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 after they obtain services and receive a bill. These requirements will empower consumers to shop and compare costs between specific providers before receiving care. Consumers have an important role to play in controlling costs, but consumers must have meaningful information in order to create the market forces necessary to achieve lower health care costs.
Review the Data
By January 1, 2023, plans and issuers must provide information on the costs of 500 common items and services to start with, and by January 1, 2024, every covered item and service. Typically, consumers receive an Explanation of Benefits after receiving care, which details the price charged by the provider, contracted or negotiated rate, and consumer cost sharing. Now, consumers will be able to receive this type of information before receiving care and use it to compare prices and better estimate potential out-of-pocket costs.
Learn before receiving care what potential out-of-pocket costs to expect for health care items and services. You can use an online tool, or request information in paper form from your health plan or coverage before receiving care.
When plans and issuers make their costs available online, consumers are given the power of price comparison. In addition to the self-service tool and machine-readable files from plans and issuers, third party developers may also create price transparency tools. Use this information to select the plans, services, and health care providers that work best for you.