How to Get the Most Out of Transparency in Coverage
For too long, Americans have been in the dark about the cost of their health care until they receive a bill. The Transparency in Coverage requirements will empower consumers to shop and compare costs among various providers before receiving care. Because consumers have an important role to play in controlling health care costs, consumers must have meaningful information to generate the market forces necessary to achieve lower health care costs and reduce spending.
As of January 1, 2023, plans and issuers must make price comparison information available with respect to an initial list of 500 identified items and services. By January 1, 2024, plans and issuers must make price comparison information available with respect to all covered items and services. This information must be made available through an internet-based self-service tool and in paper form, upon request. Typically, consumers receive an Explanation of Benefits after receiving care, which details the prices charged by the provider, the plan’s contracted or negotiated rates, consumer cost-sharing obligations, and other information. Consumers will have access to this type of information before receiving care and can use it to compare prices and better estimate potential out-of-pocket costs.
See Public Data for information on the disclosure of rate data in machine-readable files that plans and issuers began disclosing as of July 1, 2022.