We all know that the details of health insurance plans can confuse everyone involved, but particularly the consumer. With healthcare costs rising and many consumers expressing concern over their own share of the costs, the federal government created Transparency in Coverage laws in 2020. The new rules are set to roll out gradually, with several deadlines marking different requirements. One such deadline just passed on July 1 of this year.
On that date, all healthcare plan providers were required to provide cost-sharing data to consumers. By accessing this information, consumers can understand healthcare service pricing and their own out-of-pocket spending.
How to access cost-sharing data. Healthcare plan providers will be required to provide this data via machine-readable files, which must be published on a website that can be accessed by the general public. That means the provider cannot require website visitors to create an account, provide login information, or otherwise submit any other credentials in order to access the website.
What does the data include? This data will include pricing information for all covered items and services, according to negotiated rates within the network. Certain historical data for out-of-network rates must also be published (when there are 20 or more such claims for a service by any particular provider).
Later, a third set of data will be added to these files, disclosing cost-sharing information on prescription drug rates. However, the deadline for that set of data has been extended, due to the need for more guidance from the government.
All of these files must be updated monthly, to reflect changing rates, so that consumers have access to the latest information.
What consumers should do now. Ask your health insurance representative where your provider’s Transparency in Coverage data is published. If you need help interpreting that information, your representative can point you toward the correct resources.