Houston: America's Medicare Capital

Published February 2026 · 10 min read

The Numbers

Houston isn't just the largest city in Texas. It's the Medicare capital of the United States — and it's not particularly close.

That per-provider average of $463.8K is well above the national average — meaning Houston providers don't just outnumber other cities, they bill more per person too.

Why Houston?

Three factors converge to make Houston the Medicare capital:

1. The Texas Medical Center: The largest medical complex in the world. 106,000 employees. 10 million patient encounters per year. It houses MD Anderson Cancer Center (the #1 cancer hospital), Methodist Hospital, Baylor College of Medicine, and dozens more. No other city has anything comparable.

2. Demographics: Houston is America's 4th-largest city with a large and growing elderly population. Harris County alone has over 500,000 Medicare beneficiaries. The surrounding metro area adds hundreds of thousands more.

3. Specialty concentration: The Texas Medical Center attracts high-billing specialties — oncology, cardiology, orthopedics, transplant surgery. These specialties generate far more Medicare revenue per provider than primary care.

The Top 20 Medicare Cities

Here's how the nation's top cities compare:

The Per-Provider Story

Raw spending totals are partly a function of city size. The more revealing metric is spending per provider. Some smaller cities punch well above their weight:

Cities with major academic medical centers or specialty hospitals tend to have higher per-provider averages — reflecting the concentration of expensive specialty care. Cities dominated by primary care and family medicine show lower per-provider spending but may actually deliver more cost-effective care.

The Markup Puzzle

Houston's markup ratio of 4.4x means providers charge 4.4 times what Medicare actually pays. This is above the national average but not the highest among major cities — some cities show markup ratios above 5x.

High markup ratios don't necessarily indicate fraud or waste. They can reflect specialty mix (surgeons charge higher multiples than internists), local market dynamics with private insurers, and the general chargemaster inflation that pervades American healthcare.

What It Means

Houston's dominance isn't surprising once you understand the Texas Medical Center effect. But it does raise important questions:

• Is the concentration of spending in a few cities efficient, or does it create geographic inequality in care access?
• Are Houston's higher per-provider payments justified by complexity and specialty mix?
• Should Medicare adjust payments more aggressively for regional cost differences?

One thing is clear: if you want to follow the Medicare money, start in Houston.