The U.S. Centers for Medicare and Medicaid Services (CMS), along with the U.S. departments of Labor and the Treasury, finalized changes to the Transparency in Coverage rules on October 5 to improve the accessibility and reliability of pricing disclosures from health plans and insurers.
Under the final rules, plans will post in-network rate files and out-of-network allowed amount files quarterly instead of monthly, report rates by provider network rather than by plan, and attest to the files’ accuracy. Beginning with plan years starting on or after January 1, 2027, cost-sharing estimates must also be available by phone.
The original rules do not apply to excepted benefits, a category that includes most stand-alone dental plans. The ADA has urged Congress to focus transparency efforts on dental benefit payers, which control most of the information needed to determine what patients owe, while states have moved forward with their own dental plan disclosure laws.
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