The Centers for Medicare & Medicaid Services (CMS) issued a proposed rule on Friday that would require health insurers to make pricing and cost-sharing information available to the public.
If finalized, the “Transparency in Coverage” proposed rule would require health insurance issuers that offer group and individual coverage to disclose price and cost-sharing information to participants, beneficiaries, and enrollees before they receive services. The information would provide members with accurate estimates of any out-of-pocket costs that they must pay to meet their plan’s deductible, co-pay, or co-insurance requirements.
The proposal aims to empower consumers to shop and compare costs between specific providers before they receive care.
The propped rule would require health plans to:
- Give members real-time, personalized access to cost-sharing information, including an estimate of their cost-sharing liability for all covered health care items and services, through an online tool that most group health plans and health insurance issuers would be required to make available to all their members, and in paper form, at the consumer's request.
- Disclose on a public website their negotiated rates for in-network providers and allowed amounts paid for out-of-network providers. This information is intended to drive innovation, support informed, price-conscious decision-making, and promote competition in the health care industry.
This information will not only directly help patients, but will also create new opportunities for researchers, employers, and other developers to build new tools to help consumers, the Department of Health and Human Services (HHS) said in an announcement.
The proposed rule also aims to encourage health insurance issuers to offer new or different plan designs that provide incentives to consumers to shop for services from lower-cost, higher-value providers by allowing issuers to take credit for "shared savings" payments in their medical loss ratio (MLR) calculations.
The agency is seeking comment within the next 60 days on the proposed rule, as well as additional efforts to improve price and quality transparency.
In addition to the proposed rule, HHS announced on Friday it finalized a rule that requires hospitals to provide patients upon demand and online with information about their standard charges for items and services.
The actions will help shine a light on the costs of American health care, said HHS Secretary Alex Azar in the announcement. "Today's transparency announcement may be a more significant change to American health care markets than any other single thing we've done," he said.
CMS Administrator Seema Verma said both the final rule and the proposed rule will help to reduce overall health care costs. “Today's rules usher in a new era that upends the status quo to empower patients and put them first,” she said in the announcement.