RBP Rate Calculator

What is reference-based pricing?

Reference-based pricing (RBP) is a plan-design strategy where the employer pays hospitals a multiple of Medicare's allowed amount for each procedure, rather than accepting the hospital's negotiated rate with the insurance carrier. The “reference” is Medicare.

How common is it?

An estimated 7% of self-funded employers currently use reference-based pricing (Lockton 2026 National Benefits Survey). Adoption is growing, and interest is rising sharply: 54% of employers now name cost reduction as their top benefits priority, up from 38% in 2025. RBP designs are most often adopted by employers who want transparent, predictable savings — and who can absorb some friction with hospitals in exchange.

What target multiple of Medicare is typical?

RBP designs typically target the following ranges as a percent of Medicare:

Standard outpatient services (office visits, basic imaging, routine labs): 140–170%
Hospital-intensive procedures (inpatient stays, outpatient surgery, advanced imaging): 160–220%
Specialty drugs and high-cost implant procedures: 200–300%

Who helps design and implement RBP?

This kind of plan design is typically structured by your benefits consultant or broker, and administered by a TPA with reference-based pricing expertise.

What do I do next?

After using the calculator, the next step depends on what you see. If the calculator suggests an RBP target your employees would likely have access to at most hospitals, discuss it with your benefits consultant or TPA. If the target shows high risk (most hospitals would reject), you may need to either raise the target, narrow it to specific service lines, or pair RBP with a balance-billing protection arrangement.