A new issue brief summarizes the key requirements for hospitals, insurers, and self-funded employer plans under new federal price transparency rules. As of January 1, 2021, hospitals are required to make payer-negotiated rates for common services available to consumers on an online tool, and for all services in a machine-readable file. A second rule requires insurers in the individual and group markets and self-funded employer plans to make rates and individualized cost-sharing estimates for certain common services available to enrollees by January 1, 2023, and for all services by the following year.
In addition to examining how the new transparency rules may affect patient decision-making, the brief considers their impact on market pricing, including the significant geographic variation in prices for common health services.
The issue brief is available in full on the Peterson-KFF Health System Tracker, an online information hub dedicated to monitoring and assessing the performance of the U.S. health system.