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June 2014

How to Ensure That Reference Pricing Protects Consumers' Access to Health Care

In reference pricing, a health plan sets a dollar limit on what it will pay for a certain health care service. If a consumer gets that type of care from a provider that charges more than the limit, the consumer is responsible for paying the difference. This strategy can encourage consumers to opt for care from providers that deliver the best care at the best price. But if reference pricing is designed poorly, it risks shifting costs to consumers and hindering access to high-quality care. Our related issue brief, “How to Make Reference Pricing Work for Consumers,” explores reference pricing in more depth.