Price transparency is currently a hot topic in the health insurance industry and rightfully so. Consider this, when you are buying bread at the store you compare the various brands, types of bread and the price of each and base your decision on those factors. When planning a vacation you may compare the amenities, reviews and price of different hotels before booking your stay. However, when you need medical treatment you don’t know the cost until after the service is rendered. The Transparency in Coverage Rule aims to change that.
The goal of price transparency in health care is to help consumers know the cost of a covered item or service before receiving care, therefore allowing them to make informed health care decisions. There will be three phases to the Transparency in Coverage Rule. The first phase became effective on July 1, 2022. Insurance carriers and self-funded plan sponsors were required to publish machine-readable files with information on negotiated rates and allowed amounts. These files are not intended for consumer use due to the file size and format but they help lay the groundwork for Phases 2 & 3. Researchers and developers will use this data in the machine-readable files to create price comparisons that will help people choose the care that’s right for them.
Phases 2 & 3 are when this information will become useful to the consumer. As of January 1, 2023, carriers and self-funded plan sponsors must provide a user-friendly online price comparison tool for 500 covered services. Then on January 1, 2024, this online tool must provide cost-share estimates for ALL covered services. This means that consumers will no longer be in the dark about the cost of health care, rather they will have access to personalized, real-time, cost-share estimates for covered services and pharmacy before seeking treatment.
This positive step forward with informing the public on the costs of their healthcare services will be most beneficial when it gets tapped into. We strongly encourage that when this online tool is made available, it be used to make informed selection of plans, services, and health care providers.
Our ComPro Team is here to provide help with any questions you may have regarding price transparency and the phases of its implementation. Just give us a call at 402-488-5100. ComPro offers health insurance plans for Employee Benefits, Individual & Family and Medicare. We are your trusted, local resource for health insurance!
By Kayla Northup – Location Manager, MGA, Agent