The administration under President Trump has revamped the regulations that compel health insurers to reveal the amounts they negotiate with hospitals, physician practices, and other medical providers. These updated rules aim to present the cost information in a clearer, more accessible manner for the public. Since the “Transparency in Coverage” (TiC) provisions began in 2022, the majority of insurers and employer-sponsored health plans have been posting their negotiated figures on a monthly basis.
Experts note that, despite the availability of the data, the files are often cumbersome and vague, making them hard to interpret even for seasoned analysts. The complexity of the spreadsheets hampers consumers’ ability to make well-informed health-care choices.
Changes to the Transparency in Coverage Rules
On Monday, the Departments of Health and Human Services, Labor, and Treasury released a final rule intended to close loopholes in the price-transparency framework. The amendment eliminates superfluous entries, standardizes the format of the data files, and tightens insurer accountability. CMS Administrator Dr. Mehmet Oz said in a statement, “Greater transparency drives competition, reduces price disparities, and helps lower healthcare costs, a key priority for the Trump Administration.”
Under the new rule, insurers may cease reporting “ghost” rates—prices for services that a provider would never perform. Companies can also apply their own internal criteria to determine which price points to omit, provided they attach an explanatory file detailing the excluded provider-service pairings.
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The regulation further mandates that in-network rates be expressed as a specific dollar amount rather than a vague percentage or estimate. Insurers must also certify the completeness and accuracy of the published data and identify a responsible individual by name.
Impact on Consumers and Employers
Industry participants have welcomed the adjustments, saying they should simplify cost-containment efforts for employers and plan fiduciaries while giving consumers clearer options for lower-priced care locations. James Gelfand, president and chief executive of the ERISA Industry Committee, remarked, “The first round of price data opened the books. This rule makes the data usable by a general audience.”
Elizabeth Mitchell, CEO of the Purchaser Business Group on Health, said during a press call, “We believe that these new rules are going to make a really significant difference,” and added, “This has the potential to meaningfully address the affordability crisis in the commercial market.” The administration estimates the rule could produce nearly $175 million in net annual savings for health plans and issuers.
Modifications to existing in-network and out-of-network rate files will take effect five months after the final rule appears in the Federal Register, while newly created files must be operational within 11 months. The administration also lowered the threshold for reporting out-of-network payments from 20 claims to 11 claims, expanding the amount of disclosed data.
Insurers are required to make TiC files more readily discoverable on their websites and must affirm that the information they provide is both complete and accurate.
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The rule directs insurers to aggregate out-of-network pricing data by market segment, a step CMS says will facilitate direct cost comparisons across different insurance categories.
Changes to Reporting Requirements
Federal regulators have altered the reporting method for negotiated rates, now asking plans to submit prices by provider network rather than by individual plan or policy.
This shift is expected to reduce the total number of files insurers must release, since many plans share the same networks and rates, and it aligns the reporting approach with the methodology hospitals use for their own transparency disclosures.
The five-month rollout for updates to current in-network and out-of-network files follows the rule’s publication in the Federal Register.
