Federal rules aim to make health plan prices easier to compare
The Trump administration on Monday finalized rules that make health insurers post smaller, cleaner price files. Plans must also give members personal cost estimates by phone, and the files will update every three months instead of monthly. The FTC also warned 24 large health systems about incomplete hospital price data.
Health insurers will have to post price data that is easier to use under rules finalized Monday by HHS, the Labor Department and the Treasury. "Americans should know what their healthcare will cost before they receive it," Health Secretary Robert F. Kennedy Jr. said.
Here is what changes for patients. Insurers and employer plans must give members their personal cost-sharing estimates by phone, not just online or on paper. That part applies to plan years starting on or after Jan. 1, 2027.
Most of the rule fixes the data behind price-shopping apps. Since 2022, plans have posted huge files of negotiated prices every month. Those files were often hard to find and so large they were hard to use, Fierce Healthcare reports. Many included "ghost rates," prices for services a provider would never perform. CMS gives the example of podiatrists listed with rates for heart surgery. Plans must now drop those.
Plans will also post one file per network instead of one per plan, add data on out-of-network payments and update the files every three months instead of monthly. A senior executive must sign off that the data is true and complete. CMS estimates the changes will save plans about $174.5 million a year. New price-file rules take effect five months after publication; new background files follow after 11 months.
Employers cheered. "There are not a lot of wins in health policy, and we think this is a big one," said Elizabeth Mitchell, who leads the Purchaser Business Group on Health. Its members are large employers that buy coverage for workers.
Hospitals got a warning too. The Federal Trade Commission sent warning letters to 24 large health systems over incomplete or inaccurate price postings, Fierce reported.
Here's the history. The first price transparency rules came in President Trump's first term, with insurer files required starting July 2022. A planned file for prescription drug prices never took effect. The agencies now plan to design that file starting in November, with plans posting it from December 2027.
What we know: The rules are final, and phone cost estimates start with 2027 plan years.
What we don't: Whether easier data will actually lower what patients pay.
Where outlets agree HHS and Fierce Healthcare both report the rules move insurer price files from monthly to quarterly updates and require personalized cost estimates by phone.
Where they differ An AP summary described the rule as requiring monthly files, but the CMS fact sheet says in-network and out-of-network files shift to quarterly updates.