Medicare Pays 14% Less for Female-Anatomy Procedures
An analysis by Jiro Health finds the gap persists across matched Medicare and commercial insurance claims.
Updated on Nov. 5, 2026 in Women’s Health
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Jiro Health released an analysis finding Medicare pays 14% less for female-anatomy surgical procedures than for matched male-anatomy procedures. Commercial insurers paid an average of $167 less per female-anatomy procedure than male-anatomy procedures in 2025 claims.
Why it matters
The findings suggest that payment disparities tied to anatomy are carried forward by commercial insurers rather than corrected, affecting how women's health care is reimbursed across the United States. The analysis does not determine the causes of the gap or its effects on patient access.
The analysis reconstructs a 2025 Journal of Women's Health study using Medicare's fee schedule and finds the average gap rose from $75.73 in 2023 to higher levels in 2025, even after excluding 15 of the original 55 pairs flagged as questionable. The methodology does not explain the underlying cause of the differences.
The players
Jiro Health
A public benefit corporation based in Austin, Texas, that turns healthcare data into actionable intelligence.
The details
Jiro Health, a public benefit corporation that turns healthcare data into actionable intelligence, compared Medicare physician fees, insurers' posted rates, and allowed amounts on claims. The analysis is documented in its full Anatomy of a Payment Gap report.
Timeline
2023: The original study found an average Medicare gap of $75.73 per procedure.
2025: Medicare fee schedule and commercial claims data for the year were analyzed.
November 5, 2026: Jiro Health released its Anatomy of a Payment Gap analysis from Austin, Texas.
Big Picture
Jiro Health reproduced the 2025 Journal of Women's Health study, which compared Medicare fees for female- and male-anatomy procedures, and found the gap has widened in the newer data. The original study's $75.73 average gap from 2023 fees serves as the baseline for the updated comparison.
Readers who receive female-anatomy procedures may encounter lower reimbursement rates from both Medicare and commercial insurers, which can affect out-of-pocket costs and provider availability depending on their coverage. The findings do not establish how these payment differences translate into individual billing outcomes.
The takeaway
The gap in payments between female- and male-anatomy procedures appears in both Medicare and commercial claims, not only in federal fees. Patients and providers reviewing coverage may find it useful to compare the payment rates for procedures tied to their own care.
Further reading
For related coverage, see Women's Health reporting on how payment structures shape care.
More information
Read the full Anatomy of a Payment Gap analysis and methodology from Jiro Health.
Source note: This article includes information reported by Star Local.
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