Price Transparency and Variation in U.S. Health Services

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. However, ongoing litigation challenging the constitutionality of the Affordable Care Act (ACA) and the price transparency rule aimed at hospitals could affect the implementation and impact of these new rules. 

This brief summarizes the key requirements for hospitals, insurers, and self-funded employer plans under the new price transparency rules.