It's the default for every outpatient visit close to home. That's one more reason a Medigap plan carries extra weight in this corner of Utah. It's also why I'd never tell someone to drive two hours to Grand Junction for an emergency to save on coinsurance. Go to the nearest ER, and let your coverage handle the bill.
A fix has been proposed. In June 2025, MedPAC voted 17 to 0 to recommend that Congress base critical access hospital coinsurance on Medicare's payment and cap it at the inpatient deductible. As of Vermont Public's reporting in May 2026, Congress hadn't acted, largely because of the cost. I'd plan as if today's rule stays in place.
If you're comparing Medigap letters, see Plan G vs. Plan N in Utah, and the Utah birthday rule if you already have a supplement and want to switch. For a Moab hospital stay that turns into rehab, see Medicare and swing beds in Moab. I've been helping people with Medicare for more than 22 years. In a town with one small hospital, how your coverage handles that hospital's bills is one of the first things I'd check.
How we know all this: the Medicare On Main Data Desk frames every article with public data. Here that means Medicare.gov's outpatient hospital and Medigap pages, CMS's December 2025 booklet for critical access hospitals, MedPAC's June 2025 report to Congress, the HHS Inspector General's 2014 report, CMS's hospital data and 2026 cost figures, CMS's 2027 Medicare Advantage landscape files, Moab Regional Hospital's website and Vermont Public's May 2026 reporting, all read October 26, 2026. The $20,000 example is an illustration, not a price from any hospital. Hospital and carrier names are factual reporting, not endorsement. This is education, not advice. Compare plans with a licensed agent or Medicare.gov. We take no payment from any carrier to feature a plan.
Frequently asked questions
Why is my coinsurance so high at a critical access hospital?
Because of how Medicare sets it. At a critical access hospital, your 20% outpatient coinsurance is usually figured on the hospital's charges, its list prices, not on Medicare's lower payment rate. And there's no ceiling. At most other hospitals, the coinsurance for one outpatient service can't be more than the Part A deductible ($1,736 in 2026). MedPAC found that in 2022, patient cost sharing averaged 52% of all Medicare payments for outpatient care at these hospitals.
Is Moab Regional Hospital a critical access hospital?
Yes. CMS's hospital data lists Moab Regional Hospital as a critical access hospital, and the hospital describes itself as "a 17-bed not-for-profit Critical Access Hospital." San Juan Hospital in Monticello and Blue Mountain Hospital in Blanding are critical access hospitals too. The coinsurance rule applies to outpatient services at all three.
Does Medigap cover critical access hospital coinsurance?
Yes. The 20% is Part B coinsurance, and Medigap Plans A, B, C, D, F, G, M and N pay it (Plan N with copays of up to $20 for some office visits and up to $50 for an emergency room visit that doesn't lead to admission). Plan K pays 50% and Plan L pays 75%, up to their yearly limits. With Plan G, you'd pay the Part B deductible ($283 in 2026) and Medigap pays the rest of the coinsurance, whatever the charge.
Is there a cap on Medicare outpatient coinsurance?
At most hospitals, yes: Medicare.gov says the copayment for each outpatient service usually can't be more than the Part A deductible. At a critical access hospital, Medicare.gov says your copayment "may be higher and may exceed the Part A deductible." Original Medicare has no yearly out-of-pocket cap either way. Medicare Advantage plans do have a yearly in-network maximum.
Should I go to Grand Junction instead of Moab for outpatient care?
For emergencies, no. Go to the nearest hospital. For a planned procedure, it depends on your coverage. If you have a Medigap plan that pays Part B coinsurance, the rule hardly changes your cost, and staying close to home is worth a lot. If you have Original Medicare with no supplement, ask both hospitals for an estimate first. If you have a Medicare Advantage plan, your plan's copay and network decide it, not this rule.
Sources
- Medicare.gov — Outpatient hospital services: the Part A deductible ceiling and the critical access exception.
- CMS MLN006400 — Information for Critical Access Hospitals (December 2025): cost-based payment; no cap on the 20%.
- MedPAC — June 2025 Report, Chapter 7: Reducing beneficiary cost sharing for outpatient services at critical access hospitals: 20% of charges, the 52% figure, 200,000 line items, 84% / 16%, the recommendation.
- HHS-OIG — Medicare Beneficiaries Paid Nearly Half of the Costs for Outpatient Services at Critical Access Hospitals (OEI-05-12-00085, 2014): 2 to 6 times the coinsurance.
- Vermont Public / NEPM — If you're on Medicare, Vermont's smallest hospitals could land you with the largest bills (May 2026): no federal fix as of May 2026.
- CMS — Hospital General Information (Provider Data Catalog); Moab Regional Hospital: critical access status.
- Medicare.gov — Compare Medigap plan benefits: which plans pay Part B coinsurance.
- CMS — 2026 Medicare Parts A and B premiums and deductibles fact sheet: $1,736 Part A and $283 Part B deductibles.
- CMS — CY2027 Medicare Advantage and Part D landscape files (September 2026, ZIP): 12 general Grand County Advantage plans for 2027.
