By NextBestFitOther professional services
Physical therapy, mental-health counseling, optometry. A quarter of today's out-of-pocket spending in this category (elective chiropractic, massage, and therapy beyond clinical-necessity limits) stays out of pocket. Mental-health and therapy demand is highly price-sensitive, so utilization rises 15%.
Result
$209.4B
$184.9B → $209.4B
Per resident, per year
$614
÷ 341.1M people
Per household
$1,584
÷ 132.2M households
Range
$195.6B–$238.6B
Lean and costly scenarios.
How it's calculated
| # | Step | Arithmetic | Value |
|---|---|---|---|
| 1 | 2024 spending on this service (CMS NHE Table 4) Sources: CMS Office of the Actuary (2025) | $184.9B | |
| 2 | Private health insurance paid $57.3B at 1.30× the reference price → volume Sources: CMS Office of the Actuary (2025) | $57.3B ÷ 1.30× | $44.1B |
| 3 | Medicare paid $47.5B at 1.00× the reference price → volume Sources: CMS Office of the Actuary (2025) | $47.5B ÷ 1.00× | $47.5B |
| 4 | Medicaid paid $17.1B at 0.75× the reference price → volume Sources: CMS Office of the Actuary (2025) | $17.1B ÷ 0.75× | $22.8B |
| 5 | Out-of-pocket spending in 2024 Sources: CMS Office of the Actuary (2025) | $44.8B | |
| 6 | Stays out of pocket (items UHP excludes: 25%) | $44.8B × 25% | $11.2B |
| 7 | Covered out-of-pocket converted to reference-price volume | ($44.8B − $11.2B) ÷ 1.20× | $28.0B |
| 8 | Care UHP takes over, valued at 2024 prices | $155.5B | |
| 9 | Same care valued at the reference price (Medicare fee schedule) | $142.4B | |
| 10 | Re-priced at UHP rate 1.10× | $142.4B × 1.10× | $156.6B |
| 11 | Price effect (same care, new prices) | $156.6B − $155.5B | $1.1B |
| 12 | Utilization multiplier 1.15× | $156.6B × 1.15× | $180.1B |
| 13 | Utilization effect (more care) | $180.1B − $156.6B | $23.5B |
| 14 | UHP spending on this service | $180.1B | |
| 15 | Plus spending that stays out of pocket | $11.2B | |
| 16 | Plus Other insurance programs (CHIP, DoD, VA) (continues unchanged) | $0.8B | |
| 17 | Plus Other third-party payers & programs (continues unchanged) | $17.3B | |
| 18 | Total national spending on this service under the plan | $180.1B + $11.2B + $18.1B | $209.4B |
| 19 | Change from 2024 | $209.4B − $184.9B | $24.5B |
Trade-off: Prices rise $1.1B (to raise access or wages) and patients receive $23.5B more care.