Last week, the Trump administration revamped regulations intended to increase health care transparency.
“Greater transparency drives competition, reduces price disparities and helps lower health care costs, a key priority for the Trump administration,” Dr. Mehmet Oz, administrator of the Centers for Medicare & Medicaid Services, said in a statement.
At the heart of this rule is a simple idea: People should know what their health insurance will cover and what they will need to pay before receiving medical care, not after the bill arrives.”
Under the 2020 Transparency in Coverage final rules, non-grandfathered group health plans and health insurance issuers offering non-grandfathered group or individual coverage are required to post machine-readable files monthly for each plan or coverage they offer.
However, internal assessment and external stakeholder feedback has identified three main barriers to fully achieving these objectives:
- Inaccessibility because of the large size of the machine-readable files
- Data ambiguity because of lack of contextual information along with the raw data
- Areas of misalignment that make comparing data across disclosures challenging
The new rules will require health insurance companies to publish cleaned-up spreadsheets of the prices that they pay hospitals and doctors while stripping out meaningless data.
In addition, the regulations attempt to improve underlying pricing data by providing more context about in-network prices, increasing available out-of-network pricing information and strengthening accountability for the completeness and accuracy of published data, according to a fact sheet from the U.S. Department of Health and Human Services.
Reporting frequency for pricing information will change from monthly to quarterly, maintaining meaningful transparency while lowering administrative burden.
The rules also require group health plans and health insurance issuers to provide consumers with personalized cost-sharing information by phone, in addition to existing online tools.
“The biggest change here is accountability,” financial expert Michal Ryan told Newsweek. “Insurers have technically been disclosing prices for years, but much of it was so bloated and messy that it wasn’t particularly useful.”
Administration officials also said they will start developing a system for disclosing prescription drug prices next month with a target date of next May for a final drug pricing data plan.
Health plans and issuers will be expected to publish their prescription drug files using this system starting in December 2027, followed by monthly reports.
“Americans should know what their health care will cost before they receive it,” HHS Secretary Robert F. Kennedy Jr. said. “President Trump directed us to bring real price transparency to health care, and HHS is delivering. These rules give patients clearer, more reliable information to compare costs, understand their coverage and make informed decisions before they receive care.”