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Final Rule on Health Care Price Transparency Requires Private Health Insurance Plans to Reveal Prices

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A final rule on health care price transparency, issued in October 2020 by the Centers for Medicare and Medicaid Services (CMS), along with the Departments of Labor and the Treasury, will require most private health insurance plans to both provide personalized cost-sharing information to patients and publicly report negotiated prices for specific health care services.

Beginning on January 1, 2023, health plans will be required to provide their members with an online tool that will allow them to view these negotiated rates, as well as a personalized estimate of what they could expect to pay out of pocket for 500 of the most “shoppable” health care services (eg, common laboratory tests, outpatient visits, and nonurgent procedures).

By January 1, 2024, these shopping tools must report this cost information for all health care services. These new requirements are the culmination of multiple steps outlined in a 2019 executive order to create more transparency in health care, portions of which have faced legal challenges.

A JAMA Network article writes the prospect of these timely, personalized estimates of patients’ out-of-pocket health care costs can assist patients and clinicians in achieving greater value. While the provision of prices is essential, additional steps are necessary to ensure that this new policy translates into meaningful uptake, more efficient care delivery, and, most importantly, improved patient-centered outcomes.

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