Use of Pricing Information Published under the Transparency in Coverage Final Rule
This information belongs to the public
What information is being made public? How can it be accessed?
Beginning July 1, 2022, most group health plans and issuers of group or individual health insurance coverage are required to disclose, on a public website, machine-readable files containing in-network rates for covered items and services, and allowed amounts and historical billed charges for out-of-network providers. Specific technology may be needed to download and read these files given their size and complexity.
The Departments of Health and Human Services, Labor, and the Treasury envision that third-party developers and other entities will download, process, and compile this data, creating more advanced price transparency tools that will help consumers shop among plans and providers, as well as giving the broader public information on patterns in health care costs and generate opportunities for innovation. Thus, a key aspect of the Transparency in Coverage final rule is to make health care pricing information more accessible and useful to consumers by making the information available to persons and entities with the requisite experience and expertise to assist individual consumers and other health care purchasers to make informed health care decisions.
How can the machine-readable files be used?
Making pricing information publicly available strengthens the work of health care stakeholders that provide care, promote access to care, or otherwise aim to protect consumers and the health care system. These entities include researchers, regulators, lawmakers, patient and consumer advocates, and businesses that provide consumer support tools and services.
With information on pricing, these health care stakeholders can better fulfill each of the unique roles they play to improve America's health care system for consumers. For example, with pricing information, researchers can better assess the cost-effectiveness of various treatments; state regulators can better review issuers' proposed rate increases; patient advocates can better help guide patients through care plans; employers can adopt incentives for consumers to choose more cost-effective care; and entrepreneurs can develop tools that help doctors better engage with patients.
Where can I find the machine-readable files?
The Transparency in Coverage final rules require plans and issuers to make available the machine- readable files on their websites, but the Departments play no active role in publishing the files.
If you’re not able to easily find a plan’s machine-readable file on the plan’s website, we recommend that you use an internet-based search engine and search for key words associated with the required disclosures, including (but not limited to) “machine readable files,” “transparency in coverage,” “in- network rates,” and “out-of-network allowed amounts,” along with the plan’s or issuer’s name.
If you are still unable to find a plan’s or issuer’s machine-readable files, please consider contacting the plan or issuer directly to ask them about the location of the required disclosures. If the plan or issuer is unable to direct you to the location of the required disclosures, you may inform CMS of these circumstances by navigating to the Contact Us page and submitting a complaint.