Analysis of Medicare Final Payment Rates in Vermonttechnical_reportsUnder Vermont’s recently enacted Act 68 of 2025, the Green Mountain Care Board (GMCB) is directed to establish reference-based price caps for hospitals “based on a percentage of the Medicare reimbursement for the same or a similar item or service or on another benchmark, as appropriate.” Act 68 grants the GMCB the authority to determine how these price caps are structured, in consultation with health care stakeholders. Other states, including Oregon and Washington, have adopted Medicare-based price caps that benchmark commercial payments to what Medicare would have paid for the same service if the patient were a Medicare beneficiary. In both states, benchmarks are based on the final Medicare payment amount, including the base payment and all applicable add-ons and adjustments. Consistent with this approach, our analysis uses hospital data and Medicare payment formulas to compare final Medicare payments at Vermont prospective payment system (PPS) hospitals with those at PPS hospitals nationally for a standardized inpatient admission. We find that average Medicare inpatient payments to PPS hospitals in Vermont—excluding critical access hospitals (CAHs)—exceed the national average, ranking 9th among 49 states and Washington, D.C. These higher payment rates are largely driven by Vermont PPS hospitals receiving greater add-on payments and adjustments than hospitals in other states. This memo was produced by economists at the Center for Advancing Health Policy through Research (CAHPR) at the Brown University School of Public Health. CAHPR is a nonpartisan center dedicated to generating research that informs policies aimed at reducing costs, improving patient well-being, and driving meaningful transformations in U.S. health care delivery.Murray, RoslynAuthorHostert, NathanAuthorWhaley, ChristopherAuthor2026MedicareVermontPayment RatesPolicy BriefAll rights reservedIn CopyrightAll Rights Reserved10.26300/znvb-zr26