The changes focus largely on the way pricing information is organized, published and provided to consumers. They also introduce new accountability requirements for insurers and expand access to personalized cost estimates, including for people who cannot or do not use online comparison tools.
Pricing Files Will Become More Standardized and Easier To Use
Health plans and insurance issuers are already required to publish machine-readable files containing negotiated prices for in-network doctors, hospitals and other providers, along with historical information on out-of-network allowed amounts. Those files can contain millions of entries and have often been difficult for consumers, employers and researchers to analyze.
According to the U.S. Department of Labor, the new regulations will standardize how that information is published, remove unnecessary or irrelevant data and organize the files in a more consistent format. Reporting will also move from monthly to quarterly, reducing how often plans must produce the pricing files.
The rules require insurers and health plans to attest that the information they publish is true, accurate and complete to the best of their knowledge. Each file must identify the CEO, president or another senior official responsible for overseeing its accuracy.
At an HHS event announcing the changes, Secretary Robert F. Kennedy Jr. said the revisions would reduce the size of pricing data files by 70 percent. Peter Nelson, deputy administrator and director of the Center for Consumer Information and Insurance Oversight, said the existing files had become so large and repetitive that processing them could require extensive computing resources.
The administration says the more standardized files are intended to help employers compare provider networks, allow researchers to examine health care markets and enable developers to build consumer-facing price comparison tools.
According to CMS, earlier federal hospital and health plan transparency requirements were followed by an annual 6.3 percent decline among the top 25 percent of the most expensive health care service prices.
Patients Will Be Able To Request Cost Estimates by Phone
The regulations also change how consumers can obtain personalized information about their expected medical expenses. Health plans already provide cost-sharing estimates through online tools and, when requested, on paper.
Under the finalized rules, the same information must also be available by telephone. Consumers will be able to contact their health plan and request an estimate showing how much their insurance is expected to cover and what portion they may have to pay themselves.
The information is intended to help people understand deductibles, copayments and coinsurance before undergoing treatment. According to Newsweek, financial adviser Kevin Thompson said greater transparency could benefit consumers but warned that large amounts of pricing information may still be difficult for the average person to interpret.
The government is also preparing a separate pricing disclosure system for prescription drugs. HHS said development of the initial Prescription Drug File schema is expected to begin in November 2026 and be finalized around May 2027. Plans and insurers are expected to begin publishing those files using the new format in December 2027, with monthly reporting after that point.
The final rules build on Transparency in Coverage regulations adopted during President Donald Trump’s first term and on requirements that began taking effect in 2021. Their focus is now shifting from simply making pricing data public toward making that information more consistent, accessible and usable before patients receive care.
