The U.S. Department of Health and Human Services (HHS) finalized new regulations Monday aimed at making healthcare pricing and coverage information easier to find, compare, and verify.
The rules, issued through the Centers for Medicare & Medicaid Services in partnership with the Departments of Labor and the Treasury, update the existing Transparency in Coverage requirements, according to a press release.
What The New Rules Require
The final rules reduce duplicative pricing data, add more context around in-network prices, expand out-of-network pricing information, and strengthen accountability for data accuracy. Reporting frequency for pricing information will shift from monthly to quarterly. Group health plans and insurers will also be required to provide consumers with personalized cost-sharing information by phone, in addition to existing online tools.
“Americans should know what their healthcare will cost before they receive it,” said Robert F. Kennedy Jr., U.S. Secretary of Health and Human Services. He added that President Donald Trump directed the agency to bring real price transparency to healthcare. “These rules give patients clearer, more reliable information to compare costs, understand their coverage, and make informed decisions before they receive care,” said Kennedy Jr.
CMS Administrator Dr. Mehmet Oz framed the rule around a simple principle. “At the heart of this rule is a simple idea: People should know what their health insurance will cover and what they will need to pay before receiving medical care, not after the bill arrives,” Oz said.
Other officials echoed that message from their own departments. Secretary of Labor Keith Sonderling said the rules “will enhance the Transparency in Coverage files already in existence.” FTC Chairman Andrew Ferguson called healthcare price transparency “common sense,” while Deputy Secretary of the Treasury Francis Brooke said the rule would help Americans “understand the cost of their health care coverage.”
The Departments intend to start developing an initial schema for a Prescription Drug File in November, with plans and issuers expected to publish using it starting December 2027.
Part Of A Broader Enforcement Push
The rules build on an administration effort that has already pressed hundreds of hospitals to post accurate prices, with regulators warning of penalties up to $2 million annually for noncompliant facilities. Billionaire entrepreneur Mark Cuban has separately argued that transparent pricing is the clearest way for consumers to know whether they’re being overcharged.
Insurers React
The new reporting requirements directly affect major health insurers, which must comply with the updated Transparency in Coverage rules. In after-hours trading, the Cigna Group Inc. (NYSE:CI) was down 0.085% to $271.06, UnitedHealth Group Inc. (NYSE:UNH) was down 0.16% to $377.97, and CVS Health Inc. (NYSE: CVS) was up 0.06% to $87.06, according to Benzinga Pro data.
Disclaimer: This content was partially produced with the help of AI tools and was reviewed and published by Benzinga editors.
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